Colorectal: rectal cancer: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Colorectal: rectal cancer

Sample item

A 60-year-old man has a rectal adenocarcinoma 3 cm from the anal verge that invades the sphincter complex. MRI shows threatened mesorectal fascia. Which treatment approach is best?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Neoadjuvant chemoradiotherapy followed by abdominoperineal resection

For low rectal cancers involving the sphincters, a sphincter-preserving operation is not oncologically safe, so abdominoperineal resection with a permanent colostomy is used. Neoadjuvant chemoradiotherapy downstages locally advanced disease and reduces local recurrence, especially when the mesorectal fascia is threatened.

Option by option

  • A. Local transanal excision alone

    Local excision is only for small, early, low-risk tumours.

  • B. Anterior resection with a colorectal anastomosis straight away

    Anastomosis so close to the anal verge with sphincter invasion would risk a positive margin.

  • C. Hartmann's procedure with no further therapy

    Hartmann's is an emergency approach and does not treat this tumour adequately.

  • D. Neoadjuvant chemoradiotherapy followed by abdominoperineal resection (correct)

    Correct. Locally advanced low rectal cancer needs neoadjuvant treatment and abdominoperineal resection.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Neoadjuvant chemoradiotherapy followed by abdominoperineal resection. For low rectal cancers involving the sphincters, a sphincter-preserving operation is not oncologically safe, so abdominoperineal resection with a permanent colostomy is used.

Why is "Local transanal excision alone" not the answer?

Local excision is only for small, early, low-risk tumours.

Why is "Anterior resection with a colorectal anastomosis straight away" not the answer?

Anastomosis so close to the anal verge with sphincter invasion would risk a positive margin.

Why is "Hartmann's procedure with no further therapy" not the answer?

Hartmann's is an emergency approach and does not treat this tumour adequately.

What concept does this question test?

It tests Colorectal: rectal cancer in General Surgery. Neoadjuvant chemoradiotherapy downstages locally advanced disease and reduces local recurrence, especially when the mesorectal fascia is threatened.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Colorectal: rectal cancer?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.