Anal Cancer

Question 1

Most common cancer to occur in anal region

Answer 1

squamous cell (80%)

Others: melanoma, lymphoma, and adenocarcinoma

Question 2

Which groups of lymph nodes do anal cancers drain to?

Answer 2

proximal = pelvic lymph nodes

Anal margin = inguinal

Question 3

In what demographic is the incidence of anal cancer rising and why?

Answer 3

men who have sex with men

due to widespread HPV infection

Question 4

Typical demographic presenting with anal cancer

Answer 4

1:2 male:female ratio

Average age of presentation = 85-89 years.

Question 5

Risk factors for anal cancer

Answer 5

HPV (16 and 18)
- Anal intercourse
- high number of sexual partners
- MSM

HIV
Women with Hx of cervical cancer or CIN
Immunosuppressive drugs
Smoking

Question 6

Describe the typical presentation of a patient with anal cancer

Answer 6

Perianal pain
bleeding
palpable lesion
Faecal incontinence
neglected tumour in a female may present with a rectovaginal fistula.

Question 7

Describe the T staging system for anal cancer

Answer 7

TX primary tumour cannot be assessed
T0 no evidence of primary tumour
Tis carcinoma in situ
T1 tumour <2cm
T2 tumour >2 cm but <5 cm
T3 tumour >5 cm
T4 tumour of any size that invades adjacent organ(s) - for example, vagina, urethra, bladder