Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FRCR2 > Anal cancer > Flashcards

Anal cancer Flashcards

1
Q

How are anal cancers categorised anatomically

A

Anal canal - majority.

Anal verge - Lower end of anal canal

Anal margin - 5cm of perianal skin, to lower limit of anal canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the lymphatic drainage of anal tumours

What proportion of cancers are node positive at presentation

A

Low tumours of the anal margin and verge drain to the peri rectal nodes, inguinal & femoral nodes, iliac and para-aortic

Mid and upper tumours drain to internal pudendal nodes, obturator, pre-sacralW and internal iliac nodes

12% are node positive at presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors for anal cancer

A

HPV - 16 & 18
Multiple sexual partners, ano-receptive intercourse
Cervical CIN & cancer, vaginal/vulval VIN & SCC
Smoking
Immunosuppression & HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What proportion of AIN progresses to anal cancer after 5yrs

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does anal cancer tend to present

A

Bleeding, pain, itching, discharge
Faecal incontinence and frequency
Palpable mass in <25% of pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the 5yr prognosis of anal cancer

A

75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Does HPV predict for response to CRT

A

No - carry worse prognosis (opposite to H&N)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the negative prognostic factors for anal cancer

A

Increasing stage
Size (>5cm)
Nodal involvement
Mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is anal cancer investigated

A

History and examination incl genital examination and EUA
Speculum examination to assess vulva/vagina/cervix
Assess for presence of fistula (and consider defunctioning stoma)
FNA of positive nodes
Imaging - MRI pelvis
PET if >T2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What should an MRI comment on for a potential anal cancer

A

Relationship between inferior aspect of tumour and anal margin
Depth of invasion
Length and quadrant of involvement
Evidence of adjacent organ involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is a PET scan indicated for investigation of anal cancer

A

> T2 stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is nodal disease defined for anal cancer

A

N1a - internal iliac, mesorectal or inguinal nodal involvement only

N1b - external iliac node involvement only

N1c - external iliac node AND mesorectal / inguinal / int iliac nodal involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the aims of treatment of anal cancer

A

Achieve cure with locoregional control
Preservation of anal sphincter function
QOL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When is local excision indicated for anal cancer

A

Anal margin tumours - <1cm, well differentiated, and if macroscopically clear margins are possible (>5-10mm) without sphincter damage, to allow histological clear margin of >1mm

If tumour >1cm -> primary CRT

Surgery contraindicated for anal canal tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is an APER indicated for anal cancer
What doesn’t an APER treat

A

Doesn’t treat pelvic LNs

Indicated if radical CRT is contraindicated
Prev RT, adenocarcinoma or adenosquamous carcinoma histology (less likely to respond to CRT), transplated kidney in pelvis, IBD, wish to preserve fertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When is CRT standard of care for anal cancer

A

Anal canal tumour
Anal margin tumours >1cm

17
Q

What category treatments are anal SCC

A

Cat 1

18
Q

When is a defunctioning stoma indicated for anal cancer

A

Bulky tumours - Obstruction
Faecal incontinence
Risk of fistulation
Significant pain

19
Q

How is stage III anal cancer defined

A

Node positive or T4 disease
Stage IIIA - T1-2 N1
Stage IIIB - T4 N0 (T3 N0 = stage 2b)
Stage IIIC - T3-4 N1

20
Q

What is the RT dose, for a T1-2 N0 tumour

A

T1-2 N0 (stage I-IIA): 50.4Gy/28# with 40Gy/28# electively to pelvic nodes

21
Q

What is the RT dose, for a T3-4 N0 tumour, or any node positive tumour

A

Dose to primary tumour (and nodes >3cm) - 53.2Gy/28#
Dose to positive nodes - 50.4Gy/28#
Dose to elective nodal volume - 40Gy/28#

22
Q

What chemotherapy regimen is given alongside anal RT?

A

Concurrent chemotherapy
Mitomycin C + 5FU/capecitabine
MMC given IV day 1 - 12mg/m2, to max dose 20mg

5FU - days 1-4 & 29-32 ie wks 1&5 - 1000mg/m2 over 24hrs via pump
OR capecitabine 825mg/m2 bd, on days of RT (M-F) only

23
Q

What trial suggested that capecitabine could replace 5FU during chemotherapy for anal cancer

A

Extra trial

24
Q

When is mitomycin C omitted

A

GFR <50 - risk of thrombocytopenia

25
Q

What chemotherapy is given if elderly / poor PS

A

Mitomycin C, at dose 8mg/m2
AND 5FU at 750mg/m2

26
Q

What is the response rate to primary CRT for anal SCC

A

Complete tumour regression in 80-90%

27
Q

Which trial demonstrated that lower stage tumours can be treated with a lower RT dose

A

ACT II

28
Q

What are the indications for adjuvant CRT for anal cancer

A

Positive margins (<1mm) and further surgery not possible
Where completeness of excision cannot be guaranteed
Those at risk of pelvic nodal involvement

29
Q

What is the adjuvant dose for anal CRT?

A

41.4Gy/23# - scar + margin, with MMC + capecitabine
30Gy/15# - scar + margin, with MMC+5FU for wk1 only

30
Q

What volumes are margins are used for a T1 anal tumour treated with primary CRT

A

GTV - Gross primary anal tumour
CTV - GTV + 1cm
Cover Anal canal, verge, internal and external anal sphincters.
Edit from bone & muscle.
PTV - CTV + 1cm

31
Q

What volumes are margins are used for a T2N0 anal tumour treated with primary CRT

A

GTV-P
CTV - GTV +1cm
Cover Anal canal, verge, internal and external anal sphincters.

Elective nodal volume - inguinal, femoral, int & ext iliac, obturator, pre-sacral
Start 2cm above SI-joint or 1.5cm above GTV
If node negative, include lower 5cm of mesorectum
If node positive, include whole mesorectum in CTV

PTV = CTV +0.5cm (for tumour volume) and +1cm (for elective volume)

32
Q

What volumes are margins are used for a large T2, or T3-4 or node positive anal tumour treated with primary CRT

A

GTV-P & GTV-N
CTV-P - GTV +1.5cm
Cover Anal canal, verge, internal and external anal sphincters.
CTV-N = GTV-N +0.5cm

Elective nodal volume - inguinal, femoral, int & ext iliac, obturator, pre-sacral
Start 2cm above SI-joint or 1.5cm above GTV
If node negative, include lower 5cm of mesorectum
If node positive, include whole mesorectum in CTV

PTV = CTV +1cm (for tumour volume) and +0.5cm (for elective & nodal volume)

33
Q

What OARs would be planned for anal CRT

A

Bladder, rectum and small bowel, perineum & genitalia, femoral heads

34
Q

What is the follow up after completion of primary CRT for anal cancer

A

6mth MRI

35
Q

What is the local recurrence rate after primary CRT

A

20%, typically within first 18mths

36
Q

How is recurrent disease managed after primary CRT

A

Workup of recurrence: Biopsy, MRI, PET-CT to exclude distant mets

Local recurrence within RT volume - salvage surgery (APER / exenteration), or if not suitable for surgery / sufficient interval, reirradiation

Para-aortic LN - SABR

Isolated Inguinal node - surgery (block dissection)

37
Q

What is the first line management of metastatic anal SCC?
Based on what trial
What is the prognosis for this regimen

A

Carboplatin/paclitaxel
InterAAct phase II study (carbo/taxol vs cisplatin/5FU)
mOS 20mths

38
Q

How can CRT be used in the palliative setting

A

30Gy in 15# over 3 weeks
Primary & Nodes + 3 cm margin
Concurrent 5FU week 1 only

FRCR2 (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions