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FRCR CO2A Clinical Oncology > Anal Cancer FRCR CO2A > Flashcards

Anal Cancer FRCR CO2A Flashcards

(73 cards)

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1
Q

Anal Canal Anatomy

A

3 to 4 cm long

anal verge is the lower end of anal canal

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2
Q

Types of Anal Cancer

A
  1. Anal margin Tumors: small and well diff and common in men
  2. Anal Canal Tumors: women > men, mod to poorly diff, worse prognosis
  3. Dual Components (both above)
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3
Q

Peak incidence of anal cancer

A

60 to 65 yrs

Bimodal younger 35 to 40 yrs

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4
Q

RFs for anal cancer

A

HPV 16 and 18, sexually transmitted

more in homosexuals, multiple sexual partners, HIV/AIDS

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5
Q

MC pathology of Anal Cancer?

A

Squamous Cell Carcinomas (90%)

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6
Q

What is AIN?

A

graded from I to III (as in CIN)

precancerous

usually flat or raised, ulceration suggest invasion

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7
Q

Spread of Anal Cancer

A
  1. Direct from primary
  2. Lymphatic
  3. Distant
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8
Q

direct from primary spread anal cancer

A

upward : submucosally to the rectum and bladder

Laterally : ischio rectal fossa and sphincter muscle
women: vagina/urethra
men: prostate

Downward: perianal skin

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9
Q

Lymphatic spread of Anal Cancer

A

low anal tumors, anal verge and anal margin tumors : perirectal node f/b inguinal nodes and then to Ext Iliac and common iliac/para aortic

mid and upper : int iliac including the hypogastric and obturator nodes and not infrequently to PA/RPLNs

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10
Q

Distant spread

A

Liver

less frequently to the lungs and bones and rarely to the brain

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11
Q

S/S of anal cancer?

A

lump/mass either found by pt on wiping or causing pt the discomfort

Bleeding
discharge and anal discomfort

rarely inguinal LNs

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12
Q

Investigations for anal cancer

A

Biopsy of the primary

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13
Q

is inguinal LNs removed in anal cancer ?

A

usually no, increased risk of lymphedema and wound infection with subsequent delay or complication in delivery of RT

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14
Q

Ix for anal cancer

A
  1. FBC
  2. Biochemical panel
  3. HIV test
  4. MRI pelvis
  5. CT Thorax and Abdomen
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15
Q

when is Sx done in anal cancer pt?

A

Well differentiated margin tumors < 2 cm in diameter if clear surgical margins are possible

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16
Q

post op RT in anal cancer

A

+ margin

Dose: at least 30 Gy

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17
Q

Nigro et al Rx of anal cancer

A

30 Gy/ 15 # with 2 cycles of ChT (5 FU and mitomycin 2 cycles, 4 weeks apart)

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18
Q

current RT Dose for anal cancer

A

T1-2N0: 50.4 Gy/ 28 #, Nodal Volume : 42 Gy/ 28#

T3-4N0: 54 Gy/ 30 #, Nodal Volume: 45 Gy/ 30 #

Any T, N+ : 54 Gy/ 30 #,
Involved Node: 50.4 Gy/ 30#
Nodal Volume: 45 Gy/ 30 #

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19
Q

UK practice of Concurrent ChT in anal cancer

A

5 FU 1 gm/m2 D1 to D4 and mitomycin C 12 mg/m2 on D1,

2nd Cycle during last week of RT consisting of 5 FU alone

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20
Q

when is bolus added

A

all anal margin tumors and anal canal tumors that reach a superficial level (< 2 cm)w

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21
Q

where is bolus kept for Anal Cancer RT?

A

applied to the natal cleft

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22
Q

Elective Nodal Regions in Anal Canal Cancer Rx

A

B/L inguinal
Femoral
Ext Iliac
Int Iliac
Obturators
lower 5 cm of mesorectum and
Presacral LNs

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23
Q

What’s Rx of locally recurrent anal cancer

A

APR or exenteration

if Sx not possible and RT given 2 yrs back, RE RT can be considered

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24
Q

what if isolated Inguinal LN recurrence

A

LN Dissection

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25
Fungating mass RT Dose
30 Gy/ 10# or frail pts, 6 Gy / # weekly for 5 to 6 weeks
26
Palliative ChT for anal canal cancer
Cisplatin and 5 FU MMC with 5 FU
27
Rx of Adenocarcinoma of Anal canal
should be Rx as low rectal adenocarcinoma with APR
28
prognostic factor for anal cancer
TNM staging Female better than male
29
What type of cancer is primarily associated with the anal canal?
Squamous cell cancers (SCC) ## Footnote SCC of the anal canal are uncommon and primarily occur in the seventh decade of life.
30
What is the female to male ratio for anal canal cancers?
2–3:1 ## Footnote There is a slight predominance of females for cancers of the anal canal.
31
What are some risk factors for anal cancer?
* Genital infection with HPV (most frequently type 16) * Chronic immunosuppression (transplant and HIV positive patients) * Smoking (2–5 fold increase) ## Footnote These factors significantly increase the risk of developing anal cancer.
32
What is the length of the anal canal?
3–4 cm ## Footnote The anal canal extends to the palpable upper border of the anal sphincter.
33
Define peri-anal cancers.
Cancers occurring within 5 cm of the anal verge without extension into the canal ## Footnote Peri-anal cancers are defined based on their proximity to the anal verge.
34
What is anal intraepithelial neoplasia (AIN)?
A condition that can progress from low to high grade and is found in areas adjacent to squamous cell carcinoma ## Footnote AIN is a precursor to anal cancer.
35
What percentage of anal cancers are squamous cell cancers?
90% ## Footnote Squamous cell cancers include various histological subtypes such as large cell keratinizing, basaloid, and transitional.
36
List some histological subtypes of anal squamous cell carcinoma.
* Large cell keratinizing * Basaloid * Transitional (large cell non-keratinizing) ## Footnote Collectively, these subtypes are referred to as cloacogenic or epidermoid cancers.
37
What is the management approach for adenocarcinoma of the anal glands?
Managed as low rectal cancers ## Footnote Adenocarcinomas account for approximately 5–10% of anal tumors.
38
What are the common symptoms of anal carcinoma?
* Discomfort * Itching * Bleeding ## Footnote Symptoms are often dismissed as hemorrhoids, especially in 50% of cases.
39
At what age should patients be examined to exclude carcinoma?
Over the age of 60 ## Footnote This is especially important for patients presenting with a mass, enlarged inguinal nodes, pain, or persistent symptoms.
40
What are late symptoms of locally advanced anal cancer?
* Faecal incontinence * Vaginal fistula ## Footnote These symptoms indicate more advanced disease.
41
Are distant metastases common at the presentation of anal cancer?
No, they are rare ## Footnote Distant metastases typically occur later in the disease course.
42
What is included in the initial assessment for anal cancer?
Digital rectal examination, examination under anaesthesia (EUA), biopsy, transanal US, CT or MRI ## Footnote Transanal US assesses depth of invasion and perirectal nodes, while CT or MRI is used for pelvic nodal metastases.
43
What percentage of palpable or radiologically suspicious inguinal nodes may not be involved?
Up to 50% ## Footnote Fine needle aspiration (FNA) is recommended for clinically suspicious nodes.
44
What is the typical staging process for distant metastasis in anal cancer?
CT chest and abdomen ## Footnote Distant metastasis is seen in less than 5% at diagnosis.
45
What are the treatment options for localized anal tumors?
* Local excision (selected stage I patients) * Concurrent chemoradiotherapy (CRT) (stage I–III) * Radical surgery (T3 or 4 causing sphincter destruction and salvage after CRT)
46
What is the 5-year survival rate for stage I anal cancer?
70–85% ## Footnote Survival varies by stage and presence of risk factors.
47
What is the median survival for inoperable metastatic anal cancer with best supportive care?
6 months
48
What is the peak incidence age for squamous cell cancers (SCC) of the anal canal?
Seventh decade
49
Which virus is a significant risk factor for anal cancer?
Human papillomavirus (HPV, most frequently type 16) ## Footnote Other risk factors include chronic immunosuppression and smoking.
50
What percentage of anal cancers are squamous cell carcinomas?
Approximately 90%
51
What are late symptoms of locally advanced anal cancer?
* Faecal incontinence * Vaginal fistula
52
What is the classification for stage IIIB anal cancer?
T4N1 or any T N2 or N3
53
What is the recommended radiation dose for anal cancer treatment?
Debatable; as low as 30 Gy for microscopic disease and 45 Gy for non-bulky gross disease ## Footnote UK practice indicates these doses are sufficient.
54
What is the role of cisplatin in anal cancer treatment?
Under investigation as neoadjuvant, concurrent, and adjuvant treatment ## Footnote Current trials compare different CRT schedules.
55
What is the recommended follow-up schedule after anal cancer treatment?
* 6-weekly if continuing treatment response * 2, 3, and 4-monthly for the first 3 years * 6-monthly review to 5 years
56
What is the expected duration of response rates in metastatic anal cancer with chemotherapy?
Usually only a few months
57
What is the risk of serious late toxicity related to radiation dose in anal cancer treatment?
5–12% ## Footnote Includes ulceration, radionecrosis, and stenosis.
58
Fill in the blank: The anal canal is ______ long.
3–4 cm
59
What is the significance of a lesion size of 4 cm in anal cancer treatment?
Represents the threshold for local control
60
True or False: Distant metastases develop in up to 15% of anal cancer patients.
True
61
What is the overall 5-year survival rate for anal cancer?
Approximately 75%
62
What are some common symptoms of anal carcinoma?
* Discomfort * Itching * Bleeding
63
What is the role of local excision in anal cancer treatment?
Option for selected patients with stage I disease not invading sphincter muscles
64
What is the treatment for patients with stage IV anal cancer?
* Palliative chemotherapy * Palliative radiotherapy * Active symptom control
65
What is the overall 5-year survival rate?
Approximately 75% ## Footnote This statistic indicates the proportion of patients who survive at least five years after diagnosis.
66
What lesion size represents the threshold for local control?
4 cm ## Footnote Lesions larger than this size may not achieve the same rates of local control.
67
What percentage of tumours ≤4 cm achieve complete pathological response to CRT?
Up to 95% ## Footnote CRT refers to chemoradiotherapy.
68
How does spread to regional nodes affect survival rates?
It is an adverse factor, with 5-year survivals up to 20% lower than in node-negative patients ## Footnote Node-negative patients have no cancer spread to regional lymph nodes.
69
What are the control rates with CRT alone if inguinal nodes are not invading skin or deep structures?
Approximately 80% ## Footnote This refers to the effectiveness of treatment in controlling cancer spread.
70
How do perianal lesions compare to anal canal lesions in terms of prognosis?
Perianal lesions have a more favourable prognosis ## Footnote This is due to a decreased risk of nodal metastases.
71
What is the median survival of patients with distant metastases?
9–12 months ## Footnote This indicates the average length of survival for patients whose cancer has spread to distant sites.
72
1st L systemic therapy for metastatic anal canal carcinoma | NCCN 2025
Carboplatin and Paclitaxel | other FOLFCIS mFOLFOX6
73
2nd L systemic therapy for metastatic anal canal carcinoma | if no IO used
Cemiplimab Dostarlimab Nivolumab Pembrolizumab

FRCR CO2A Clinical Oncology (36 decks)

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