Colon Polyps, Intestinal Polyposis Syndromes, Colorectal Screening, Colorectal Cancer, Anal Cancer Flashcards
what is the first part of the large intestine?
the cecum which is connected to the ileum and is located in the RLQ
what 4 portions make up the colon?
- Ascending
- Transverse
- Descending
- Sigmoid – just before the rectum
what is the proximal colon?
Refers to the ascending and transverse colon
what are the functions of the colon?
The colon (part of the large intestine) does not play a major role in absorption of nutrients
- It’s functions are to remove water, salt and some nutrients during stool formation
- The colon absorbs vitamin K
what is a colon polyp?
a growth in the inner lining of the colon which protrudes into the colon
very common
size, number, and histology are all important
how do you dx colon polyps?
colonoscopy, barium enema, sigmoidoscopy
do colon polyps usually cause problems?
no, but may become malignant
shapes of colon polyps
pedunculated (mushroom cap), sessile, or flat/depressed
flat and depressed are concerning for malignancy
colon polyps signs (PE)
typically asymptomatic unless causing obstruction or bleeding
GI bleeding
Intestinal obstruction
colon polyps sx’s
- asymptomatic
- BRBPR
- rectal tenesmus (sensation you need to move your bowels, but nothing there)
- change in bowel habits
non-neoplastic colon polyps classifications
mucosal polyps
inflammatory polyps
hyperplastic polyps
submucosal polyps
hamartamous polyps
neoplastic colon polyps classifcations
adenomatous polyps
mucosal polyps
non-neoplastic colon polyps (resemble normal colonic-type tissue)
- Small <5mm
- Resemble adjacent tissue
- Histologically normal tissue – No increased risk of turning into cancer
- No clinical significance
inflammatory pseudopolyps
non-neoplastic colon polyps (resemble normal colonic-type tissue)
- Irregularly shaped islands of intact mucosa (result of mucosal ulceration and regeneration)
- Inflammatory Bowel Disease process (common in Ulcerative Colitis, Crohn’s Disease)
- Presence can complicate recognition of true adenomas
what are inflammatory pseudopolyps caused by?
inflammatory bowel disease process (UC, Crohn’s disease)
hyperplastic polyps
non-neoplastic colon polyps (resemble normal colonic-type tissue)
- MOST COMMON NON-NEOPLASTIC POLYPS
- Normal cellular components but may be indistinguishable from adenomatous polyps
- NEED TO BE CUT OUT B/C SMALL CHANCE CANCEROUS
- Serrated/Sawtooth pattern
- Most found rectosigmoid and <5mm, typically do not exhibit dysplasia or develop into CRC
what is the most common non-neoplastic colon polyp?
hyperplastic polyps
what do hyperplastic polyps resemble?
- Normal cellular components but may be indistinguishable from adenomatous polyps
- NEED TO BE CUT OUT B/C SMALL CHANCE CANCEROUS
what is the pattern of hyperplastic polyps?
serrated/sawtooth pattern
where are hyperplastic polyps found? size? dysplasia? develop into CRC?
rectosigmoid
<5mm
don’t exhibit dysplasia or develop into CRC
submucosal polyps
non-neoplastic colon polyps (resemble normal colonic-type tissue)
-Looks like lymphoid tissue, Fribromas
-Lipoma
Most common submucosal
-Yellow in color and soft
-“Pillow sign” – indentation with forceps (squeeze it and it goes back to its normal shape/pops back)
-No increased risk of colorectal cancer
what is the most common submucosal polyp?
lipoma
- yellow in color and soft
- “pillow sign”
hamartamous polyps
non-neoplastic colon polyps (resemble normal colonic-type tissue)
- Grow in disorganized fashion
- Classified as non-neoplastic, but can develop dysplasia and lead to CRC
Many polyposis syndromes derive from this polyp (seen in familial autosomal dominant syndromes)
what derives from hamartamous polyps?
Many polyposis syndromes derive from this polyp (seen in familial autosomal dominant syndromes)
do hamartamous polyps lead to CRC?
Classified as non-neoplastic, but can develop dysplasia and lead to CRC
adenomatous polyps
neoplastic colon polyps (can turn malignant)
PRECANCEROUS
benign tumor of glandular tissue
2/3 of all colonic polyps
Personal history of colon adenomas increases risk of CRC
how many years for adenomatous polyps transition to cancer?
7-10 years = Average time to transition from adenoma to cancer – ADENOCARCINOMAS
what is the most common colonic polyps?
adenomatous polyps
risk factors of adenomatous polyps
- Older age
- Increased BMI – increased abdominal girth
- Lack of physical activity
- Men > women
- Smoking
preventive methods for adenomatous polyps
- Low fat diet, high in fruit, vegetables and fiber
- Normal body weight and exercise
- Decrease consumption of ETOH, especially beer
- Aspirin
- COX-2 agents reduction in advanced adenomas
histological classification of adenomatous polyps?
♣ AS GO FROM TUBULAR TO VILLOUS MALIGNANCY POTENTIAL INCREASES
Tubular Adenoma – 80% of colonic adenomas (MOST COMMON)
Tubulovillous Adenoma – 5-15% of adenomas
Villous Adenoma – Highest risk of becoming cancerous compared to the other 2 which also have increased cancer risk
what adenomatous polyp has the highest risk of becoming cancerous?
villous adenoma
what is the most common adenomatous polyp?
tubular adenoma
characteristics associated w/increased CRC risk for adenomatous polyps
- villous histology
- high grade dysplasia
- number and size
- >1 or more advanced size (>1cm)
- >3 of any size
removal of Adenomatous polyps associated with what?
with reduced CRC incidence
colon polyp screening/dx
I. FOBT - Fecal Occult Blood Testing
II. Double-Contrast Barium Enema
III. CT Colonography (“Virtual” Colonoscopy)
IV. Flexible Sigmoidoscopy
V. **Colonoscopy
**GOLD STANDARD!!!
Fecal Occult Blood Testing (FOBT)
colon polyp screening/dx tool
Take stool and test with reagent and tells you if blood is present in the stool by changing color
Not always positive b/c they don’t always bleed
Double-Contrast Barium Enema
colon polyp screening/dx tool
Old standard, can only see 50% of polyps >1cm
Flexible Sigmoidoscopy
colon polyp screening/dx tool
Good b/c a majority of colon cancers happen in the Descending Colon and the Sigmoid Colon
what is the GOLD STANDARD of colon polyp screening/dx?
Colonoscopy!!!
CAN REMOVE POLYP ON SITE!!!
risks of colonoscopy
-Perforation – can perforate mucosa in colon
-Significant bleeding
Intolerance to sedation
-Dehydration/electrolyte imbalance in elderly
-Need to prep for colonoscopy beforehand – can cause you to be dehydrated
polyp management/treatment?
polypectomy
-Eradication of colon polyps is key for minimizing cancer risk and mortality
what are intestinal polyposis syndromes?
caused by genetic mutations and can be inherited
autosomal dominant
types of intestinal polyposis syndromes?
I. Lynch Syndrome/Hereditary Nonpolyposis Colorectal Cancer (HNPCC)
II. Familial Adenomatous Polyposis (FAP)
III. Hamartomatous Polypsis Syndromes
A) Familial Juvenile Polyposis
B) Peutz-Jehgers Syndrome
what are the indications to consider hereditary intestinal polyposis syndrome?
- Patient with family history of CRC affecting >1 family member
- Personal or family history of colorectal cancer developing early age <50 years
- Personal or family history of multiple polyps (>20)
- Personal or family history of multiple extracolonic malignancies (have polyps and endometrial cancer, etc.)
what is the most common intestinal polyposis syndromes/
Lynch syndrome/hereditary nonpolyposis colorectal cancer
MOST COMMON OF THE INHERITED COLON CANCERS
what is the CRC risk of Lynch syndrome?
CRC risk is 80% - so if get polyp, likely to turn malignant
average age of onset and more common in who for Lynch syndrome?
Avg. onset 45 years old
Moderately higher in men
what is Lynch syndrome/hereditary nonpolyposis colorectal cancer caused by? predominantly what type of tumors? involves what part of the colon?
caused by DNA mismatch repair
Predominantly adenomas
Preferential involvement right colon
do pts with Lynch syndrome/hereditary nonpolyposis colorectal cancer develop repeat colon cancer?
20-40% develop repeat colon cancer of remaining colon
what may people with Lynch syndrome/hereditary nonpolyposis colorectal cancer also have?
metachronous cancer
-may have another cancer as well as colon cancer
extracolonic malignancies of Lynch syndrome/hereditary nonpolyposis colorectal cancer
***Endometrial Carcinoma (MOST COMMON)
Uterine, Ovarian, Stomach, Small Bowel, Hepatobiliary, Urinary tract, Brain and Skin cancers
- **Turcot Syndrome
- variant typically involving brain tumors gliomas (pt prone to developing glioblastomas)
what is the most common extracolonic malignancy of Lynch syndrome/hereditary nonpolyposis colorectal cancer?
Endometrial Carcinoma
HPI of Lynch syndrome/hereditary nonpolyposis colorectal cancer
***Presenting at young age – 45 years old
History of rectal bleeding, bowel obstruction, perforation
Family history
what will you find on PE of Lynch syndrome/hereditary nonpolyposis colorectal cancer?
- Poorly differentiated tumors in the right colon
- pt may be asymptomatic
Lynch syndrome/hereditary nonpolyposis colorectal cancer Diagnosis
- Colonoscopy
- Genetic Testing
- Masses (cancers) tested for microsatellite instability – used for prognosis
Lynch syndrome/hereditary nonpolyposis colorectal cancer Treatment
Colectomy – cut out as much of colon as you can
Lynch syndrome/hereditary nonpolyposis colorectal cancer Surveillance
Yearly colonoscopy 1-2 years starting age 20-25 years of age
familial adenomatous polyposis caused by?
Germline mutation of the APC gene
familial adenomatous polyposis epidemiology
- affects both sexes equally
- average onset age 16 y/o
- 1% of inherited polyposis syndrome
what is familial adenomatous polyposis characterized by?
Characterized by colon having >100 adenomas
what is the chance of getting cancer if have familial adenomatous polyposis?
cancer is 100%, average age of 39 y/o
extracolonic manifestations with familial adenomatous polyposis
Gardner Syndrome – FAP patient with extracolonic manifestations
Gardner syndrome presentation
Desmoid tumors - M/C
-benign tumor in the abdomen that comes from connective tissue in the belly – common after pregnancy
-supernumerary or missing teeth, skin cysts/lesions
CHRPE (congenital hypertrophy of the retinal pigment)
Duodenal adenomas
Fundic Gland Polyps – in fundus of the stomach
familial adenomatous polyposis Turcot syndrome
FAP with brain tumors - RARE!!!
desmoid tumors in Gardner syndrome with familial adenomatous polyposis
- M/C extracolonic feature in FAP
- 2nd most common cause of death in FAP pts
- locally invasive, fibromatous tumors, can metastasize
what is the 2nd most common cause of death in FAP pts?
desmoid tumors (m/c extracolonic feature in FAP)
HPI of familial adenomatous polyposis
Presenting at young age
History of rectal bleeding, bowel obstruction, perforation
Family history
PE of familial adenomatous polyposis
Asymptomatic
> 100 adenomas on colonoscopy
Extracolonic Manifestations
Screening/Dx of familial adenomatous polyposis
Genetic testing patient and family
Age 10-12 yearly flexible sigmoidoscopy
Yearly colonoscopy once polyps detected
Tx and Surveillance of familial adenomatous polyposis
- Prophylactic Colectomy
- Remaining rectum or ileal pouch will need to be screened q6mo-2 years
- Age 20-25 EGD q1-3 years
Chemoprophylaxis with NSAIDs and COX2
- FDA approved Celecoxib as adjunctive therapy to polypectomy and surgical resection
- Increased risk of stroke and MI with COX2
what are the two types of Hamartomatous Polyposis syndromes?
Familial Juvenile Polyposis
Peutz-Jehgers Syndrome (PJS)
Familial Juvenile Polyposis, what is it? caused by? what does “Juvenile” mean? present where?
Type of hamartomatous polyposis syndromes
- benign polyps at risk for malignancy
- “Juvenile” = histology of the polyps
caused by mutation in SMAD4 or BMPR1A
present in small bowel, stomach, colon, and rectum
HPI & PE in Familial Juvenile Polyposis
Asymptomatic
***Painless rectal bleeding
Rectal prolapse
Failure to thrive
Family history
Familial Juvenile Polyposis Surveillance
Screening age 15 yos q1-3 years colonoscopy
Familial Juvenile Polyposis Diagnosis
> 5 Juvenile polyps of the colon
Multiple juvenile polyps throughout the GI tract
Family history of juvenile polyps
Genetic testing
Peutz-Jehgers Syndromes (PJS)
Type of hamartomatous polyposis syndromes
-rare, inherited GI disorder
- mutations of a gene
- pts may present with GI bleeding, intussusceptions or obstruction
what do pts with Peutz-Jehgers Syndromes develop?
polyps on the mucous lining of the intestine and dark discolorations on the skin and mucous membranes
Lips and inside of cheeks have dark discolorations
cancer risk for Peutz-Jehgers Syndromes
Overall cancer risk is 50% by age 50
what extracolonic malignancies occur in Peutz-Jehgers Syndromes
breast and testicular cancer are most common
also get GI malignancies in stomach, small bowel and colon
age of onset for Peutz-Jehgers Syndrome
24 years old
Peutz-Jehgers Syndrome dx and surveillance
- Genetic testing available: STK11 gene
- Colonoscopy every 2-3 years starting age 18 years old
- EGD q2-3 years starting age 10
- Breast exam and testicular exam
- Routine mammogram and breast ultrasound
hx of pt that should be obtained when doing colorectal screening
Start obtaining family history in patients starting at age 20
Update history every 5-10 years
Questions to ask:
-Family history of CRC <50 y/o, etc.
when should you start obtaining fam hx for colorectal screening
starting at age 20
when should you update your hx for colorectal screening?
every 5-10 years
PE findings for colorectal screening/cancer
asymptomatic
***Any patient over 40 y/o that presents with bowel changes, hematochezia r/o for colorectal cancer via at least a colonoscopy or sigmoidoscopy
average risk pt for colorectal cancer
> 50 y/o
> 45 y/o for African Americans
average risk pt timeline for screening
50-75 years old – screen
76-85 years old – screening is at providers discretion
> 85 years old – stop screening
when do you screen a pt for colorectal cancer?
50-75 y/o
when do you stop screening a pt for colorectal cancer?
> 85 y/o
when is screening for colorectal cancer at the providers discretion?
76-85 y/o
colorectal cancer prevention tests for average risk pts
***COLONOSCOPY q10 YEARS
Flexible Sigmoidoscopy q5 years or Flex sig PLUS FIT q10 years
CT colongraphy q5 years
CANCER PREVENTION TEST SHOULD BE OFFERED FIRST
colorectal cancer detection tests for average risk pts
***Annual fecal immunochemical test annually
Annual fecal occult blood testing (gFOBT) annually
Fecal DNA q1-3 years
***IF CANCER DETECTION TEST +, MUST THEN HAVE A CANCER PREVENTION TEST
if the colorectal cancer detection test is positive, what must be done?
pt then must have a cancer prevention test
High risk colorectal cancer pts based on personal characteristics
- Previous Colorectal Cancer
- Large (>1cm) adenomatous polyps
- Adenoma Polyps of villous, tubovillous, histology
- IBD disease – Ulcerative Colitis and Crohn’s after 8 years active disease
- Intestinal Polypsosis syndrome (e.g. FAP, Lynch)
- African Americans
High risk colorectal cancer pts based on family history
- One 1st degree relative with CRC or advanced adenoma <60 years of age
- ≥Two 1st degree relatives with CRC or advanced adenoma @ any age
***IMPORTANT – One 1st degree relative with CRC or adenoma >60 y/o: screen SAME as average risk
what pt do you screen SAME as average risk pt?
One 1st degree relative with CRC or adenoma >60 y/o
colorectal screening recommendations for general population AND pt with any distant relative with CRC or polyps
average risk screening tests
colorectal screening recommendations for pt with 1st degree relative CRC <60 y/o or two 1st degree relatives at any age
begin screening at age 40 or at age 10 years younger
colonoscopy every 5 years
colorectal screening recommendations for pt with 1st degree relatives with CRC >60 years, or in two 2nd degree relatives
same risk as average risk
colonoscopy strongly suggested as screening method
colorectal screening recommendations for pt with Lynch Syndrome risk
age 20-25 or 10 years younger than youngest affected relative - colonoscopy q1-2 years, then yearly age 40
genetic testing
colorectal screening recommendations for pt with FAP risk
age 10-12 sigmoidoscopy yearly
colonoscopy yearly after polyp discovered
genetic testing and counseling
colorectal screening recommendations for pt with personal history of CRC
total colon exam w/in 1 year after resection, repeat at 3 years
repeat 5 years if normal
colorectal screening recommendations for pt with personal hx of adenoma
polyps removal
colonoscopy timeline based on timeline
colorectal screening recommendations for pt with inflammatory bowel disease
begin 8 years after onset of pancolitis, colonoscopy 1-2 years
in what pts should you do a DRE and test stool b/c may be colon cancer?
ANY PATIENT THAT IS POSTMENOPASUAL OR ADULT MALE THAT HAS NO REASON BE IRON DEFICIENT – NEED TO DO DRE AND TEST STOOL B/C MAY BE COLON CANCER
age onset of colorectal cancer? more common in who?
age 50 years and peaks at age 65
more common in males > females
___ sided colorectal cancers are most common
left sided colorectal cancers are most common
1/2 in rectum and rectosigmoid
right sided colorectal cancer more common in?
inherited colon cancers
proximal colon carcinoma rates are higher in who?
African Americans > Caucasians
is it common to have metastatic disease with colorectal cancer? Common sites of metastases? most common site of metastases?
YES!!! 1 out of 5 CRC diagnosed will have metastatic disease
***Common sites are regional lymph nodes, liver, lungs, and peritoneum
***Liver is most common site of metastases b/c mesenteric veins drain through the portal vein
what is the most common site of metastases in colorectal cancer?
Liver is most common site of metastases b/c mesenteric veins drain through the portal vein
modifiable risk factors for colorectal cancer?
“Western” diet – red meat, increased fats
Obesity/waist circumference
Smoking
Alcohol consumption
non-modifiable risk factors for colorectal cancer?
Race – African Americans > Caucasians
Hereditary Polyposis Syndromes (ex: FAP, Lynch)
Family history of colon cancer
Patient age
Inflammatory Bowel Disease (UC and Crohn’s)
Childhood Abdominal Radiation – for another malignancy
modifiable prevention factors for colorectal cancer?
Diet and Macronutrients
- Rich in fruit, vegetables
- Adequate fiber
- Limited amount of red meat
Physical activity
NSAIDs - Low dose aspirin
clinical presentation for colorectal cancer
- Patients with suspicious symptoms and/or signs
- Change in bowel habits
- Change in caliber of stool (ex: stools are now pencil thin) - Asymptomatic individuals discovered by routine screening
- Emergency admission with intestinal obstruction, peritonitis, or rarely, an acute GI bleed
symptoms of right sided colon cancer
- Vague abdominal pain
- Iron deficiency anemia
- Fatigue
- GI bleeding
- Weakness from chronic blood loss
symptoms of left sided colon cancer
-Obstructive symptoms
-Colicky abdominal pain
<b>-***Change in bowel habits</b>
-Constipation alternating with loose stools
-Stool streaked with blood
symptoms of rectal cancer
- Rectal tenesmus
- Urgency
- Recurrent hematochezia
- Narrow caliber stools
what symptoms for colorectal cancer are concerning for metastatic disease?
weight loss, cachexia, and ascites
colorectal cancer PE findings
- Rectal Bleeding
- Abdominal Pain
- Cachexia, weight loss, back pain, urine or bowel changes, ascites, pallor indicative of progressive disease
what is the GOLD STANDARD for dx of colorectal cancer?
COLONOSCOPY WITH BIOPSY
preoperative staging for colorectal cancer
- CBC with differential
- Liver Function Tests
- Carcionembryonic antigen (CEA) level - Not used for dx, but used for recurrence
- CT Chest/Abdomen and Pelvis
- Endorectal ultrasonography may guide operative management of rectal cancer)
what is the carcionembryonic antigen (CEA) level for colorectal cancer
Not used for dx, but used to monitor progression pre-post surgery, indicator of recurrence of colon cancer (tumor marker)
Expect to normalize after surgery
what must you do when staging?
need to dissect at least 12 lymph nodes
what is T1?
tumor invades submucosa
what is T2?
tumor invades muscular propria
what is T3?
tumor invades thru muscular propria into pericolorectal tissues
what is T4a?
tumor penetrates to the surface of the visceral peritoneum
what is T4b?
tumor directly invades or is adherent to other organs or structures
what is the treatment of choice in all stages of colorectal cancer?
Surgery
colorectal cancer treatments
- ***SURGERY - Tx of choice
- Chemotherapy - stages III & IV colon cancer
- Radiation + Chemotherapy - rectal cancer stages II-IV
chemotherapy tx for what stages of colon cancer?
stages III and IV colon cancer
radiation + chemotherapy for what stages of rectal cancer?
stages II-IV
what is the function of the rectum?
to store stool and give the patient the sensation that the stool is ready to be evacuated
where is the colon located?
in the abdominal wall cavity
where is the rectum located?
in the peritoneal space which is a much smaller tighter space next to other organs such as the uterus, prostate, bladder, and ureters
This makes the surgical approach much more difficult
what does rectal cancer benefit from for tx?
neoadjuvant therapy prior to surgical excision
for rectal cancer, why do you want to give chemo and radiation?
b/c it is much easier to spread since in peritoneal space and close to many other organs
what does primary management of localized colon cancer involve?
surgery to remove the affected segment
colon cancer surgical options
Laparoscopic colectomy
Open colectomy
- Subtotal colectomy
- Total colectomy
- +/- ostomy
rectal cancer surgical options
- Total Mesorectal excision
- ***Transanal excision = most common for localized rectal cancer
- Transanal endoscopic microsurgery
- Transsphinteric excision
- Low anterior resection with colorectal anastomosis
- Abdominoperineal resection with a colostomy
what is the most common surgical option for localized rectal cancer?
Transanal excision
Stage I colon cancer tx
colectomy
stage II colon cancer tx
colectomy
stage III colon cancer tx
colectomy + adjuvant therapy (chemo)
stage IV colon cancer tx
chemotherapy (goal to slow progression of tumor)
- +/- resect isolated liver or lung met if possible
- +/- colectomy
rectal cancer treatment
Stage I: Excellent prognosis surgery alone
Stage II & Stage III: Chemoradiation + Surgery
-Neoadjuvant Chemoradiation (preoperative) surgery chemo +/- radiation again
what has a worse prognosis, colon or rectal cancer?
rectal cancer (and higher recurrence rate too)
colorectal cancer postop surveillance - PE
do PE every 3-6 months for two years
then every 6 months for 3 years
colorectal cancer postop surveillance - CT Abd/Pelvis
annually for 5 years
EXCEPT:
-resected metastasis - q3-6 months every 2 years -> q6 months for 5 years
colorectal cancer postop surveillance - colonoscopy
do colonoscopy 1 year after surgery -> if negative then at 5 years; or 3 years???
if not done preoperatively perform colonoscopy 3-6 months postop
rectal cancer postop surveillance - proctoscopy
every 6 months q3-5 years
post op surveillance tests for colorectal cancer
PE, CT abd/pelvis, colonoscopy, proctoscopy (rectal cancer)
what is anal cancer?
Tumors arising in mucosa (Glandular, Transitional, Squamous)
-Look like bladder and esophageal cancers
what is peri-anal/anal margin cancer?
Arise/distal to the squamous mucocutaneous junction and or arise within the skin
what correlates very strongly with anal cancer as the cause?
HPV
what is the most common anal cancer histology?
Small cell carcinoma (SCC)
-arise from the transitional or squamous mucosa elements of anal canal
non-keratinizing SCC anal cancer
Tumors arising above the Dentate line of the anal canal
keratinizing SCC anal cancer
tumors arising distal to Dentate line
other anal cancer histology
adenocarcinoma
melanoma
sarcoma - rarest
anal cancer cause and more common in who?
Caused by HPV (Human Papilloma virus)
Women > men
anal cancer risk factors
<b>-***HPV</b>
- Female
- lifetime number of sexual partners
- genital warts
- cig smoking
- HIV
- Receptive anal intercourse
- chronic immunosuppressive conditions
anal cancer symptoms
<b>-***RECTAL BLEEDING</b>
- Anorectal pain
- Rectal mass sensation
- No symptoms
anal cancer PE
Rectal mass on Digital Rectal Exam (DRE)
Condylomata (genital warts)
Bleeding
anal cancer initial dx tools
Endoscopy with biopsy
Anoscopy
Rigid Proctosigmoidoscopy
anal cancer work-up
CT scan or MRI abdomen/pelvis
-To look for metastatic disease
PET/CT scan
-PET CT good for SCC to see if any metastatic disease
Fine-needle aspiration or biopsy of node if noted on imaging
anal cancer tx stages 0-III
Chemoradiotherapy (Neoadjuvant)
Progression of disease or persisting disease necessitates surgery
anal cancer tx stage IV (metastatic disease)
Systemic Chemotherapy
Palliative Chemoradiotherapy
anal cancer post-tx surveillance
Every 3-6 months for five years:
- Digital Rectal Examination (DRE)
- Anoscopy
- Inguinal node palpation (looking for metastatic disease)
+/- CT chest/abdomen/pelvis annually for three years
