Multidisciplinary Oncology Conference Sinai Hospital Anal Cancer

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Multidisciplinary Oncology ConferenceSinai
Hospital Anal Cancer

• May 23, 2006
• Vanita Ahuja, PGY4

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DM

• 87 yo previously healthy male with fecal
  incontinence and change in bowel habits for one
  month
• On PE, bulky 5X5 cm anal canal tumor invading
  sphincter
• PMH skin cancer
• SH Lives independently
• Biopsy Infiltrating moderately differentiated
  squamous cell carcinoma
• EUS, Mediport placement, diverting loop colostomy
• Discharged home on POD5
• Radiation oncology follow-up
• Stage T3N0M0

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Epidemiology

• Relatively rare
• 3,500 cases of anal canal tumors reported in 2000
• Increasing incidence in younger men
• Changes in lifestyle
• Anal receptive intercourse
• HPV or HIV infection

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Anatomy
Anal Canal
5 cm
Anal Margin
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Anal Canal Tumors

• Epidermold Carcinoma
• Squamous
• Basaloid
• Mucoepidermoid
• Melanoma
• Adenocarcinoma
• Sarcoma

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Management

• Nigro Protocol (1974)
• Based on external beam radiation, with concurrent
  bolus mitomycin-C (MMC)
• Modified Nigro Protocol
• Cispatin-based combined modality therapy
• Surgical therapy
• Tumors
• Salvage therapy

MD Anderson, 2003, American Cancer Society
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Anal Margin Lesions

• Bowens Disease (anal intraepithelial
  neoplasia)
• Pagets Disease (see figure A)