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Is anal cancer more prevalent in men or women?
What is the average age at diagnoses of anal cancer and there is an increased incidence in me <_____years of age attributed to __________.
60 years old, 45 years due to male homosexuality and anal intercourse.
Etiological factors of anal cancer include:
- genital warts
- genital infections
________% of large bowel cancers are anal cancer?
Clinical presentation of anal cancer includes:
- rectal bleeding
- change in bowel habits
- sensation of a mass
- rectal discharge
Detection and/or diagnosis of anal cancer is made through:
- physical exam
- anoscopy/and or proctoscopic exam
Once a diagnosis of anal cancer has been made, the extent of the disease is evaluated with:
The pathology os 80% of anal cancers is ________.
The dentate line is where the cells change from _____above the line and _______below the line. The _______are at the dentate line and are very important to save so that the patient will not have to have an ostomy(with a bag).
columnar, squamous, sphincters
Staging of anal cancer is with the ______ system and is based on size and ______ of invasion.Spread is by direct extension or _______. Above the dentate line lymphatic spread goes to the________ nodes. Below the dentate line lymphtic spread is to the ______ nodes.
- TNM, depth, lymphatics,
- internal iliac nodes
- inguinal nodes
Surgery for anal cancer is saved for _____or if chemo/radiation__________.
Treatment for anal cancer is combination of _____ and chemotherapy which includes_____ and _______.
- radiation therapy
- 5-FU, mitomycin C
RT treatment fields for anal cancer are ____ or ___field technique with ________to the ______nodes.
RT doses alone are _______ with shrinking fields to ______. Dose chemorads is ______ with shrinking fields to ________.
- AP/PA, 4 field technique, electrons to inguinal nodes
- 60-65 Gy /45 Gy
- 45 Gy / 5940-6940 cGy
Why are electrons used for the inguinal nodes?
Inguinal nodes are very superficial &photons are skin sparing (unless flashing). Electrons, however, deposit there energy right at the surface.
What organs are ar risk when treated the anus with radiation therapy, and what are the tissue tolerance doses?
What is the rationale behind treating with a full bladder?
- Bladder-6000 cGy
- small bowel-4000 cGy
- Femoral heads- 5000 cGy
- When the bladder is full, it gets the small bowel out of the way. This isa good idea because the bladder can withstand more dose than the small bowel.
RT position for treating anal cancer is supine with a marker on the _______. Borders of the treatment portal are as follows:
Superior: lower border of the _______joints.
Inferior: _____cm distal to the primary tumor
Lateral: inclusion of the _____nodes.
- anal verge
- 3 cm
- inguinal nodes
Side effects of RT for anal cancer are severe and often the patient needs pain medication. Because of skin flash, _____ ____ is the #1 side effect and often leads to skin breakdown. Other side effects include ______ and _______due to irradiation of the small bowel, and lowered blood counts due to ____________.
- moist desquamation
- N&V Diarrhea
- Bone marrow suppression
The anal canal is _______cm long.
The lymph node systems involved with anal cancer are:
external and internal iliac nodes , inferior mesenteric
STAGING for ANAL CANCER
(for info only)***not on test
T1 - 2 cm or less
T2 - 2 - 5 cm
T3 - >5 cm
- invades adjacent organ, e.g. vagina, urethra, bladder. (invasion of
the rectal wall, perirectal skin, subcutaneous tissue, or sphincter
muscle is not included as T4.)
N0 - no lymph nodes
N1 - perirectal lymph nodes
N2 - unilateral internal iliac or (unilateral) inguinal lymph nodes or both
N3 - perirectal AND inguinal lymph nodes; and/or bilateral internal iliac; and/or (bilateral) inguinal lymph nodes
- 0 - Tis
- I - T1 N0
- II - T2-3 N0
- IIIA - T1-3 N1, T4 N0
- IIIB - T4 N1, Any N2, Any N3
- IV - M1
- Stages I-II: no nodes
- Stage IIIA-either spread to one node site or invasion of an ajacent organ (local spread)
- Stage IIIB-spread to two nodal sites or invasion of adjacent organ and spread to one nodal site(regional spread)
- Stage IV- metastasized
What does IAS and EAS stand for on the picture, and what kind of cells are above and below the dentate line?
- IAS:internal anal sphincter
- EAS:esternal anal sphincter
- Above dentate line: columnar
- Below dentate line: squamous