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home - Colon - Colorectal and Anal Cancer - Anal Cancer Written by Dr Sebastian Zeki

Knows the pathology of benign and malignant tumours of the colon
and rectum
Has awareness of the molecular genetics of colorectal
carcinogenesis and the adenoma-carcinoma sequence
Knows the range of predisposing conditions including inherited
syndromes and acquired colonic diseases
Knows the range of clinical presentation and the means of
diagnosis, investigation, management and follow-up
Knows the strategy for prevention including procedures for

Uses clinical assessment and selects investigations to reach a rapid
conclusion as to whether a patient might have colorectal cancer and
arranges timely investigation.
Refers the patient to the multi-disciplinary team CbD, mini-CEX,

Shows ability to react to possible diagnosis of malignancy in a timely

Communicates with patient and family in a sympathetic and
understanding manner, explains next steps, involves other health
professionals (including the GP) as appropriate

Anal Cancer

Anal Cancer WHO Classification of Anal margin cancer(=perianal skin cancer):Squamous cell carci-noma (most common).Giant condyloma.Basal cell carcinoma.Bowen's disease.Paget's disease.Others Lymphatic drainage of canal is to superficial lymph nodesDrainage more proximal is to peri-rectal nodesDrainage more proximal to this is to the inferior mesenteric nodes High grade (HSIL)-assoc with HPV16 Anal Cancer Progression of ASIL to inva-sive anal SCC risk factors:HIV seropositivity.A lower CD4 count.Type of HPV infection.Higher levels of DNA of high-risk.HPV types in the anal canal. Many not associated with HPV but follow same pattern Chronic immunosuppres-sion (any type) assoc.with progression from LSIL to HSIL or invasive cancer Sexual activity —Anal sex< 30 and history of STD’s/ Several sexual partners whether male or femaleCervical cancer in women — More likely to have anal cancer if also have cervical cancerHIV- Strong associationAlso more likely to have HPVCigarette smokingAssoc with smokers, esp current. Risk Factors WHO Classification of Anal canal cancers:Large cell keratinizing (above dentate line) squamous cell carcinoma.Large cell nonkeratinizing (transitional) squamous cell carcinoma.Basaloid (25%) squamous cell carcinoma.Adenocarcinoma (behave like rectal cancers).Small cell carcinoma.Rectal type.Of anal glands.Within anorectal fistula.Undifferentiated. Human papillomavirus infectionHPV assoc.premalignancy is calledanal squamous intraepi- Radiation Therapy:Min 45Gy divided over 5 weeks.Delivered AP Anal canal cancer-DRE-Chest/ Abdo/ Pelvis CT-Consider Pelvic MRI-HIV + CD4 if indicated T1-2, N0 T3-T4, N0or any T, N+ Mets Mitomycin/ 5-FU+ RT Mitomycin/ 5-FU+ RT Cisplatin based chemo DRE at 8-12 weeks and 6 monthly If recurrence then consider abdomino-perineal resec-tion and 5FU/cisplatin Anal margin cancer-DRE-Chest/ Abdo/ Pelvis CT-Consider Pelvic MRI-HIV + CD4 if indicated T1-2, N0 T3-T4, N0or any T, N+ Mets Local excision- if inadequate margins then give 5FU based chemo Mitomycin/ 5FU +RT Cisplatin based chemo Subtypes:Low grade (LSIL)- assoc with other HPV types Treatment External anal sphincter muscle Internal anal sphncter muscle Levator ani muscle Rectal mucosa Columns of Morgagni Perianal skin Squamous mucosa Dentate (pectinate) line Written by Dr Sebastian Zeki

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