Anal Cancer

Question 1

Anal cancer is a rare form of cancer. What cell types causes this?

1 - cuboidal
2 - squamous
3 - columnar

Answer 1

2 - squamous

Question 2

How many cases of rectal cancer are there generally each year?

1 - 20
2 - 200
3 - 2000
4 - 200,000

Answer 2

4 - 200,000

Question 3

What is the incidence of anal cancer in women?

1 - 1 / 100
2 - 1 / 1000
3 - 1 / 10,000
4 - 1 / 100,000

Answer 3

4 - 1 / 100,000

Question 4

What is the incidence of anal cancer in men who have anal sex with HIV negative men?

1 - 3.5 / 100
2 - 35 / 1000
3 - 35 / 10,000
4 - 35 / 100,000

Answer 4

4 - 35 / 100,000

• incidence doubles if they are HIV positive

Question 5

There are a number of risk factor for anal cancer. All of the following are risk factors, but which one accounts for 90-100% of cases?

1 - low fibre intake
2 - polyps
3 - human papillomavirus 16 and 18
4 - age
5 - multiple sexual partners
6 - immunosuppression

Answer 5

3 - human papillomavirus 16 and 18

• rates expected top fall with HPV vaccine
• further increased risk if HPV 16 or 19 with HIV

Question 6

What is the most common type of anal carcinoma?

1 - adenocarcinoma
2 - squamous cell carcinoma
3 - carcinoma in situ
4 - basal cell carcinoma

Answer 6

2 - squamous cell carcinoma

Question 7

Anal cancer has a similar pathophysiology to cervical cancer. There is intraepithelial neoplasia, which can then lead to cancer and can be staged I-III. Do stages I-III always progress to cancer?

Answer 7

• no
• they can, but stages II and III can also regress

Question 8

Which of the following is not a common presentation of anal cancer?

1 - haemorrhoids
2 - rectal bleeding
3 - anorectal pain
4 - no symptoms

Answer 8

1 - haemorrhoids

Question 9

Order the following in order from diagnosis to staging in anal cancer:

1 - CT scan of the chest
2 - physical examination
3 - CT of abdomen and pelvis
4 - anal biopsy for diagnosis
5 - PET scan

Answer 9

2 - physical examination
4 - anal biopsy for diagnosis
1 - CT scan of the chest
3 - CT of abdomen and pelvis
5 - PET scan

• not all are required though

Question 10

What is the primary treatment for anal cancer?

1 - surgery
2 - radiotherapy
3 - chemotherapy
4 - chemo with radiotherapy

Answer 10

4 - chemo with radiotherapy

• typically squamous cell carcinomas are resistant to chemotherapy

Question 11

If a patient has recurrent or persistent anal cancer, what is the therapy of choice?

1 - radical surgery
2 - radiotherapy
3 - chemotherapy
4 - chemo with radiotherapy

Answer 11

1 - radical surgery

• extra-levator abdominal perineal resection

Question 12

What is the 5 year prognosis following anal cancer?

1 - 8%
2 - 18%
3 - 48%
4 - >80%

Answer 12

4 - >80%

• 66% if lymph nodes are involved
• 35% if metastasis are involved