anal

Staging Anal Cancer

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Anal Cancer Staging MCQ
Q) In anal carcinoma, involvement of the external iliac lymph nodes indicates which stage of disease according to the AJCC staging system?
a) Stage II
b) Stage IIIA
c) Stage IIIB
d) Stage IV (M1)
Correct Answer: c) Stage IIIB
Explanation: Primary tumor (T) TX: primary tumor cannot be assessed T0: no evidence of primary tumor Tis: carcinoma in situ (Bowen disease, high-grade squamous intraepithelial lesion [HSIL], anal intraepithelial neoplasia II-III [AIN II-III]) T1: tumor 2 cm or less in greatest dimension T2: tumor >2 cm but <5 cm in greatest dimension T3: tumor >5 cm in greatest dimension T4: tumor of any size invades adjacent organ(s), e.g. vagina, urethra, bladder (Note: direct invasion of the rectal wall, perirectal skin, subcutaneous tissue, or the sphincter muscle(s) is not classified as T4) Regional lymph nodes (N) Nx: regional lymph nodes cannot be assessed N0: no regional lymph node metastasis N1: metastasis in regional lymph nodes N1a: metastases in inguinal, mesorectal, and/or internal iliac lymph nodes N1b: metastases in external iliac lymph nodes N1c: metastases in external iliac and in inguinal, mesorectal, and/or internal iliac lymph nodes Distant metastasis (M) Mx: distant metastasis cannot be assessed M0: no distant metastasis M1: distant metastasis (Note: involvement of para-aortic or more distant lymph nodes is considered M1) AJCC Staging: Stage 0: Tis N0 M0 Stage I: T1 N0 M0 Stage II: T2, T3 N0 M0 Stage IIIA: T1, T2, T3 N1 M0 Stage IIIB: T4 N0/N1 OR T1, T2, T3 with N1b or N1c Stage IV: Any T, any N, M1

Haemorrhoidectomy

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Q) 57 year old male come to the surgery clinic with bleeding PR. He is diagnosed with Haemarrhoids . What is  not an indication of haemorrhoidectomy 

a) Persistent Second degree haemorrhoid 5 days after sclerotherapy

b) 3rd degree haemorrhoid

c) Fibrosed  haemorrhoid

d)  Interno-external haemorrhoids when the external haemorrhoid is well defined.

Ans a

Haemorrhoids can persist for 10 days after sclerotherapy

The indications for haemorrhoidectomy include:

● third- and fourth-degree haemorrhoids;

● second-degree haemorrhoids that have not been cured by non-operative treatments;

● fibrosed haemorrhoids;

● interno-external haemorrhoids when the external haemorrhoid is well defined.

Four degrees of haemorrhoids ●●

First degree – bleed only, no prolapse ●●

Second degree – prolapse but reduce spontaneously ●●

Third degree – prolapse and have to be manually reduced ●●

Fourth degree – permanently prolapsed

MCQS on Rectum