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Work-up
All stages
Digital rectal examination, sigmoidoscopy with biopsy
CT scan of chest and abdomen with IV and oral contrast, pelvic CT or MRI with contrast
Consider HIV testing and CD4 level if indicated
Consider PET-CT scan
Gynecologic exam for women, including screening for cervical cancer
NCCN Guidelines Version 2.2017 Anal Carcinoma
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 Relative Survival
Poor Prognostic Factors
Nodal involvement
Skin ulceration
Male gender
Tumor >5 cm
HPV negative and/or p16 negative
Ajani JA et al. JAMA 2008;299:1914–1921
Bartelink H et al. J Clin Oncol 1997;15:2040–2049
Glynne-Jones R et al. Cancer 2013;119:748–755
Rodel F et al. Int J Cancer 2015;136:278–288
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