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Self-Assessment Questions


Management of Rectal Cancer: Review Questions

Douglas G. Adler, MD

Dr. Adler is an Assistant Professor of Medicine and Director of Gastrointestinal Endoscopy, University of Texas Health Science Center at Houston, Houston, TX.

Choose the single best answer for each question.

1. A 60-year-old man presents for an annual physical examination. The examination is normal except for a palpable mass in the rectum on digital rectal examination. The patient denies any change in bowel habits and feels well. Rectal cancer is suspected. What is the next best step in the evaluation of this patient?
  1. Computed tomography (CT) scan of the abdomen and pelvis
  2. Double-contrast barium enema
  3. Flexible sigmoidoscopy with biopsy of the lesion
  4. Full colonoscopy with biopsy of the lesion
  5. Magnetic resonance imaging (MRI) scan of the abdomen and pelvis
Click here to compare your answer.

2. A 62-year-old woman is found to have a rectal mass on screening colonoscopy. Biopsies of the lesion reveal adenocarcinoma. Which of the following modalities would best assess the local extent of disease in this patient?

  1. CT scan of the abdomen and pelvis
  2. Endoscopic ultrasound (EUS) examination of the rectosigmoid colon
  3. MRI scan of the abdomen and pelvis
  4. Positron emission tomography (PET) scan of the abdomen and pelvis
  5. Transabdominal ultrasound of the pelvis
Click here to compare your answer.

3. A 78-year-old woman with coronary artery disease and severe chronic obstructive pulmonary disease is admitted to the hospital with painless jaundice. CT scan reveals the presence of multiple lesions in the liver, suggestive of metastases, and a nearly obstructing rectal mass. Colonoscopy demonstrates a large, ulcerated tumor in the proximal rectum and a residual lumen of less than 1 cm in diameter. While in the hospital, the patient develops a large bowel obstruction. What is the best treatment modality for this patient?

  1. Immediate radiation therapy of the rectal mass
  2. Placement of a colonic decompression tube
  3. Emergency surgery with resection of the mass
  4. Emergency surgery with creation of a diverting colostomy
  5. Placement of a rectal self-expanding metal stent
Click here to compare your answer.

4. A 57-year-old man is found to have a rectal mass on digital rectal examination. Subsequent colonoscopy and biopsy confirm rectal adenocarcinoma. EUS examination demonstrates penetration of the tumor into, but not through, the muscularis propria. EUS guided fine needle aspiration of a suspicious peritumoral lymph node yields positive cytology for malignancy. CT scan demonstrates no metastases. The patient is staged as T2N1M0. What procedure should be attempted to remove the primary lesion in this patient?
  1. Endoscopic mucosal resection (EMR) to remove the lesion
  2. Endoscopic argon plasma coagulation (APC) therapy to cauterize and ablate the lesion
  3. Surgical transanal excision of the lesion
  4. Surgical colectomy
  5. Surgical abdominoperineal resection (APR)
Click here to compare your answer.

5. A 70-year-old man is found to have distal rectal cancer during a screening colonoscopy. The patient undergoes preoperative staging and is found to have a 1.5-cm rectal mass that does not invade the muscularis propria of the rectal wall. There is no regional lymphadenopathy and no evidence of distant metastases. The patient is staged at T1N0M0. The patient is advised to undergo APR but refuses because it will lead to anal sphincter loss and permanent colostomy. Which of the following represents a viable alternate therapeutic option for this patient?

  1. Chemotherapy alone
  2. Radiation therapy alone
  3. Chemoradiation therapy
  4. Full-thickness surgical removal of the tumor (transanal excision)
  5. Endoscopic ablation of the tumor with APC
Click here to compare your answer.

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