Transcript AnalCancerCases

Anal Cancer - Case 1
 62 years old woman with 6 months
history of anal pain
 Clinically T3 squamous cell carcinoma
growing anteriorly
 Which staging process ?
Anal Cancer - Case 1
 62 years old woman with 6 months
history of anal pain
 Clinically T3 squamous cell carcinoma
growing anteriorly
 Which staging process ?
 MRI; T3, N1 (left groin), M0
Anal Cancer - Case 1
 MRI; T3, N1, M0
 What treatment option ?
Anal Cancer - Case 1
 MRI; T3, N1, M0
 What treatment option ?
 Induction therapy (3 months) with
chemo followed by chemo - rad
 Which radiation dose ?
Anal Cancer - Case 1
  50 Gy chemo - rad
 How about the groin metastasis ?
Anal Cancer - Case 1
  50 Gy chemo - rad
 How about the groin metastasis ?
 Wait and see ?
 When and how to evaluate the effect
of the treatment ?
Anal Cancer - Case 1
 When and how to evaluate the effect
of the treatment ?
 Continuously during the radiation
period
Anal Cancer - Case 1
 Evaluate outcome continuously during
the radiation period
 If poor effect, when is the best
timing for surgery ?
 What type of surgery and how about
the groin ?
 How handle the perineal wound ?
Anal Cancer - Case 1
 Surgery was planned 6 - 8 weeks
after the end of chemo-radiation.
 The patient had a laparoscopic APR
with resection of the posterior vaginal
wall. No dissection of the groin.
 If surgery was performed later due
to a recurrence ? Any difference ?
Anal Cancer - Case 1
 Any difference with delayed surgery ?
 Perineal wound healing ?
 Consider TRAM - graft ?
Case 2
Anal Cancer - Case 2
 78 years old gentleman had a stalked
polyp in the anal canal. Biopsy
showed cancer. Clearly resectable.
 Which staging process ?
Anal Cancer - Case 2
 78 years old gentleman had a stalked
polyp in the anal canal. Biopsy
showed cancer. Clearly resectable.
 Which staging process ?
 Ultrasound T1, N0
 MRI T1, N0, M0
Anal Cancer - Case 2
 Ultrasound T1, N0
 MRI T1, N0, M0
 How to treat ?
Anal Cancer - Case 2
 Ultrasound T1, N0
 MRI T1, N0, M0
 How to treat ?
 Pathology; Malignant melanoma !
 What to do now ?
Anal Cancer - Case 2
 Malignant melanoma
 Treatment options ?
 T3 - 4, N0, M0
 APR ? Local excision ?
 Curable at all ?
Case 3
Anal Cancer - Case 3
 Treatment options ?
Case 4
Anal Cancer - Case 4
 26 years old woman with a rather
small (< 2 cm) squamous cell cancer
growing anteriorly in the anal canal.
 Staging ; T1, N0, M0
 Treatment options ?
Anal Cancer - Case 4
 Local excision ?
 Radiotherapy ?
Pros and cons !
ANAL CARCINOMA
Timing of surgery
The decision of whether or not
surgery has to be done is often
based on the pre-radiotherapy
status
ANAL CARCINOMA
Timing of surgery
The main discussion comes
after 45 - 50 Gy
ANAL CARCINOMA
Timing of surgery
If surgery has been decided
wait 4 - 6 weeks
but not more 8 weeks
ANAL CARCINOMA
Timing of surgery
Avoid surgery after 60 Gy
Main reason is impaired
healing
ANAL CARCINOMA
Local excision
Never after
radiotherapy !
ANAL CARCINOMA
Local excision
If the tumour recur after
local excision do not operate
again use radiotherapy