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3: MED2 Y3 - Gastrointestinal [7] > [8] Anal Cancer > Flashcards

[8] Anal Cancer Flashcards

1
Q

How common is anal cancer?

A

Relatively rare - accounts for about 4% of colorectal cancers

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2
Q

What are the types of anal cancer?

A

Squamous cell carcinomass Adenocarcinomas Melanomas and anal skin cancers

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3
Q

What % of anal cancers are squamous cell carcinomas?

A

About 80%

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4
Q

Where do squamous cell anal cancers arise?

A

Below the dentate line

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5
Q

What % of anal cancers are adenocarcinomas?

A

About 10%

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6
Q

Where do anal adenocarcinomas arise?

A

From the upper anal canal epithelium and the crypt glands

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7
Q

What may precede the development of invasive squamous anal carcinoma?

A

Anal intraepithelial neoplasia (AIN)

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8
Q

Where does anal intraepithelial neoplasia affect?

A

Either the perianal skin or anal canal

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9
Q

What is AIN strongly linked to?

A

Infection with HPV

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10
Q

What is the grading of AIN dependant on?

A

The degree of cytological atypia, and hte depth of that atypia in the epidermis

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11
Q

What is considered to be high-grade AIN?

A

Grade 2 and 3

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12
Q

What is the clinical relevance of high grade AIN?

A

It is pre-malignant, and may progress to invasive cancer

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13
Q

What are the risk factors for the development of anal cancer?

A

HPV infection HIV infection Increasing age Smoking Immunosuppressant medication Crohn’s disease

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14
Q

What % of cases of anal cancer are accounted for by HPV infection?

A

80-90%

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15
Q

Which HPV viruses in particular increase the risk of HPV infection?

A

HPV-16 and HPV-18

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16
Q

What are the main symptoms of anal cancer?

A

Pain and rectal bleeding Anal discharge Pruritis Palpable mass

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17
Q

What % of patients with anal cancer have pain and rectal bleeding?

A

About 50%

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18
Q

What features can be seen in locally invasive anal cancer?

A

Perianal infection Fistula-in-ano

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19
Q

What feature may be present if the anal sphincters are invaded in anal cancer?

A

Faecal incontinence Tenesmus

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20
Q

What should be done on examination in suspected anal cancer?

A

Screen perineum and perianal region for any ulceration or the presence of wart-like lesions

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21
Q

What needs to be done in women with suspected anal cancer?

A

A vaginal examination is important, to assess for the presence of additional vulval or vaginal lesions

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22
Q

Should a DRE be done in anal cancer?

A

It should be attempted, however may not always be possible due to pain

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23
Q

What should be done if a mass is palpable on DRE?

A

You should remember to document the distance from the anal verge where it is fely, and the fraction of the anal circumference which it occupies

24
Q

Which lymph nodes should be examined when suspecting anal cancer?

A

Inguinal lymph nodes

25
Q

Which area drains into the superficial inguinal lymph nodes?

A

The area below the dentate line

26
Q

Which lymph nodes to the anal canal and rectum above the dentate line drain into?

A

The mesorectal, para-aortic, and paravertebral nodes

27
Q

What can the differential diagnoses for any anal pathology be divided into?

A

Benign and malignant

28
Q

What are the benign differentials for anal cancer?

A

Haemorrhoids Anal fissure Fistula-in-ano Anal warts

29
Q

What are the malignant differentials for anal cancer?

A

Low rectal cancer Skin cancer

30
Q

What initial investigations may be done in suspected anal cancer?

A

Proctoscopy Examination under anaesthetic Smear test for women HIV testing

31
Q

What is the purpose of proctoscopy in suspected anal cancer?

A

To obtain a better initial assessment of the anal canal

32
Q

What is the purpose of examination under anaesthesia in patients with suspected anal cancer?

A

It allows for much better assessment for tumour size and invasion of local structures Allows for a biopsy to be taken for histological confirmation

33
Q

When should a HIV test be considered in suspected anal cancer?

A

If you suspected immunosuppression on a background of high risk behaviour

34
Q

Why may a smear test be done in women with suspected anal cancer?

A

To exclude any cervical intraepithelial neoplasia

35
Q

What should be done if signs of vulval intraepithelial neoplasia are present?

A

Further biopsies

36
Q

What should be done once a biopsy has been taken and anal cancer has been confirmed?

A

Further staging investigations

37
Q

What staging investigations are done in anal cancer?

A

USS-guided Fine Needle Aspiration (FNA) CT thorax-abdomen-pelvis MRI pelvis

38
Q

What is biopsied using USS-guided FNA in anal cancer?

A

Any palpable inguinal lymph nodes

39
Q

What is the purpose of a CT thorax-abdomen-pelvis in anal cancer staging?

A

Look for distant mets

40
Q

What is the purpose of a MRI pelvis in anal cancer staging?

A

To assess the extent of local invasion (T stage)

41
Q

Who needs to be included in the MDT for the management of anal cancer?

A

Oncologists General surgeons Radiologists Specialist nurses

42
Q

What is the first choice treatment of anal cancer?

A

Chemo-radiotherapy

43
Q

What chemo-radiotherapy treatment is usually given in anal cancer?

A

External beam radiotherapy to the anal canal and inguinal lymph nodes, combined with dual-chemotherapy agents,

44
Q

Give an example of dual-chemotherapy agents used in chemotherapy in anal cancer?

A

Mitomycin C and 5-flurouracil

45
Q

What is an exception to chemo-radiotherapy being the treatment of choice in anal cancer?

A

In early T1N0 carcinomas, where wide local excision may be the preferred treatment

46
Q

Why might wide local excision be preferred to chemo-radiotherapy in early T1N0 anal cancers?

A

To avoid the increased morbidity associated with chemo-radiotherapy

47
Q

When is surgical excision used in anal cancer?

A

It is usually reserved for management of advanced disease, after failure of chemo-radiotherapy, or in early T1N0 carcinoams

48
Q

What are the surgical options for management of anal cancer?

A

Abdominoperineal resection Posterior or total pelvic exenteration

49
Q

What surgical management option is used for the majority of patients with anal cancer requiring surgical intervention?

A

Abdominoperineal resection

50
Q

When do most recurrences of anal cancer occur?

A

In the first 3 years

51
Q

What should be done after remission for anal cancer?

A

Patients should be reviewed every 3-6 months for a period of 2 years, and 6-12 monthly after 5 years

52
Q

What pattern of relapse tends to occur in anal cancer?

A

They tend to relapse locally and regionally, rather than metastasise

53
Q

What is the most common short-term complication of anal cancer treatment?

A

Chemoradiation-related pelvic toxicity

54
Q

What symptoms may develop from chemoradiation-related pelvic toxicity?

A

Dermatitis Diarrhoea Proctitis and cystitis Leucopenia Thrombocytopenia

55
Q

What longer term complications may result from anal cancer and its treatment?

A

Fertility issues Faecal incontinence Vaginal dryness Erectile dysfunction Rectovaginal fistula

56
Q

What is prognosis related to in anal cancer?

A

The initial staging of the tumour and lymph node spread

3: MED2 Y3 - Gastrointestinal [7] (44 decks)

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