Radiation Proctitis

Question: Treatment of radiation Proctitis with persistent bleeding
Answer: first sucralfate enemas then argon beam coagulation, then resection

Anal Cancer

Question: What is the treatment of Anal Cancer?
Answer See Below:
Anal Canal (above Dentate) - usually chemoradiation

    Adenocarcinoma - same concept as rectal cancer (if T1 and small < 3cm then WLE) - if not APR

    Squamous/Basaloid (cloacogenic), mucoepidermoid - NIGRO, if recurrent then APR

    Melanoma - no difference between APR and WLE

Anal Margin (below dentate) - usually excision

    Squamous of Basal - same concept as skin cancer, WLE although made need APR if sphnicters involved

    Bowen's disease - WLE with clear margins because this is malignant

    Paget's Disease - intractable itching, positive PAS, 1/3 with concurrent rectal cancer - WLE

Anal Anatomy

Question: Lymph Drainage of upper, middle, and lower rectum?
Answer: Upper and middle rectum lymph nodes drain to inferior mesenteric nodes whereas lower rectum drains into both inferior mesenteric and internal iliac nodes