Anal Cancer
275 results
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Anal Cancer- Key Concepts
- Verrucous Carcinoma
- Melanoma
- Perianal Paget’s Disease (Intraepithelial Adenocarcinoma)
- Basal Cell Carcinoma
- Gastrointestinal Stromal Tumor (GIST)
- Conclusion
- References
- Introduction and Epidemiology
- Evaluation and Staging
- Physical Examination
- Radiologic Evaluation
- Anal Anatomy
- Perianal Squamous Cell Carcinoma
- Anal Canal Squamous Cell Carcinoma
- Anal Adenocarcinoma
Malignancy- A 25-year-old man with a known APC mutation undergoes a laparoscopic restorative total proctocolectomy/ileal pouch–anal anastomosis. Which of the following is the most common extracolonic manifestation?
- A 64-year-old woman with a history of cervical intraepithelial neoplasia presents with a firm 3-cm mass protruding at the anal verge. Anoscopy shows a fixed mass just distal to the dentate line. A biopsy of the lesion is performed, which has the findings shown in the Figure. Colonoscopy findings are unremarkable and computed tomography of the chest, abdomen, and pelvis reveals no evidence of distant disease. Magnetic resonance imaging reveals no locoregional nodal or sphincter involvement. The next best step in management for this patient is:
- A 56-year-old man presents to the office with biopsy-proven midrectal adenocarcinoma on colonoscopy. Rigid sigmoidoscopy in the office shows a 5-cm circumferential mass 8 cm from the anal verge. Staging evaluation with computed tomography of the chest, abdomen, and pelvis and magnetic resonance imaging of the pelvis preoperatively demonstrates a T3N1M0 cancer. What is the next step in management for this patient?
- A 72-year-old patient with severe systolic congestive heart failure and oxygen-dependent chronic obstructive pulmonary disease completes chemoradiation for a locally advanced rectal adenocarcinoma 5-cm proximal to the anal verge. Reexamination of the rectum 8 weeks after chemoradiation reveals normal, intact mucosa, and magnetic resonance imaging of the pelvis reveals no visible cancer or suspicious mesorectal nodes. What is the most appropriate therapy for this patient?
- A 63-year-old woman is diagnosed with a 1.5-cm, well-differentiated perianal squamous cell cancer that is 3.5 cm from the anal verge, with no involvement of the anal sphincter mechanism. There is no radiographic evidence of inguinal nodal or metastatic disease. The best treatment option for this patient is:
- A 54-year-old woman was referred to you with a newly diagnosed anal squamous cell carcinoma. Physical examination reveals a 1.2-cm distal anal canal lesion and no palpable inguinal lymphadenopathy. Magnetic resonance imaging of the pelvis shows no sphincter involvement and no regional lymphadenopathy. What is the most appropriate next step?
- A 70-year-old woman presents with a 3-cm lesion at the anal verge extending into the anal canal. Biopsies show a squamous cell carcinoma. Staging magnetic resonance imaging confirms a lesion 3.1 × 1.2 × 0.5 cm in size, possibly involving the internal sphincter muscle, without lymphadenopathy. What is the T stage in this patient?
- A 55-year-old man with HIV presents to your clinic complaining of severe itching around his anus that sometimes bleeds when he scratches. On physical examination, he has an excoriated and slightly raised area around the anus measuring about 50% of circumference on the right side. Biopsy shows confirmed high-grade squamous intraepithelial lesions. Which of the following is the best treatment option for this patient?
- A 52-year-old man is diagnosed with a 1.5-cm anal canal squamous cell cancer. He is HIV positive and has been taking highly active antiretroviral therapy for several years; his CD4 count is 225 while his viral load is undetectable. Which of the following is the most appropriate management for this patient?
- A 55-year-old man undergoes low anterior resection with primary anastomosis for a T2N0 rectal cancer located 9 cm from the anal verge. The splenic flexure was mobilized, the inferior mesenteric artery was divided distal to the take-off of the left colic artery, followed by total mesorectal excision. His recovery is uneventful. He returns to the clinic 3 months after surgery describing normal erections, but he is unable to ejaculate. At which step of the operation is nerve damage most likely to have occurred?
- A 68-year-old man with a history of a hemorrhoidectomy and fecal urgency presents with a T3n1m0 rectal cancer 5 cm from the anal verge. He has no family history of colorectal cancer. What is the most important consideration when counseling the patient about his surgical treatment options?
Malignancy- A 67-year-old man with anal cancer involving anterior rectal wall and dentate line and prostate, staged T4N1aM0, had undergone chemoradiation and presents for evaluation 8 weeks after therapy completion. He reports that discomfort is nearly gone from the anal canal and that his bowel movements are normal. On examination, there is a shallow 1-cm ulcer. What is the best next option?
- A 58-year-old patient presents to the clinic reporting anal pain and bleeding with bowel movements. Examination shows an ulcer at the anal verge measuring 1.5 cm. Biopsy shows invasive squamous cell carcinoma. Pelvic magnetic resonance imaging (MRI) shows the lesion invades the external sphincter. What is the patient’s T stage?
- A 62-year-old woman presents to the office with a 1-month history of rectal pain, bleeding, and perianal mass. On digital rectal examination and anoscopy, a 3-cm firm mass is noted at the left lateral anal canal. Inguinal examination is unremarkable. Biopsy of the mass shows moderately differentiated squamous cell carcinoma. Staging computed tomography (CT) of the chest and abdomen and magnetic resonance imaging (MRI) of the pelvis demonstrate a T2N1M0 tumor. What is the best next step in her management?
- A 38-year-old HIV-positive male patient is diagnosed with a cT3N1M0 squamous cancer of the anal canal. The patient’s CD4 count is 250 cells/mm3. What is the most appropriate next step in management?
- A 61-year-old man is found to have a 2-cm mass in the mid-rectum (8 cm from the anal verge) on diagnostic colonoscopy. Biopsy reveals moderately differentiated adenocarcinoma. Computed tomography (CT) reveals no evidence of metastatic disease, and magnetic resonance imaging (MRI) demonstrates a cT3, node-negative cancer. After presentation at a multidisciplinary tumor board, the patient agrees to total neoadjuvant therapy. The patient has a complete clinical response to treatment and opts for close radiologic and endoscopic surveillance in an effort to avoid surgery. On a surveillance proctoscopy 6 months after treatment, the patient is found to have a 7-mm recurrence at the original cancer site. Which of the following is the best next step in management?
- A 63-year-old woman is diagnosed with a poorly differentiated microsatellite–stable rectal cancer 7 cm from the anal verge on screening colonoscopy. She denies trouble with continence. Staging computed tomography (CT) of the chest/abdomen/pelvis does not demonstrate distant disease; a mass is confirmed in the mid rectum with evidence of lymphadenopathy. Rectal magnetic resonance imaging (MRI) demonstrates this tumor is a T4aN2M0 with threatened circumferential radial margin. The multidisciplinary tumor board recommends total neoadjuvant chemotherapy with FOLFOX and long-course chemoradiation therapy. Six weeks after completing neoadjuvant therapy, flexible sigmoidoscopy demonstrates persistent tumor. Restaging MRI after total neoadjuvant therapy is consistent with persistently threatened posterior radial margin with tumor extending to the presacral fascia. The multidisciplinary tumor board’s best recommendation for her is
- A 40-year-old woman is referred to you because of a 6-month history of painful hemorrhoids that have not been responsive to topical therapy and stool softeners. A 3-cm, ulcerated, hard mass extending into the anal canal is found on perianal examination and biopsied. Pathology comes back as anal squamous cell cancer. What is the most appropriate next step?
- Anorectal Disease
- A patient presents with persistent anal pain despite use of fiber and bowel regimen. On examination, the patient has a linear 2-cm tear in the right lateral position of the anal canal with exposure of the underlying internal sphincter. The most appropriate next step in the management of this patient is
- A 36-year-old man who is HIV-positive presents to your clinic with a 6-week history of perianal burning and itching. Rectal examination reveals multiple small condylomata within the anal canal. Intraoperative excisional biopsies of the condylomata confirm human papillomavirus (HPV). Which of the following HPV subtypes confers the highest risk of anal high-grade dysplasia and squamous cell carcinoma?
- A 45-year-old man, who reports sex only with men (MSM), has been referred to you for evaluation of a whitish anorectal lesion identified on initial screening colonoscopy. Biopsies confirmed high-grade squamous intraepithelial lesion (HSIL), for which he ultimately underwent excision and fulguration. What is the recommended surveillance?
- A screening anal pap was performed on a 33-year-old male patient with well-controlled human immunodeficiency virus (HIV). Cytology is consistent with high-grade squamous intraepithelial lesion (HSIL). The most appropriate next step in management is
- A 64-year-old woman with history of cervical cancer treated with radical hysterectomy presents with anal itching and burning. Examination demonstrates a well-circumscribed hyperkeratosis/lichenification rash. Which of the following is the best next step in her management?
- A 41-year-old patient presents to your clinic with anal pain for the past 2 months. On anoscopy and examination, a 1-cm ulcer is seen at the dentate line. The patient is sexually active with a single partner and received a kidney transplant 10 years ago. What is the most likely diagnosis of the anal lesion?
- You are performing a high-resolution anoscopy on a patient referred for high-grade squamous intraepithelial lesion (HSIL) seen on an anal pap. You identify two areas with high-grade dysplasia. What is the treatment of choice?
- A 56-year-old patient is diagnosed with rectal cancer just above the dentate line. What is the lymphatic drainage of this lesion?
- Anorectal Disease
- A 55-year-old woman with a history of high-risk cervical human papillomavirus presents with a 2.5 x 1 cm exophytic, firm lesion that extends from the anal verge to just below the dentate line. Biopsy was significant for squamous cell cancer. Which nodal basin would this lesion most likely drain?
- You evaluate a patient with a 3-month history of pruritis ani. Examination reveals perianal erythema and excoriation. You treat the patient with dietary modification and calamine-zinc barrier. The patient returns in 3 months reporting no symptomatic improvement. What is the next step in management?
- A 56-year-old HIV positive man with anal condyloma acuminata undergoes excision and fulguration of these lesions under general anesthesia. The pathology shows foci of high-grade dysplasia related to human papillomavirus. What is the next step in the management?
- A 53-year-old woman with a history of kidney transplantation 5 years ago presents with perianal itching and a painful lump. On examination, several perianal small cauliflowerlike lesions are noted. In addition to anoscopy what is the next step in management for this patient?
- Miscellaneous
Anal Squamous Cell Cancers (Revised 2018)- Anal Intraepithelial Neoplasia
Management of Anal Dysplasia
Fundamentals of Rectal Cancer Surgery- Pelvic Floor
- Anorectal Crohn’s Disease
- About ASCRS Textbook of Colon and Rectal Surgery
- Preoperative Staging
- Benign Disease
- A 30-year-old female patient undergoes proctocolectomy and ileal pouch anal anastomosis (IPAA) for familial adenomatous polyposis. What surveillance is recommeded for her?
- A 65-year-old man with Crohn’s disease presents with intermittent bleeding from a long-standing anal fistula. He is on infliximab with good endoscopic control. On examination, there are large skin tags and an external fistula opening with irregular, heaped up, and friable edges. There is no evidence of abscess. Which of the following would be the most appropriate next step?
- Colorectal Cancer: Minimally Invasive Surgery
- Management of Rectal Cancer (2020)
- Endoscopy
- ASCRS Annual Meeting 2024
- Rectal Cancer: Nonoperative Management
- Anal Fissure and Anal Stenosis
- Dermatology and Pruritus Ani
- Colorectal Cancer: Preoperative Evaluation and Staging
- Rectal Anatomy
- Perioperative
- Rectal Cancer Biology and Hereditary Cancer Syndromes
- Anatomy and Embryology of the Colon, Rectum, and Anus
- Low Anterior Resection Syndrome (LARS)
- Miscellaneous