Flashcards in CSS.47.AnalCarcinoma Deck (37):
1
what procedure/evaluation is indicated in a patient with anal bleeding that does not respond to medical management?
anoscopy and/or colonoscopy
2
is the first-line treatment for nonmetastatic anal canal carcinoma surgical or nonsurgical?
nonsurgical
3
how long should you wait after chemoradiation for anal carcinoma prior to proceeding to surgery and why?
allow up to 12 weeks for regression of lesion after chemoradiation prior to proceeding to surgery
4
what surgery is indicated if combined chemoradiation fails to treat anal carcinoma?
abdominoperineal resection
5
what is the primary presentation of anal fissure?
sharp pain with defecation, associated with bright red blood when wiping
6
what is the primary presentation of internal hemorrhoids?
painless rectal bleeding
7
what is the primary presentation of thrombosed external hemorrhoids?
constant pain that persists for days
8
what are three common causes of pruritus ani
rectal mucosal prolapse, irritation of hemorrhoidal skin tags, dietary irritants (citrus, caffeine, spicy food, tomatoes, dairy)
9
what are 5 risk factors for anal carcinoma (what makes a patient "high risk") and what evaluation should you perform for any anal complaints?
age > 50, HIV, HPV (anal/gyn), colorectal adenomas, and relevant family history - endoscopy
10
when evaluating for suspected anal carcinoma, which lymph node basin should you evaluate? how should you evaluate associated lymphadenopathy and why?
pay attention to inguinal nodes, evaluate LA with FNA to r/o regional LN involvement
11
when evaluating suspected anal carcinoma, what three imaging modalities can be used to assess for distant mets?
abdominal/pelvic CT; abdominal pelvic MRI; PET-CT
12
why should you perform a gynecologic evaluation in female patients with suspected anal carcinoma?
evaluate for gynecologic dysplasia b/c HPV is implicated in both neoplastic processes
13
Define T1 anal canal carcinoma
size < 2 cm
14
Define T2 anal canal carcinoma
size 2-4.9cm
15
Define T3 anal canal carcinoma
size >5 cm
16
Define T4 anal canal carcinoma
invades adjacent organs
17
Define N1 anal canal carcinoma
perirectal node involvement
18
Define N2 anal canal carcinoma
Unilateral internal iliac or inguinal LN involvement
19
Define N3 anal canal carcinoma
perirectal AND inguinal LN involvement or bilateral internal iliac / inguinal nodes
20
Define M0 anal canal carcinoma
no distant mets
21
Define M1 anal canal carcinoma
distant mets
22
What are the TNM stages (1) a/w Stage I anal canal carcinoma?
T1N0M0
23
What are the TNM stages (2) a/w Stage II anal canal carcinoma?
T2-3, N0, M0
24
What are the TNM stages (3) a/w Stage IIIA anal canal carcinoma?
T1-3, N1, M0
25
What are the TNM stages (2) a/w Stage IIIB anal canal carcinoma?
T4, N1, M0 OR T-any, N2, M0
26
What are the TNM stages (1) a/w Stage I anal canal carcinoma?
T any, N any, M1
27
why is nonsurgical therapy the standard of care for initial treatment of anal canal carcinoma?
high response rate and high rate of sphincter preservation
28
what is the standard chemoradiation protocol to treat anal canal carcinoma
45 Gy in 25 fractions over 5 weeks to the primary cancer + 5-FU infused on days 1-4 & 29-32 + mitomycin C bolus days 1 & 29
29
what is the systemic therapy for metastatic anal canal carcinoma?
5-FU & cisplatin
30
how long does it take residual anal canal carcinoma to regress after chemoradiation?
up to 12 weeks
31
when should you perform repeat assessment of residual masses after chemoradiation for anal canal carcinoma and how should you evaluate?
biopsy mass at 12 weeks after completion of chemoradiation. If positive, proceed to surgery.
32
Name three preoperative considerations prior to APR for anal canal carcinoma
1) stoma site marking; 2) preop abx; 3) VTE ppx
33
what step should be considered to facilitate wound healing in patients undergoing APR after radiation therapy?
consider a myocutaneous flap
34
what are the basic steps of APR?
1) pt in lithotomy; 2) lap or open mobilization of distal colon and rectum; 3) divide mesentery at proximal SMA pedicle; 4) once dissected to pelvic floor, start dissection from perineal approach cephalad to meet intraabdominal portion while maintaining a wide dissection thru levator muscles; 5) resect specimen and send grossly close margins to frozen for eval; 5) place muscle flap in pelvis and close perineal defect in several layers with absorbable suture
35
how is an APR performed in the supine and prone positions?
perform abdominal portion of procedure in supine position, create colostomy, close abdominal incision, place patient prone to complete perineal portion of procedure
36
what is the postoperative follow up for anal canal carcinoma s/p APR?
follow up q3-6mo for 5 years with inguinal LN examination and anoscopy + topical acetic acid to survey for recurrent HPV dysplasia. If pt with T3 or greater disease or node posiitve disease, annual C/A/P imaging x 3 years
37