Anal Cancer

Question 1

What histological type of cancer are majority if anal cancers

Answer 1

Squamous cell carcinoma - below dendate line

Question 2

How common is anal cancer

Answer 2

accounts for around 4% of colorectal cancers

Question 3

What are the other types of anal cancers you can get

Answer 3

Adenocarcinomas - upper anal canal epithelium

Rarer ones are - melanoma and anal skin cancers

Question 4

What pre-cancerous condition can precede to the development of invasive squamous anal carcinoma.

Answer 4

anal intraepithelial neoplasia

Question 5

Which infection is AIN associated with

Answer 5

HPV

Question 6

How is AIN graded

Answer 6

grading of AIN is dependent on the degree of cytological atypia and the depth of that atypia in the epidermis

AIN 1 - 3 like CIN 1 -3

Question 7

What are the risk factors of Anal cancers

Answer 7

HPV infection ( HPV 16 and 18)
HIV infection 
Increasing age 
Smoking 
Immunosuppression 
Crohn’s disease

Question 8

What are the clinical features of anal cancer

Answer 8

Rectal pain 
Rectal bleeding 
Anal discharge 
Pruritus 
Palpable mass

Question 9

What are the differential diagnosis for anal cancer

Answer 9

Haemorrhoids
Anal fissure
Anal fistula
Rectal cancer

Question 10

What are the initial investigations you would carry to investigate anal cancer

Answer 10

Proctoscopy
Examination under anaesthesia (EUA) - allows the option to take a biopsy
Consider HIV test

For women: smear test to exclude CIN ( HPV link)

Question 11

If anal cancer is found what are the next steps

Answer 11

Staging investigations

USS guided FNA of inguinal lymph nodes

CT CAP

MRI pelvis

Question 12

What is the first line management of anal cancers

Answer 12

Chemo-radiotherapy

external beam to the anal canal and inguinal lymph nodes ( radiotherapy)

Combined with chemo agents - mitomycin C and 5-fluorouracil.

Question 13

When is surgery indicated for anal cancer

Answer 13

As management of advanced disease

Failure of chemo-radiotherapy

Early T1N0 carcinomas ( curative )

Question 14

What is the surgical management of anal cancers

Answer 14

abdominoperineal resection (APR), yet for some a posterior or total pelvic exenteration is required.

Question 15

How are patients managed post surgery

Answer 15

There is post surgery surveillance carried out every 3-6 months for a period of 2 years as most recurrences occur in this time. Most recurrences will be local rather than distant

Question 16

What are some short term complications of treatment

Answer 16

Chemoradiation-related pelvic toxicity presenting with:

dermatitis, diarrhoea, proctitis, and/or cystitis.

Question 17

What are the long term complications of treatment

Answer 17

fertility issues, faecal incontinence, vaginal dryness, erectile dysfunction, and rectovaginal fistula.