Skip to main content
SpringerLink
Log in

Anal Cancer

  • Chapter
  • First Online:
Handbook of Evidence-Based Radiation Oncology

Abstract

5,070 new cases in 2008 with increasing incidence over the last three decades. Majority are SCC (75–80%); others are adenocarcinoma or melanoma. HPV: strongly associated with SCC and may be requisite for disease formation. High-grade intraepithelial lesions are precursors. In particular HPV-16, 18 as in cervical cancer. AIDS is associated with anal cancer, likely through an association with immunodeficiency in the setting of HPV coinfection. Increased risk if CD4 < 200. Additional Risk Factors: > 10 sexual partners, history of anal warts, history of anal intercourse < age 30 or with multiple partners, history of STDs. Anatomy: anal canal is 3–4 cm long. Extends from anal verge to the anorectal ring. The dentate line lies within the anal canal and divides it by histology. Proximal to the dentate line is colorectal mucosa, distal to it is nonkeratinizing squamous epithelium. The dentate line contains transitional mucosa. Anal margin is 5 cm ring of skin around the anus. Use CT to measure depth of inguinal nodes using the femoral vessels as a surrogate: large variations exist (Koh et al. 1993). Anal margin tumors: may behave like skin cancers, and can be treated as skin cancer as long as there is no involvement of the anal sphincter, tumor < 2 cm, moderately or well-differentiated. Adenocarcinoma: higher local and distant recurrence rates with chemo-RT compared to SCC. Use 5-FU chemo-RT pre-op followed by APR (Papagikos et al. 2003). Lymph node drainage: superiorly (above dentate line) along hemorrhoidal vessels to perirectal and internal iliac nodes; inferior canal (below dentate line) and anal verge to inguinal nodes. Presentation: bleeding, anal discomfort, pruritis, rectal urgency.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 49.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Ajani JA, Winter KA, Gunderson LL, et al. Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a Randomized Controlled Trial. JAMA 2008;299(16):1914-1921.

    Article  PubMed  CAS  Google Scholar 

  • Bartelink H, Roelofsen F, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase iii randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol 1997;15:2040-2049.

    PubMed  CAS  Google Scholar 

  • Cotter SE, Grigsby PW, Siegel BA, et al. FDG-PET/CT in the evaluation of anal carcinoma. Int J Radiat Oncol Biol Phys 2006;65:720-725.

    Article  PubMed  Google Scholar 

  • Cummings BJ, Keane TJ, O’Sullivan B, et al. Epidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin-c. Int J Radiat Oncol Biol Phys 1991;21(5):1115-1125.

    Article  PubMed  CAS  Google Scholar 

  • Ellenhorn JDI, Enker WE, Quan SH. Salvage abdominoperineal resection following combined chemotherapy and radiotherapy for epidermoid carcinoma of the anus. Ann Surg Oncol 1994;1:105-110.

    Article  PubMed  CAS  Google Scholar 

  • Flam M, Madhu J, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a Phase III Randomized Intergroup Study. J Clin Oncol 1996;14:2527-2539.

    PubMed  CAS  Google Scholar 

  • Gerard JP, Ayzac L, et al. Treatment of anal canal carcinoma with high dose radiation therapy and concomitant fluorouracil-cisplatinum. Long-term results in 95 patients. Radiother Oncol 1998;46(3):249-256.

    Article  CAS  Google Scholar 

  • Glynne-Jones R, Meadows H, Wan S, et al. Extra – a multicenter phase ii study of chemoradiation using a 5 day per week oral regimen of capecitabine and intravenous mitomycin c in anal cancer. Int J Radiat Oncol Biol Phys 2008;72(1):119-126.

    Article  PubMed  CAS  Google Scholar 

  • Greenall MJ, Quan HQ, Decosse JJ. Epidermoid cancer of the anus. Br J Surg 1985;72:S97.

    Article  PubMed  Google Scholar 

  • Hatfield P, Cooper R, Sebag-Montefiore D. involved-field, low-dose chemoradiotherapy for ­early-stage anal carcinoma. Int J Radiat Oncol Biol Phys 2008;70(2):419-424.

    Article  PubMed  CAS  Google Scholar 

  • Hoffman R, Welton ML, et al. The significance of pretreatment CD4 count on the outcome and treatment tolerance of HIV-positive patients with anal cancer. Int J Radiat Oncol Biol Phys 1999;44:127-131.

    Article  PubMed  CAS  Google Scholar 

  • James R, Wan S, Glynne-Jones D, et al. A randomized trial of chemoradiation using mitomycin or cisplatin, with or without maintenance cisplatin/5FU in squamous cell carcinoma of the anus (ACT II). Abstract LBA4009. Presented at ASCO annual meeting, May 30, 2009.

    Google Scholar 

  • John M, Pajak T, et al. Dose escalation in chemoradiation for anal cancer: preliminary results of RTOG 92-08. Cancer J Sci Am 1996;2(4):205.

    PubMed  CAS  Google Scholar 

  • Koh WJ, Chiu M, Stelzer KJ, et al. Femoral vessel depth and the implications for groin node radiation. Int J Radiat Oncol Biol Phys 1993;27:969-974.

    Article  PubMed  CAS  Google Scholar 

  • Martenson JA, Gunderson LL. External radiation therapy without chemotherapy in the management of anal cancer. Cancer 1993;71(5):1736-1740.

    Article  PubMed  Google Scholar 

  • Meropol NJ, Niedzwiecki D, Shank B, et al. Induction therapy for poor-prognosis anal canal carcinoma: a Phase II Study of the Cancer and Leukemia Group B (CALGB 9281). J Clin Oncol 2008;26(19):3229-3234.

    Article  PubMed  CAS  Google Scholar 

  • Milano MT, Jani AB, Farrey KJ, et al. Intensity-modulated radiation therapy (IMRT) in the treatment of anal cancer: toxicity and clinical outcome. Int J Radiat Biol Phys 2005;63:354-361.

    Article  Google Scholar 

  • Myerson RJ, et al. Elective clinical target volumes for conformal therapy in anorectal cancer: an Radiation Therapy Oncology Group consensus panel contouring atlas. Int J Radiat Oncol Biol Phys 2008;74:824-830.

    Article  PubMed  Google Scholar 

  • Ng Y, Ying Kin NY, Pigneux J, et al. Our experience of conservative treatment of anal cancal carcinoma combining external irradiation and interstitial implants. Int J Radiat Oncol Biol Phys 1988;14:253-259.

    Google Scholar 

  • Papagikos M, Crane CH, et al. Chemoradiation for adenocarcinoma of the anus. Int J Radiat Oncol Biol Phys 2003;55:669-678.

    Article  PubMed  Google Scholar 

  • Salama JK, Mell LK, Schomas DA, et al. Concurrent chemotherapy and intensity-modulated radiation therapy for anal canal cancer patients: a multicenter experience. J Clin Oncol 2007;29:4851-4856.

    Google Scholar 

  • Sandhu APS, Symonds RP, et al. Interstitial Iridium-192 implantation combined with external radiotherapy in anal cancer: ten years experience. Int J Radiat Oncol Biol Phys 1998;40:575-581.

    Article  PubMed  CAS  Google Scholar 

  • Schwarz JK, Siegel BA, Dehdashti F, et al. Tumor response and survival predicted by post-therapy FDG-PET/CT in anal cancer. Int J Radiat Oncol Biol Phys 2008;71(1):180-186.

    Article  PubMed  Google Scholar 

  • Trautmann TG, Zuger JH. Positron emission tomography for pretreatment staging and post-treatment evaluation in cancer of the anal canal. Mol Imaging Biol 2005;7:309-313.

    Article  PubMed  Google Scholar 

  • UKCCCR Anal Cancer Trial Working Party. Epidermoid anal cancer: results from the UKCCCR randomized trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. Lancet 1996;348:1049-1054.

    Article  Google Scholar 

Further Reading

  • Boman BM, Moertel CG, et al. Carcinoma of the anal canal. A clinical and pathological study of 188 cases. Cancer 1984;54:114-125.

    CAS  Google Scholar 

  • Janjan NA, Ballo MT et al. The Anal Region. In: Cox JD, Ang KK, editors. Radiation oncology: rationale, technique, results. 8th ed. St. Louis: Mosby; 2003. 537-556.

    Google Scholar 

  • Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin 2008;52(2):71-96.

    Article  Google Scholar 

  • Minsky BD. Cancer of the Anal Canal. In: Leibel SA, Phillips TL, editors. Textbook of radiation oncology. 2nd ed. Philadelphia: Saunders; 2004. 913-922.

    Google Scholar 

  • Papillon J, Montbarbon JF. Epidermoid carcinoma of the anal canal. A Series of 276 cases. Dis Colon Rectum 1987;30:324-333.

    Article  CAS  Google Scholar 

  • Peiffert D, Bey P, Pernot M, et al. Conservative treatment by irradiation of epidermoid carcinomas of the anal margin. Int J Radiat Oncol Biol Phys 1997;39:57-66.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgement

We thank Richard M. Krieg for his valuable advice in the preparation of this chapter.

Author information

Authors and Affiliations

  1. Radiation Oncology, Kaiser Permanente, San Francisco, CA, USA

    Amy Gillis MD

  2. Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada

    Hans T. Chung MD

  3. Radiation Oncology, University of California San Francisco, San Francisco, CA, USA

    Gautam Prasad MD, PhD

Authors
  1. Amy Gillis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hans T. Chung MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gautam Prasad MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Div. Radiation Oncology, Oregon Clinic, SW. Barnes Rd. 9205, Portland, 97225, Oregon, USA

    Eric K. Hansen

  2. Department of Radiation Oncology, University of California, San Francisco, Divisadero Street, Suite H-1031 1600, San Francisco, 94143, California, USA

    Mack Roach

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag New York

About this chapter

Cite this chapter

Gillis, A., Chung, H.T., Prasad, G. (2010). Anal Cancer. In: Hansen, E., Roach, M. (eds) Handbook of Evidence-Based Radiation Oncology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92988-0_23

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-92988-0_23

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-92987-3

  • Online ISBN: 978-0-387-92988-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation