A questionnaire was administered detailing lifestyle habits, medical history and sexual practices. Anal swabs for cytology and human papillomavirus studies were obtained, followed by biopsies of visible lesions. Blood was obtained for HIV testing and measurement of CD4 levels. HIV infection, lower CD4 levels and human papillomavirus infection were associated with high rates of incident HSIL among homosexual men. The surgeon's perspective.
Colorectal carcinoma presenting during pregnancy is uncommon.
Pregnant patients with unexplained rectal bleeding should be evaluated by anorectal examination and flexible sigmoidoscopy. Treatment is individualized to each patient, but a strategy of proceeding immediately with a surgical resection when a diagnosis is made early in pregnancy and allowing the fetus to develop to safe delivery before treating when the diagnosis is made late in pregnancy is recommended. Most patients present with advanced tumors and have a poor prognosis, but prognosis by stage is not different from that in the general population. Adjuvant radiation and chemotherapy have limited roles in the treatment of pregnant women with colon and rectal carcinoma. Future challenges are aimed at improving survival through earlier diagnosis and the development of adjuvant therapies that are effective in patients with advanced disease.