1. Anal Disease/Neoplasms 5 October 2005

2. Which of the following is not true about a rectovaginal fistula A.Can result from obstetric or operative injury B.Is an abnormal communication between the anterior wall of the anal canal or rectum and the posterior wall of the vagina C.Inflammatory bowel disease can be a cause of simple rectovaginal fistulae D.About 50% of small rectovaginal fistuale secondary to obstetric trauma will heal spontaneously E.Endovascular advancement of an anorectal flap can be created to repair a low, simple fistula.

3. A.True. B.True. C.False. Inflammatory bowel disease can be a cause of complex rectovaginal fistulae. Simple RV fistulae are generally due to traumatic or infectious causes. Complex fistuale are caused by inflammatory bowel disease, irradiation or neoplasm D.True. E.True.

4. Anal Condylomata acuminata A.Have a characteristic papillary appearance that can involve the perianal skin, anal verge, and anoderm B.Are caused by HPV-16 and HPV-18 C.Up to 65% recur after excision D.Malignant transformation is common and should be treated in the same manner as squamous cell carcinoma of the anus

5. A.True. Have a characteristic papillary appearance that can involve the perianal skin, anal verge, and anoderm B.False Most warts are caused by HPV-6 and HPV-11 C.True Up to 65% recur after excision D. False Malignant transformation is RARE. However, if it does occur, it should be treated in the same manner as squamous cell carcinoma of the anus

6. Kaposi’s Sarcoma - True or False A.Kaposi’s sarcoma of the colon and rectum is generally asymptomatic B.Kaposi’s sarcoma of the colon and rectum most often presents with bleeding, diarrhea, and obstruction C.The characteristic lesion is a red, round, submucosal nodule with central umbilication D.A superficial biopsy is sufficient to make the diagnosis E.Surgical therapy is only indicated with failure of medical management

7. A.TRUE Kaposi’s sarcoma of the colon and rectum is generally asymptomatic B.FALSE While KS of the colon/rectums is generally asymptomatic, it can present with bleeding, diarrhea, and obstruction C.TRUE The characteristic lesion is a red, round, submucosal nodule with central umbilication D.FALSE A DEEP biopsy is required to yield an accurate result E.FALSE There is no effective medical treatment. Surgery is indicated only to control massive bleeding, perforation or obstruction.

8. Which of the following are true about perianal neoplasms A.Squamous Cell Carcinomas grow slowly and lesions are characterized by central ulcers with irregular, raised edges. B.Basal Cell Carcinoma is more common in men than women and rarely metastasize. C.Similar to Paget’s disease of the nipple, Paget’s disease of the perianal area is associated with an invasive or in situ adenocarcinoma.

9. Which of the following are true about perianal neoplasms A.FALSE. Squamous Cell Carcinomas grow slowly and lesions are characterized by rolled, everted edges with central ulceration. B.TRUE. Basal Cell Carcinoma is more common in men, usually occur in the 6 th decade, and rarely metastasize. C.FALSE. Paget’s disease of the perianal area is generally a benign neoplasm, but in some cases can become invasive and become adenocarcinoma.

10. Squamous cell carcinoma of the anal canal SCC above the dentate line metastasizes to the _______ (superior/inferior) rectal vessels. Lesions below the dentate line metastasize to the ______ (obturator/inguinal) nodes.

11. SCC above the dentate line metastasizes to the superior rectal vessels. Lesions below the dentate line metastasize to the inguinal nodes.

12. Which of the following are used for the treatment of squamous cell carcinoma of the anal canal? A.Local excision B.Abdominoperineal resection C.Chemotherapy with 5-FU, mitomycin C D.Pelvic radiation

13. A.Local excision The treatment of choice for carcinoma in situ or microscopic invasive carcinoma of the anal canal. However, at the time of diagnosis, many tumors are too large or advanced for local excision B.Abdominoperineal resection Not routinely performed as the primary treatment. It is associated with a high rate of recurrence. This modality is reserved for patient who have failed local treatment after chemoradiation, those with complications for treatment (such as fecal incontinence) and those unable to tolerate chemoradiation C.Chemotherapy with 5-FU, mitomycin C The standard treatment for SCC of anus. Used in association with pelvic radiation. Chemoradiation is associated with complete regression in 90% of patients and 5 year survival rates of 76-90%. D.Pelvic radiation

14. Which of the following are true in regards to anal melanoma? A.Anal Melanoma is the third most common site for melanoma following skin and eyes. B.The most common symptom is rectal bleeding C.Lesions are radioresistant but chemosensitive D.Treatment with abdominoperineal resection shows a survival advantage over wide local resection.

15. A.TRUE. Anal Melanoma is the third most common site for melanoma following skin and eye. B.TRUE. The most common symptom is rectal bleeding C.FALSE Lesions are radioresistant and not sensitive to chemotherapy or immunotherapy. D.FALSE. There is no difference in survival between APR and wide local resection. Both have survival rates of 15-17%