Anus

Question 1

epidemiology

Answer 1

most common in females (63% deaths)

Question 2

aetiology

Answer 2

HPV (90/100 are HPV+)
HIV
smoking

Question 3

what pathological types are there

Answer 3

adenocarcinoma
squamous cell carcinoma
melanoma
under-reported due to being classes as rectal or SCC skin

Question 4

what are the types of spread

Answer 4

local and lymphatics, and blood

Question 5

what is the local spread

Answer 5

skin

Question 6

what is the blood spread

Answer 6

uncommon but to the liver and lung

Question 7

what is the lymphatic spread

Answer 7

inguinal nodes, as fairly superficial these can be palpable

Question 8

diagnosis steps

Answer 8

physical exam
biopsy
CT/MRI / CT/PET

Question 9

is presentation late or early

Answer 9

often late

Question 10

what are the presentation

Answer 10

physical lump
bleeding
severe itching
changes in bowel habits
fistula
pain
sometimes diagnosed as haemorrhoids

Question 11

what staging system is used

Answer 11

TNM

Question 12

what is stage 0

Answer 12

AIN, anal carcinoma is situ

Question 13

what is stage 1

Answer 13

only affects the anus <2cm
NOT spread to the sphincter muscle

Question 14

what is stage 2

Answer 14

> 2cm, not spread to LN or other parts of the body

Question 15

what is stage 3

Answer 15

> 5cm, which has spread to LN or nearby regions e.g vagina or bladder

Question 16

what is stage 4

Answer 16

spread to distant parts of the body ie the liver

Question 17

what are the SE of cape

Answer 17

sore hands and feet

Question 18

what are the SE of cisplatin

Answer 18

whole body rash

Question 19

what are the treatment options

Answer 19

surgery, chemo or RT

Question 20

what types of surgery are there

Answer 20

resection or full

Question 21

chemo

Answer 21

often adjuvant with RT
Mitomycin + 5FU continuous infusion for 5 days, week 1 = M+ 5-FU and week 5 = only 5-FU, therefore a pump is worn for 5 days/ 5 fractions via a picc line

Question 22

why is chemo used

Answer 22

sensitises the tumour

Question 23

what is the palliative RT dose

Answer 23

20Gy in 5

Question 24

what is the radical RT dose

Answer 24

50.4 Gy in 28 fractions
phase 1 = 30.6Gy in 17
phase 2 = 19.8 Gy in 11

Question 25

what is the dose to the primary

Answer 25

50.4Gy in 28

Question 26

what is the dose to primary + nodes

Answer 26

53.2Gy in 28

Question 27

dose to uninvolved nodes

Answer 27

40Gy in 28

Question 28

why is a wax bolus sometimes used

Answer 28

not everyone has a self bolus, might not be able to achieve adequate target coverage
tumour might extend past the anal verge
the bolus brings the D-max to the surface, inguinal nodes are fairly superficial

Question 29

what are the RT side effects

Answer 29

diarrhoea: decrease fibre
constipation: increase fibre, laxative
urgency: just can’t wait
frequency
cystitis: keep hydrated
nocturia
fatigue
pain: pain scale, paracetamol
tenesmus: don’t strain, suppository
blood in stool
skin reaction: moisturise
fungation
radiation cystitis
sickness and nausea from chemo
ulceration (late)