rectal adenocarcinoma.

Discussion in 'MRCS Forum' started by Lona., Apr 14, 2008.

  1. Lona.

    Lona. Guest

    A 64-year-old woman has been experiencing pain with each bowel movement and is found to have a rectal mass. Biopsy confirms rectal adenocarcinoma. Operative planning and preoperative counseling for a patient with a rectal carcinoma can be best provided if the patient is staged before surgery by -

    a- Rigid proctoscopy
    b- Barium enema
    c- MRI of the pelvis
    d- CT scanning of the pelvis
    e- Rectal endosonography
  2. Lona.

    Lona. Guest

    Answer: e. (Zinner, 10/e, pp 1455-1500) Workup of a patient with a diagnosed rectal cancer should include CT scan of the upper abdomen in search of liver metastases and assessment of the depth of local invasion by transanal ultrasound. Sonographic staging of the rectal wall and pararectal lymph nodes has become crucial in planning the magnitude of the resection and choice of preoperative treatment. The survival advantages of neoadjuvant radiation therapy now seem clear. Administering radiation preoperatively to large or deeply invasive tumors often reduces the tumor mass and permits clean resection of previously bulky disease. In addition, the cytoreductive effect of preoperative radiation therapy now allows many patients to undergo sphincter-saving procedures and avoid the morbidity of proctectomy and colostomy.

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