Anal Canal Tumors Research Articles

Significance of lateral lymph node dissection in squamous cell carcinoma of the anal canal: a retrospective cohort study.

The JCOG (Japan Clinical Oncology Group) 0212 study did not confirm the noninferiority of mesorectal excision (ME) alone to ME with LLND for rectal or anal adenocarcinomas. Furthermore, the significance of LLND for SCCs remains unknown. We evaluated the significance of lateral lymph node dissection (LLND) of squamous cell carcinoma (SCC) of the anal canal. This retrospective cohort study was conducted in 435 patients with SCCs among 1,781 patients with anal canal tumors. In 40 patients who underwent LLND, the 5-year relapse-free survival (5y-RFS) and 5-year overall survival (5y-OS) were compared between groups with positive and negative histopathological findings. In 71 patients with negative lateral lymph node metastasis in the preoperative diagnosis, the 5y-RFS, 5y-OS, and 5-year local recurrence-free survival were compared between patients who did and did not undergo LLND. The clinical and pathological T stages predicted pathological lateral pelvic lymph node metastasis. There was no statistically significant difference in 5y-RFS and 5y-OS between patients who did and did not undergo LLND. Among patients who underwent LLND, 5y-RFS in those with positive histopathological findings (15.0%) was worse than that in those without (59.2%) (p = 0.002). In patients who underwent LLND, 5y-RFS in those with positive histopathological findings than in those without LLND did not contribute to prognosis.

Nodal Elective Volume Selection and Definition during Radiation Therapy for Early Stage (T1-T2 N0 M0) Perianal Squamous Cell Carcinoma: A Narrative Clinical Review and Critical Appraisal.

Distinction between anal canal and perianal squamous cell carcinomas (pSCCs) is essential, as these two subgroups have different anatomical, histological, and lymphatic drainage features. Early-stage true perianal tumors are very uncommon and have been rarely included in clinical trials. Perianal skin cancers and aCCs are included in the same tumor classification, even though they have different lymphatic drainage features. Furthermore, pSCCs are treated similarly to carcinomas originating from the anal canal. Radiation therapy (RT) is an essential treatment for anal canal tumors. Guidelines do not differentiate between treatment volumes for perianal tumors and anal cancers. So far, in pSCC, no study has considered modulating treatment volume selection according to the stage of the disease. We conducted a narrative literature review to describe the sites at higher risk for microscopic disease in patients with early-stage perianal cancers (T1-T2 N0 M0) to propose a well-thought selection of RT elective volumes.

ПРИМЕНЕНИЕ АУТОЛОГИЧНОЙ МИКРОФРАГМЕНТИРОВАННОЙ АДИПОЗНОЙ ТКАНИ В ЛЕЧЕНИИ ПОСТЛУЧЕВОГО ЯЗВЕННОГО ПРОКТИТА

Abstract. Introduction. Radiation-induced ulcerative proctitis is a serious complication of cancer radiotherapy for prostate, cervix, uterine body, anal canal, and other pelvic tumors. Given the development pattern, there are currently no pathogenetic methods for the treatment of radiation-induced ulcerative proctitis. Aim: To develop a technique for and evaluate its effectiveness in the treatment of patients with radiation-induced rectal ulcers using autologous microfragmented adipose tissue. Materials and Methods. The study included 30 patients, of which 24 (80.0%) were women and 6 (20.0%) were men. Manual lipoaspiration was used to obtain autologous adipose tissue. Then we performed its microfragmentation via transfers. Concentrated autologous adipose tissue was introduced into the edges of the radiation-induced ulcerative defect on the rectal wall under endoscopic control. При контрольной ректоскопии через 6 месяцев у 28 (93,3 %) пациентов была отмечена полная эпителизация постлучевых язвенных дефек- тов прямой кишки. Results and Discussion. The manipulation, from sampling the adipose tissue through the end of injection lasted a little more than an hour (Me = 75.0 min). No intraoperative complications were detected. In one female patient (3.3%), a local recurrence of cervical cancer was found, and therefore that patient was excluded from the study. Control rectoscopy showed the complete epithelialization of post-radiation ulcerative rectal defects in 28 (93.3%) patients after 6 months. Conclusions. The technique proposed to use autologous microfragmented adipose tissue is affordable and effective in the treatment of patients with radiation-induced ulcerative proctitis.

ПРИМЕНЕНИЕ АУТОЛОГИЧНОЙ МИКРОФРАГМЕНТИРОВАННОЙ АДИПОЗНОЙ ТКАНИ В ЛЕЧЕНИИ ПОСТЛУЧЕВОГО ЯЗВЕННОГО ПРОКТИТА

Introduction. Post-radiation ulcerative proctitis is a serious complication after radiotherapy for cancer of the prostate, cervix and uterine body, anal canal, and other pelvic tumors. Given the mechanism of occurrence, there are currently no pathogenetic methods for the treatment of post-radiation ulcerative proctitis. Aim. Is to develop a technique and evaluate its effectiveness in the treatment of patients with post-radiation rectal ulcers using autologous microfragmented adipose tissue. Material and methods. The study included 30 patients, of which 24 (80.0% were women and 6 (20.0%) were men. Manual lipoaspiration was used to obtain autologous adipose tissue. Then, microfragmentation was performed through transfers. The introduction of autologous concentrated adipose tissue was performed in edges of post-radiation ulcerative defect of the rectal wall under endoscopic control. Results and discussion. The duration of the manipulation from the moment of adipose tissue sampling to the end of the injection was a little more than an hour (Me = 75.0 min). No intraoperative complications were identified. One patient (3.3%) had a local recurrence of cervical cancer, and therefore the patient was excluded from the study. Control rectoscopy after 6 months in 28 (93.3%) patients showed complete epithelialization of post-radiation ulcerative defects of the rectum. Conclusion. The technique of using autologous microfragmented adipose tissue is affordable and effective in the treatment of patients with post-radiation ulcerative proctitis

Radiodermatitis: severity, predictive factors and discontinuation of radiotherapy in patients with anal and rectal cancer.

to determine the prevalence of radiodermatitis, severity grades and predictive factors of its occurrence in patients with anal and rectal cancer followed up by the nursing consultation, and to analyze the association of severity grades of radiodermatitis with temporary radiotherapy interruption. a quantitative, cross-sectional and retrospective study, carried out with 112 medical records of patients with anal and rectal cancer undergoing curative radiotherapy followed up in the nursing consultation. Data were collected using a form and analyzed using analytical and inferential statistics. 99.1% of patients had radiodermatitis, 34.8% of which were severe. The predictive factors were female sex, age greater than 65 years, anal canal tumor, treatment with cobalt device and IMRT technique. Treatment interruption occurred in 13% of patients, associated with severe radiodermatitis. there was a high prevalence of radiodermatitis, mainly severe, which resulted in treatment interruption.

Anorectal Melanoma-Brownish Black Mass Not Always a Hemorrhoid.

The non-specific clinical symptoms of anorectal brownish-black mass do not help to differentiate colorectal cancer, hemorrhoids, rectal ulcers which result in a delayed diagnosis or lead to inadequate management of lethal anorectal melanoma. Primary malignant melanoma of the anorectal region is an uncommon tumor, constituting approximately 1% of anal canal tumors which may be misdiagnosed clinically as hemorrhoids. Because of aggressive behavior and poor prognosis, efficient and prompt diagnosis is required in these cases. We report 2 cases of this rare tumor.

Patterns of pathologic lymph nodes in anal cancer: a PET-CT-based analysis with implications for radiotherapy treatment volumes

BackgroundThis study investigates the patterns of PET-positive lymph nodes (LNs) in anal cancer. The aim was to provide information that could inform future anal cancer radiotherapy contouring guidelines.MethodsThe baseline [18F]-FDG PET-CTs of 190 consecutive anal cancer patients were retrospectively assessed. LNs with a Deauville score (DS) of ≥3 were defined as PET-positive. Each PET-positive LN was allocated to a LN region and a LN sub-region; they were then mapped on a standard anatomy reference CT. The association between primary tumor localization and PET-positive LNs in different regions were analyzed.ResultsPET-positive LNs (n = 412) were identified in 103 of 190 patients (54%). Compared to anal canal tumors with extension into the rectum, anal canal tumors with perianal extension more often had inguinal (P < 0.001) and less often perirectal (P < 0.001) and internal iliac (P < 0.001) PET-positive LNs. Forty-two patients had PET-positive LNs confined to a solitary region, corresponding to first echelon nodes. The most common solitary LN region was inguinal (25 of 42; 60%) followed by perirectal (26%), internal iliac (10%), and external iliac (2%). No PET-positive LNs were identified in the ischiorectal fossa or in the inguinal area located posterolateral to deep vessels. Skip metastases above the bottom of the sacroiliac joint were quite rare. Most external iliac PET-positive LNs were located posterior to the external iliac vein; only one was located in the lateral external iliac sub-region.ConclusionsThe results support some specific modifications to the elective clinical target volume (CTV) in anal cancer. These changes would lead to reduced volumes of normal tissue being irradiated, which could contribute to a reduction in radiation side-effects.

Prognostic role of ultrasonography staging in patients with anal cancer.

BACKGROUNDCarcinomas of the anal canal are staged according to the size and extent of the disease; however, we propose including a novel ultrasound (US) staging system, based on depth of tumor invasion. In this study the clinical American Joint Committee on Cancer (AJCC) staging guidelines and the US classificationss in patients with anal cancer were compared.AIMTo evaluate the prognostic role of the US staging system in patients with anal cancer.METHODSThe data of 48 patients with anal canal squamous cells carcinoma, observed at our University Hospital between 2007 and 2017, who underwent pre-treatment assessment with pelvic magnetic resonance imaging (MRI), total body computed tomography (CT) scan and endoanal US were retrospectively reviewed. Anal canal tumors were clinically staged according to AJCC, determined by MRI by measurement of the longest tumor diameter, and CT scan. Endoanal US was performed with a high multi-frequency (9-16 MHz), 360° rotational mechanical probe; US classification was based on depth of tumor penetration through the anal wall, according to Giovannini’s study. All patients were treated with definitive radiation combined with 5-fluorouracile and Mitomycin-C. After treatment patients were followed-up regularly.RESULTSAt baseline there were 30 and 32 T1-2, 18 and 16 T3-4, 31 and 19 N+ patients classified according to the clinical AJCC and US staging system respectively. After a mean follow-up of 98 months, 38 patients (79.1%) are alive and 28 (58.3%) are disease free. During follow up 20 patients (41.6%) experienced recurrences. After univariate analysis, American Society of Anesthesiologists (ASA) score (P = 0.00000001) and US staging (P = 0.009) were significantly related to disease-free survival (DFS). When overall survival and DFS functions were compared, a statistically significant difference was observed for DFS survival when the US staging was applied with respect to the clinical AJCC staging. By combining the 2 significant prognostic variables, namely the US staging with the ASA score, four risks groups with different prognoses were identified.CONCLUSIONOur findings suggest that US staging may be superior to traditional clinical staging, since it is significantly associated with DFS in anal cancer patients.

Epidemiological and prognostic single center study of anal carcinoma

BackgroundAnorectal carcinoma includes the anal margin, the anal canal, and the lower rectum. The incidences of anal tumors represent 1.4 % of all gastrointestinal tumors. Patients and methodsOur study is retrospective and was conducted at Baghdad Medical City. Patient’s data were collected from the medical records through a predesigned sheet that included the following information: demographic data, medical history, past-history, presenting symptoms, pathological data, and treatment details. ResultsThe median age was 49 years. As regard tumor extension, 85.71 % of patients had anal disease, while anorectal cancer was encountered in 14.28 % of cases only. Male to female ratio was 1:3. Most of cases were SCC 78.57 %. Only 11 patients (39.28 %) were diagnosed as Stage I, whereas 12 patients (42.85 %) had Stage II-III disease. Moderate differentiated tumors are the most common. The tumor mass located between 5–10cm das a distance from anal verge in 12 (42.85 %) of patients. We found 6 (21.42 %) patients with positive virology tests with no specificity detected. APR was the mainstay for treatment of stage I disease. Neoadjuvant treatment followed by TME resection was the treatment found in locally advanced tumors. The mean Overall Survival (OS) for patients received neoadjuvant CRT in the study was 43.5 months, while, the mean OS was 45.73 months in the adjuvant setting. Univariate analysis for OS according to prognostic factors revealed that sites of cancer, grades and histopathology were significant independent prognostic factors for OS in this study. The anal canal tumor was associated with shorter OS (33.25) months in comparison to the anorectal cancer (OS=47.22 months). Based on tumor grade, well and moderate differentiation have better OS (60.21 months) while, poorly grade was associated with shorter OS (43.07 months). On the concern of SCC, it was associated with shorter OS (37 months) in comparison to higher survival in patients with adenocarcinoma (46.13 months). ConclusionAnal canal cancer has poorer prognosis than anorectal. The early-stage has a better OS that needs more effort for early diagnosis and treatment.

Is Local Resection of Anal Canal Tumors Feasible with Transanal Endoscopic Surgery?

An important drawback of local surgery for lesions in the anal canal is the difficulty of achieving en bloc full-thickness resections. The aim of this study is to evaluate TEM/TEO in lesions of this type from the point of view of morbidity, mortality and the quality of the pathology specimen. This is an observational study with prospective data collection from June 2004 to July 2018. Two groups are defined: group A (rectal tumors with proximal margin between 0 and ≤4cm from anal verge) and group B (distal margin > 4cm from anal verge). A technical description is provided; resections and postoperative complications in both groups are compared. During the study period, 757 patients underwent TEM/TEO. Finally, 692 patients were included, 192 patients in group A and 500 patients in group B. An en bloc surgical specimen was obtained in 176/192 patients (91.7%), although the defect was completely sutured in 132 (68.8%). In the comparative analysis, group A did not present significantly greater fragmentation of the resected piece [16/192 (8.3%) vs. 36/500 (7.2%), p = 0.630], although group A was associated with greater involvement of the surgical margin [28/192 (14.6%), 32/500 (6.4%), p = 0.001] and clinically relevant morbidity [16/192 (8.3%), 20/500 (4%), p = 0.034]. There was no mortality. The use of TEM/TEO to remove lesions originating in the anal canal is feasible. But we have to take into account that there is an increase in complications, technical difficulties and affected margins resection.

538P - Planned organ preservation for T2 T3 M0 rectal adenocarcinoma: A possible option using chemoradiotherapy (CRT) and contact X-ray brachytherapy (CXB). A French multicenter study

BackgroundStandard treatment for T2-3 M0 rectal adenocarcinoma is rectal resection (TME) often combined with neoadjuvant CRT. If a clinical complete response (cCR) is achieved a “watch and wait” (or local excision) is a possible option to improve quality of life. The Lyon R96-02 phase III trial has demonstrated that adding a CXB boost to CRT was able to increase safely the chance of cCR (1). Since the manufacture in 2010 of the PapillonTM CXB machine, this strategy has seen a renaissance. MethodsBetween 2003 and 2016, 74 patients M0 have been treated in 3 French centres (Lyon, Mâcon, Nice). Median age was 74 years. Classification was done using MRI and/or Endorectal ultrasound. T2: 45, T3: 29. CRT was: CAP 50 (capecitabine: 800mg/m2 BID + RT: 50Gy/ 25 fr/5 weeks). CXB delivered a local boost of 90-110Gy in3-4 fractions over 4-6 weeks either before or after CRT. The boost was given first if T<3.5cm in diameter. Close surveillance was every 3 months using Digital rectal examination, endoscopy and MRI. ResultsOut of 74 patients with a median follow-up time of 40 months, the cCR rate at 6 months (after treatment initiation) was 95%. The 3-year local recurrence rate and specific cancer survival were respectively 10% and 88%. Organ preservation was seen in 95% with a good bowel function in 90% of cases. Among 6 patients with local recurrence none was seen for polypoid T2T3a < 3.5cm in diameter. For tumor treated using CXB first (42 pts) a cCR was observed at week 4 in 67% and at 3 month in 95% of cases (vs 75% at 3 months for CXB given after CRT) (2). ConclusionsA possible option for T2 T3 a-b < 5cm is organ preservation combining CRT and CXB. For polypoid lesions < 3.5cm treated using CXB first the chance of cCR at 3 months and long term rectal preservation are above 85%. In such selected patients, a “planned” organ preservation can be proposed from the start as it is presently for SCC anal canal tumors. The ongoing OPERA phase III trial is testing this proposal.

Anal canal adenocarcinoma with neuroendocrine features accompanying secondary extramammary Paget disease, successfully treated with modified FOLFOX6: a case report

BackgroundAnal canal cancer occasionally accompanies extramammary Paget disease. Although most of them are squamous cell carcinoma, anal canal adenocarcinoma with neuroendocrine features accompanying secondary extramammary Paget disease has never been reported.Case presentationHere, we report a 76-year-old man presented with pruritus in the perianal area. Investigation revealed a fist-sized perianal erythema, diffuse liver tumors, and right inguinal lymph node swelling. Pathological examination of biopsies from the erythema suggested secondary extramammary Paget disease with positive cytokeratin-7 and -20 expressions and negative GCDFP-15 expression. The anal canal tumor was confirmed by digital examination and endoscopy. Biopsies from the anal canal tumor, swollen lymph node, and Paget lesion all showed poorly differentiated adenocarcinoma with neuroendocrine features expressing synaptophysin and chromogranin A. Serum CEA and NSE levels were high, 809.4 ng/ml and 85.8 ng/ml, respectively. After chemotherapy with modified FOLFOX6 for 2 months, the Paget lesion disappeared, and the primary anal canal tumor and liver metastases shrunk remarkably. Serum CEA and NSE levels decreased promptly to within normal ranges.ConclusionsThis is a clinically significant case, as it reveals novel pathological features about anal canal cancer with secondary Paget disease and successfully treated with modified FOLFOX6. Careful pathological investigation and appropriate treatment choice are needed for this rare cancer.

So Now My Patient Has Squamous Cell Cancer: Diagnosis, Staging, and Treatment of Squamous Cell Carcinoma of the Anal Canal and Anal Margin.

Squamous cell carcinomas of the anal canal and the anal margin are rare malignancies that are increasing in incidence. Patients with these tumors often experience delayed treatment due to delay in diagnosis or misdiagnosis of the condition. Distinguishing between anal canal and anal margin tumors has implications for staging and treatment. Chemoradiation therapy is the mainstay of treatment for anal canal squamous cell, with abdominoperineal resection reserved for salvage treatment in cases of persistent or recurrent disease. Early anal margin squamous cell carcinoma can be treated with wide local excision, but more advanced tumors require a combination of chemoradiation therapy and surgical excision.

Extended pelvic resection for rectal and anal canal tumors is a significant risk factor for perineal wound infection: a retrospective cohort study.

Perineal wound infection (PWI) rates are high after abdominoperineal resection (APR) and total pelvic exenteration (TPE). This study identified risk factors for PWI after surgery for anorectal tumors and examined the relationship between the surgical excision volume with the PWI degree. A retrospective review involving 135 patients who underwent surgical excision of anorectal tumors was performed. Superficial PWI included cellulitis and superficial dehiscence; deep PWI included major dehiscence, perineal abscess, and presacral abscess. The adjacent organ resection type was classified according to the dead space size formed by surgical excision. Of the 135 patients, 119 underwent APR, and 16 underwent TPE. PWI occurred in 75 patients (superficial PWI, 44; deep PWI, 31). Adjacent organ resection was an independent risk factor for PWI. The cases with adjacent organ resection were classified into small-defect APR, large-defect APR, and TPE. Large-defect APR and TPE cases had significantly higher rates of deep PWI than APR cases without adjacent organ resection. Adjacent organ resection involving the removal of one or more organs and that involving wide-range muscle resection are strong risk factors for deep PWI.

Proteomic signatures reveal a dualistic and clinically relevant classification of anal canal carcinoma.

Aetiologically linked to HPV infection, malignancies of the anal canal have substantially increased in incidence over the last 20 years. Although most anal squamous cell carcinomas (SCCs) respond well to chemoradiotherapy, about 30% of patients experience a poor outcome, for undetermined reasons. Despite cumulative efforts for discovering independent predictors of overall survival, both nodal status and tumour size are still the only reliable factors predicting patient outcome. Recent efforts have revealed that the biology of HPV-related lesions in the cervix is strongly linked to the originally infected cell population. To address the hypothesis that topography also influences both gene expression profile and behaviour of anal (pre)neoplastic lesions, we correlated both proteomic signatures and clinicopathological features of tumours arising from two distinct portions of the anal canal: the lower part (squamous zone) and the more proximal anal transitional zone. Although microdissected cancer cells appeared indistinguishable by morphology (squamous phenotype), unsupervised clustering analysis of the whole proteome significantly highlighted the heterogeneity that exists within anal canal tumours. More importantly, two region-specific subtypes of SCC were revealed. The expression profile (sensitivity/specificity) of several selected biomarkers (keratin filaments) further confirmed the subclassification of anal (pre)cancers based on their cellular origin. Less commonly detected compared to their counterparts located in the squamous mucosa, SCCs originating in the transitional zone more frequently displayed a poor or basaloid differentiation, and were significantly correlated with reduced disease-free and overall survivals. Taken together, we present direct evidence that anal canal SCC comprises two distinct entities with different cells of origin, proteomic signatures, and survival rates. This study forms the basis for a dualistic classification of anal carcinoma, with implications for management, outcome expectations, and possibly therapy. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Tumors and Tumorlike Conditions of the Anal Canal and Perianal Region: MR Imaging Findings.

Tumors and tumorlike conditions of the anus and perianal region originate from the anal canal and anal margin or result from direct extension of tumors from adjacent organs. The anatomy of the anal canal is complex, and its different histologic characteristics can lead to diverse pathologic conditions. The anal canal extends from the anorectal junction to the anal verge. The World Health Organization classification of anal canal tumors includes (a) anal intraepithelial neoplasia, the precursor of squamous cell carcinoma (SCC), and (b) invasive tumors. Invasive tumors are further classified on the basis of cell type as epithelial tumors (SCC, adenocarcinoma, mucinous adenocarcinoma, small cell carcinoma, and undifferentiated carcinoma), nonepithelial tumors, carcinoid tumors, melanoma, and secondary tumors (direct spread from rectal, cervical, or prostate carcinoma). The anal margin, or perianal skin, lies outside the anal verge and encompasses a radius of 5 cm from the anal verge. Tumors in the anal margin are classified according to the World Health Organization classification of skin tumors. Anal margin tumors include SCC, anal intraepithelial neoplasia, also known as Bowen disease, adenocarcinoma and its precursor Paget disease, basal cell carcinoma, and verrucous carcinoma (Buschke-Löwenstein tumor), which is a rare variant of SCC. Imaging plays an important role in the evaluation, staging, and follow-up of patients with anal and perianal tumors. However, because of the overlap in imaging features among these diverse entities, a definitive diagnosis is best established at histopathologic examination. Nevertheless, familiarity with the pathogenesis, imaging features, and treatment of these tumors can aid radiologic diagnosis and guide appropriate patient treatment. (©)RSNA, 2016.

Chemoradiotherapy with Brachytherapy or Electron Therapy Boost for Locally Advanced Squamous Cell Carcinoma of the Anus\u2014Reducing the Colostomy Rate

PurposeThe aim of this study is to determine overall survival, disease-specific survival and stoma-free survival after treatment of squamous cell carcinoma of the anus with chemoradiotherapy followed by brachytherapy or electron boost in a recent cohort of patients.MethodsFifty-two patients (median age 62 years) were treated with radical chemoradiotherapy (mitomycin C, infusional 5-fluorouracil concurrently with conformal radical radiotherapy 45 Gy in 25 fractions over 5 weeks) followed by a radiotherapy boost between 1 December 2000 and 30 April 2011. Follow-up was to 30 November 2014. Thirty-six patients received a boost (15–20 Gy) over 2 days with 192Ir needle brachytherapy for anal canal tumours, and 16 patients received electron beam therapy (20 Gy in 10 fractions in 2 weeks) for anal margin tumours. A defunctioning stoma was only created prior to chemoradiotherapy for fistula or severe anal pain.ResultsThe overall survival for the 36 patients treated with chemoradiotherapy followed by brachytherapy was 75 % (95 % CI, 61–89) at 5 years, the disease-specific survival was 91 % (95 % CI, 81–101 %), and the stoma-free survival was 97 % (95 % CI, 91–103 %) all at 5 years. For the 16 patients treated with an electron boost for anal margin tumours, the 5-year overall survival, disease-specific survival and stoma-free survival were 68 % (95 % CI, 44–92 %), 78 % (95 % CI, 56–100 %) and 80 % (95 % CI, 60–100 %), respectively.ConclusionsA very low stoma formation rate can be obtained with radical chemoradiotherapy followed by a brachytherapy boost for squamous cell carcinoma of the anal canal but not with an electron boost for anal margin tumours.

Squamous cell carcinoma of the anal margin

Squamous cell carcinoma of the anal margin is a rare disease. Accurate clinical staging with physical exam and imaging is important and determines the treatment. Evidence-based management is challenging because there is a paucity of randomized controlled trials and existing literature seldom distinguishes between anal canal and margin tumors. In this article, we review the anatomy, presentation, classification, and clinical management of squamous cell carcinoma of the anal margin.

Second primary malignancies in anal carcinoma.

534 Background: Survival of cancer patients is increasing. Therefore, there is a need to evaluate long term complications in cancer survivors. There is no data on second primary malignancies in anal cancer. This study was conducted to evaluate second primary malignancies in patients with anal carcinoma. Methods: We selected adult patients diagnosed with anal cancer from National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) 13 database We calculated the risk of second primary malignancies in the anal cancer patients using multiple primary standardized incidence ratio (MP-SIR) session of SEER*stat software. Results: Among 7,661 patients with anal carcinoma, 3,196 were men and 4,465 were women. Median follow up duration was 87 months (range: 7-239 months). Median age at the time of diagnosis of SPM was 69.33 yrs (range: 34-103 yrs). Median latency for SPM was 52 months (range: 6-219 months). A total of 675 patients (9.07%) developed 747 second primary malignancies, with an observed/expected (O/E) ratio of 1.41 (95% confidence interval =1.32-1.52, p&lt;0.001), and an absolute excess risk of 55.36 per 10,000 populations. Significant excess risks were observed for oral cavity and pharyngeal tumor, rectal and anal canal tumor, laryngeal tumor, lung and bronchial cancer, Kaposi sarcoma, hematologic malignancies, ovarian, vaginal, and vulval tumors. Conclusions: The risk of second primary malignancies in adult patients with anal cancer is significantly increased compared to general population.

Su1249 Could Positron Emission Tomography Detect Colorectal Adenomas and Cancers?

Background: Fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDGPET) is frequently used in the diagnosis of tumors, including colorectal cancer (CRC). This study aimed to determine whether PET could be used to detect CRC and colorectal adenomas, with endoscopic and pathologic confirmation. Methods: The PET results were verified by colonoscopy. Patients who underwent total colonoscopy (TCS) and PET between October 2002 and September 2012 at a tertiary cancer center were evaluated. TCS and PET were performed independently within 1 year. Cases of diminutive polyps (1-5 mm) were not included. Advanced CRC was defined as tumor extending into the muscularis propria or deeper, corresponding to T2-T4 stages according to TNM classification. Early-stage CRC was defined as tumors invading within submucosal layer, corresponding to Tis and T1 stages. Excluding advanced CRC, lesions were classified according to morphology as flat, depressed, or protruded. PET and PET-CT images were reviewed by at least 2 board-certified radiologists. Focal FDG uptake was determined in each portion of the colon (cecum and ascending, transverse, descending, and sigmoid colon) and rectum. FDG uptake in a matched segment containing a lesion was defined as a true positive result. Cases with a previous history of colorectal resection, direct invasion or peritoneum dissemination of other cancers, hyperglycemia (>150 mg/dl), incomplete TCS, hereditary colon cancer, preceding therapy, and anal canal tumors were excluded. To clarify the detectability of adenoma and CRC, nonepithelial tumors were excluded. Results: We identified 2483 consecutive eligible patients. A total of 694 lesions, 6 mm or larger, were detected by TCS: 205 advanced CRCs, 132 earlystage CRCs, and 357 adenomas. Of the 694 lesions that were 6 mm or larger, 374 (53.9%) were PET positive. Of the 531 cases with positive FDG uptake, 374 (70.4%) had lesions detected in the matched segments. False positive, which was defined as no or trivial findings despite of significant FDG uptake, was 157 (29.6%). Sensitivities of PET for advanced CRC, early-stage CRC, and adenoma were 98%, 69%, and 23%, respectively. Table1 summarizes the sensitivities of PET stratified by tumor pathology and size. The increase in sensitivity correlated with lesion size and tumor grade. The sensitivity was nearly 50% for small (6-9 mm) early-stage CRCs. PET was able to detect approximately 40% of large adenomas (1019 mm in size); however, its sensitivity for small adenomas (6-9 mm) decreased to 10%. Regarding morphology, PET was significantly less sensitive for flat lesions than for depressed or protruded lesions (p < 0.001). Conclusions: The sensitivity of PET in diagnosis of CRC stratified by lesion size, pathology, and morphology was evaluated. PET had an acceptable sensitivity for early-stage CRCs and large adenomas. Table1. PET sensitivity stratified by lesion size and pathology