Appreciate the evolution of methods of managing anal carcinomas and appropriate selection of modalities to employ in various situations at the present time. Understand methods of integrating chemotherapy and radiation to achieve desirable outcomes. The management of anal cancer underwent an interesting transformation over the last two decades. Prior to this period, the standard definitive treatment for carcinoma of the anal canal was abdominal-perineal resection, which necessitated a permanent colostomy.
The inner lining of the anal canal is the mucosa. Most anal cancers start from cells in the mucosa. Glands and ducts tubes leading from the glands are found under the mucosa. The glands make mucus, which acts as a lubricating fluid. Anal cancers that start from cells in the glands are called adenocarcinomas. Anal cancers are often divided into 2 groups, which are sometimes treated differently:.
Although a rare disease, anal cancer is increasingly being diagnosed in patients with risk factors, mainly anal infection with the human papilloma virus. Magnetic resonance imaging MRI with external phased-array coils is recommended as the imaging modality of choice to grade anal cancers and to evaluate the response assessment after chemoradiotherapy, with a high contrast and good anatomic resolution of the anal canal. MRI provides a performant evaluation of size, extent and signal characteristics of the anal tumor before and after treatment, as well as lymph node involvement and extension to the adjacent organs. MRI is also particularly helpful in the assessment of complications after treatment, and in the diagnosis for relapse of the diseases. Primary neoplastic conditions of the anal canal are uncommon.
Electronic address: mbmorton partners. The dominant etiology is infection with human papilloma virus HPV , which is the most common sexually transmitted disease in the United States. Vaccines directed against oncogenic HPV serotypes exist, and their utility for preventing anal neoplasia is under investigation.