Anus Flashcards
epidemiology
most common in females (63% deaths)
aetiology
HPV (90/100 are HPV+)
HIV
smoking
what pathological types are there
adenocarcinoma
squamous cell carcinoma
melanoma
under-reported due to being classes as rectal or SCC skin
what are the types of spread
local and lymphatics, and blood
what is the local spread
skin
what is the blood spread
uncommon but to the liver and lung
what is the lymphatic spread
inguinal nodes, as fairly superficial these can be palpable
diagnosis steps
physical exam
biopsy
CT/MRI / CT/PET
is presentation late or early
often late
what are the presentation
physical lump
bleeding
severe itching
changes in bowel habits
fistula
pain
sometimes diagnosed as haemorrhoids
what staging system is used
TNM
what is stage 0
AIN, anal carcinoma is situ
what is stage 1
only affects the anus <2cm
NOT spread to the sphincter muscle
what is stage 2
> 2cm, not spread to LN or other parts of the body
what is stage 3
> 5cm, which has spread to LN or nearby regions e.g vagina or bladder
what is stage 4
spread to distant parts of the body ie the liver
what are the SE of cape
sore hands and feet
what are the SE of cisplatin
whole body rash
what are the treatment options
surgery, chemo or RT
what types of surgery are there
resection or full
chemo
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
why is chemo used
sensitises the tumour
what is the palliative RT dose
20Gy in 5
what is the radical RT dose
50.4 Gy in 28 fractions
phase 1 = 30.6Gy in 17
phase 2 = 19.8 Gy in 11
what is the dose to the primary
50.4Gy in 28
what is the dose to primary + nodes
53.2Gy in 28
dose to uninvolved nodes
40Gy in 28
why is a wax bolus sometimes used
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
what are the RT side effects
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)
