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INTRODUCTION

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Epidemiology

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Epidemiology
Incidence: 7,210 (male: 2,660; female: 4,550. Estimated new cases for 2014 in the United States) Stage at Presentation
1.5 per 100,000 male per year, 1.9 per 100,000 female Stages I/II: 50%
Deaths: Estimated 950 in 2014 (male: 370; female: 580) Stage III: 29–40%
Median age at diagnosis: 60 years Stage IV: 10–13%
Male to female ratio: Slight female predominance    

Daling JR et al. J Natl Cancer Inst 2000;92:1500–1510

Fred Hutchinson Cancer Research Center, Changing Trends in Sexual Behavior May Explain Rising Incidence of Anal Cancer Among American Men and Women. Fred Hutchinson Cancer Research Center (fhcrc.org). 2004-07-06. Retrieved 2010-04

Frisch M et al. Gynecol Oncol 2009;114:395–398

Maggard MA et al. Dis Colon Rectum 2003;46:1517–1523; discussion 1523–1524; author reply 1524

Ryan DP et al. Int J Cancer 2010;127:675–684

Ryan DP et al. N Engl J Med 2000;342:792–800

Siegel R et al. CA Cancer J Clin 2014;64:9–29

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov (accessed in 2013)

Uronis HE and Bendell JC. Oncologist 2007;12:524–534

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Work-up

All stages

  1. Sigmoidoscopy with biopsy

  2. CT scan of abdomen and pelvis, or MRI

  3. Chest x-ray or chest CT

  4. Consider HIV testing

  5. Consider PET-CT scan

  6. Gynecologic exam for women, including screening for cervical cancer

 

Positive inguinal lymph node on imaging

  1. Fine-needle aspiration or biopsy of node

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Pathology

By convention, anal cancer should now refer only to squamous cell cancers arising in the anus. Earlier surgical series often did not make this distinction. Adenocarcinomas occurring in the anal canal should be treated according to the same principles applied to rectal adenocarcinoma. Similarly, melanomas and sarcomas should be treated according to the same principles applied to those tumor types at other sites

The distal anal canal is lined by squamous epithelium, and tumors arising in this portion are often keratinizing. Around the dentate line, the mucosa transitions from squamous mucosa to the nonsquamous rectal mucosa. Tumors arising in this transitional zone are often nonkeratinizing and previously were referred to as basaloid or cloacogenic

 

Clark MA et al. Lancet Oncol 2004;5:149–157

Ryan DP et al. N Engl J Med 2000;342:792–800

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Five-Year Survival (After Chemoradiation)

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Stages I/II: 80%
Stage III: 60%
Stage IV: 30.5%

 

Howlader N et al., eds. SEER Cancer Statistics Review, 1975–2008. Bethesda, MD: National Cancer Institute, http://seer.cancer.gov/csr/1975_2008/, based on November 2010 SEER data submission, posted to the SEER website, 2011

 

Poor Prognostic Factors

  1. Nodal involvement

  2. Skin ulceration

  3. Male gender

  4. Tumor >5 cm

 

Bartelink F et al. J Clin Oncol 1997;15:2040–2049

Comments: Highlights of Gastrointestinal Cancer Research 1999;3:539–552

Gunderson LL et al. Proc Am Soc Clin Oncol 2011;29:257s [abstract 4005]

UKCCR (UK Co-ordinating Committee on Cancer Research). Lancet 1996;348:1049–1054

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Staging

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