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Epidemiology
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
Sigmoidoscopy with biopsy
CT scan of abdomen and pelvis, or MRI
Chest x-ray or chest CT
Consider HIV testing
Consider PET-CT scan
Gynecologic exam for women, including screening for cervical cancer
Positive inguinal lymph node on imaging
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)
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
Nodal involvement
Skin ulceration
Male gender
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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