Abstract
Squamous cell cancer (SCC) of the anus is rare and accounts for only 2–4% of all lower alimentary tract malignancies. A multidisciplinary approach is essential with close co-operation and communication required between radiologist, surgeon, medical oncologist, radiation oncologist, pathologist and nursing specialists. An indolent natural history and a low rate of distant metastases means anal cancer is usually amenable to loco-regional treatment. Randomized controlled studies in Europe and the United States have confirmed that synchronous chemoradiation (SCRT), using mitomycin and 5-fluorouracil as the primary modality, is superior to radiotherapy alone in the treatment of anal cancer. Local control has improved but the relative 5-year survival rate has changed little for patients treated in the last two decades. The aim of this chapter is to summarize the available evidence and to define the role of imaging, chemoradiation-based, chemotherapy and surgical treatment options. We hope this chapter provides a useful and practical update.
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14.37 Guidelines
•Engstrom PF, Amoletti JP, Benson AB, et al., NCCN Practice Guidelines: Anal Cancer Version 2. 2009 (08/19/09). Available at www.nccn.org/professionals/physician (last accessed September 27 2009)
•Guidelines for the management of Colorectal cancer issued by the Association of Coloproctology of Great Britain and Ireland; 3rd Edition 2007.
•Fleshner PR, Chalasani S, Chang GJ et al., Practice parameters for anal squamous neoplasms. Dis Colon Rectum 2008;51:2–9.
•Glynne-Jones R, Northover J, Oliveira J. ESMO Guidelines Working Group. Anal cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2009; 20(4):57–60.
14.38 Reviews
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Eng C, Pathak P (2008) Treatment options in metatstatic squamous cell carcinoma of the anal canal. Curr treat Options Oncol 9 (4–6):400–407
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Glynne-Jones, R., Mawdsley, S. (2011). Anal Cancer. In: Blanke, C., Rödel, C., Talamonti, M. (eds) Gastrointestinal Oncology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-13306-0_14
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