• Account for 1.5% of GI tract cancers
• Usually long history of perianal complaints
• Disease may be quite extensive at presentation
• Associated with chronic anal infection (human papillomavirus)
• Tumors anatomically found from the upper to lower border of the internal anal sphincter, 6-12 mm above dentate line
• Referred to as epidermoid carcinoma
• Women are at increased risk
• Homosexual males at greatly increased risk
• 7/106 men; 9/106 women
• Increased incidence in males and females practicing anal sex
• Increased risk with history of anogenital warts; STD; > 10 sexual partners; cervical, vulvar, or vaginal cancer
• Increased incidence in persons who smoke or who are immunosuppressed (HIV infection and transplantation)
• Perianal irritation, may be long-standing
• Palpable mass, may be indurated
• Physical exam with digital rectal exam
• Assessment for lymphadenopathy (groins)
• Exam under anesthesia, anoscopy with biopsy
• Endorectal US to assess size and depth of invasion
• Chest film, CT to assess for metastatic disease
• Chemoradiation is mainstay of therapy
• Role of surgery limited
• Overall reported recurrence rates with local excision high
• Local excision for small, well-differentiated, mobile lesions confined to the submucosa
• Surgery is largely used as salvage procedure or for recurrent/persistent disease (abdominal perineal resection)
• Radiation therapy (XRT): 30 Gray to primary tumor and pelvic and inguinal nodes
• Mitomycin is given on day 1 of XRT
• Two 4-day infusions of 5-fluorouracil (5-FU) given on day 1 and day 28 of chemoradiation therapy
• Cisplatin may be used in place of mitomycin
• Recurrence of disease
• Metastatic disease
• Tumor size is best predictor
• Mobile lesions < 2 cm have cure rates of 80%
• Tumors > 5 cm associated with 50% mortality
• Metastatic disease more likely to be present with increasing depth of invasion, size, and histologic grade
• Lymph node disease at presentation is poor prognostic indicator
• 40% ...
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