Devita, Hellman, and Rosenberg's Cancer

LWBK1006-20 LWW-Govindan-Review December 12, 2011 19:4

Chapter 20•Cancer of the Gastrointestinal Tract 271

Question 20.5.9. A 52-year-old teacher presents with a 2-month history of rectal bleeding.

A rectal examination revealed a palpable mass 6 cm from the anal verge.

Subsequent colonoscopy confirmed a friable, tethered mass biopsy that

showed moderately differentiated adenocarcinoma. Transrectal ultra-

sound revealed a T3 N1 cancer. CT scans of the chest, abdomen, and

pelvis revealed no metastatic sites. Which of the following treatment

strategies would you recommend?

A. Abdominoperineal resection (APR) with a total mesorectal excision

(TME) followed by adjuvant chemoradiation

B. APR with TME followed by chemotherapy alone

C. Short-course 5-day neoadjuvant radiation (25 Gy) followed by APR

with TME

D. Prolonged-course neoadjuvant 5FU-based chemoradiation followed

by APR with TME and adjuvant chemotherapy

Question 20.5.10.Which of the following appropriately staged patients with rectal cancer

would be the BEST candidate for transanal excision?

A. A 48-year-old woman with a 2.5-cm T1 moderately differentiated

rectal adenocarcinoma 4 cm from the anal verge.

B. A 65-year-old man with a 4.5-cm T2 well-differentiated circumfer-

ential rectal mass 6 cm from the anal verge.

C. A 30-year-old man with a 2-cm well-differentiated T1 mucinous ade-

nocarcinoma 12 cm from the anal verge.

D. A 52-year-old woman with a 3-cm well-differentiated T1N1 adeno-

carcinoma 5 cm from the anal verge.

E. None of the above.

Question 20.5.11.For the patient you have selected for transanal resection in Question

20.5.10, pathological review of the excised specimen showed no lympho-

vascular invasion and all margins were negative. Which of the following

options would you recommend?

A. No further therapy

B. Short-course (25 Gy/5 fractions) radiation

C. Intracavitary radiation

D. Adjuvant chemotherapy without radiation

E. Adjuvant chemotherapy with radiation

Question 20.5.12.The following are true statements regarding MYH-associated polyposis,

EXCEPT:

A. Inheritance is autosomal dominant.

B. Clinical features of MYH-related polyposis are similar to FAP.

C. The MYH-gene is a base-excision repair gene.

D. A deficiency in MYH leads to accumulation of somatic mutations in

the APC gene.