Anal cancer Flashcards
What are anal cancers usually?
SCC arising from below the dentate line
What are upper anal cancers usually?
Adenocarcinomas
What is anal intraepithelial neoplasia?
precancerous condition that can affect either the perianal skin or anal canal which has a strong link to SCC and HPV
What are the risk factors for anal cancer?
HPV infection, HIV infection, increasing age, smoking, immunosuppression, Crohns
What are the clinical features of anal cancer?
rectal pain or rectal bleeding, anal discharge, pruritus and palpable mass, perianal infection, fistulas, faecal incontinence and tenesmus, ulceration, wart like lesions, lymphadenopathy
Where does lymph from below the dentate line drain?
superficial inguinal nodes
Where does lymph from above the dentate line drain?
mesolectal, para-aortic and paravertebral nodes
What are the differential diagnosis for anal cancer?
haemorrhoids, anal fissure, anal fistula, anal wards, malignant disease, rectal cancer or skin cancer
What are the initial investigations for anal cancer?
proctoscopy, examination under anaesthetic, biopsy, smear test to exclude CIN and a HIV test
What imaging would be done for anal cancer?
USS guided FNA (lymph nodes), CT thorax abdomen pelvis (metastasis) and MRI (tumour invasion)
What is the management for anal cancer?
chemo and radiotherapy, external beam radiotherapy, abdominoperineal resection
What are the complications of anal cancer?
Chemoradiation-related pelvic toxicity which can present with dermatitis, diarrhoea, proctitis and cystitis, long term may present with fertility issues, faecal incontinence, vaginal dryness, Erectile dysfunction, rectovaginal fistula
