Anal Cancer with Mediastinal Lymph Node Metastasis

Squamous cell carcinoma of the anal canal remains rare, with metastatic disease even less commonly reported. We present a case of a patient with both a prior history of squamous cell carcinoma of the anal canal as well as breast cancer, who was without evidence of disease for 1 year. She was subsequently found to have FDG-avid mediastinal lymphadenopathy, initially assumed to be related to her more recent breast cancer. However, a biopsy confirmed recurrent anal cancer, with HPV infection. This represents a novel site of spread for anal cancer, one not yet reported in the literature.

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Phase II study of capecitabine in substitution of 5-FU in the chemoradiotherapy regimen for patients with squamous cell carcinoma of the anal canal.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.659 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 659-659

Author(s):

Suilane Coelho Ribeiro ◽

Camila Venchiarutti ◽

Rachel Riechelmann ◽

Erlon Gil ◽

Caio Nahas ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Anal Canal ◽

Sample Size ◽

Cell Carcinoma ◽

Anal Cancer ◽

Local Control ◽

Squamous Cell ◽

Hemorrhagic Cystitis ◽

Performance Status ◽

Stage Ii

659 Background: Squamous cell carcinoma (SCC) of the anal canal is an uncommon malignancy accounting for 1-5% of intestinal tumors; however, its incidence has been increasing. The standard treatment of anal canal SCC stage II-III consists of infusional 5-fluorouracil associated with mitomycin and radiotherapy. This scheme was proposed by Nigro in 1974, and since then no other effective treatment was developed. Methods: Patients with SCC of anal cancer T2-4N0M0 or T (any) N1-3M0, with good performance status, normal blood and renal function were treated with capecitabine 825 mg/m2 12/12hs during radiotherapy associated with a single dose of mitomycin 15 mg/m2 on Day 1. Primary objective is determine local control rate in 6 months with capecitabine, mitomycin and radiotherapy in patients with SCC of the anal canal. After the end of the treatment patients were reassessed for clinical and radiological response. Sample size was calculated using Fleming's single stage. Considering 85% of expected events (rate of local control in 6 months), standard deviation and a 5% error, sample size calculated was 51 patients. Results: 13 patients have been included, 9 patients have finished, 3 patients are still in treatment and 1 patient was excluded because of poor compliance with oral medications. Regarding the staging, 5 patients (38,4%) with stage II, 4 patients ( 30,8%) with stage IIIA and 4 patients (30,8%) with stage IIIB. Among patients who finished the treatment and were reevaluated 1 patient ( 16,7%) presented partial clinical response, 6 patients (83,3%) had clinical complete response. Three patients are waiting for clinical and radiologic reassessement. The main toxicities observed were grade I diarrhea ( 30,7%), grade II (38,5%) and III (30,7%) radiodermitis, nausea ( 38,5%), grade I-II plaquetopenia( 30,7%). Grade I hand–foot syndrome was observed in 1 patient and hemorrhagic cystitis related to radiotherapy was observed in 1 patient. No serious adverse event was observed. Colostomy was required in 1 patient before the beginning of the treatment. Conclusions: The study is ongoing but capecitabine and mytomicin with radiotherapy seem to be a safe treatment for SCC of the anal cancer.

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Anal intraepithelial neoplasia progression to squamous cell carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.353 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 353-353

Author(s):

Bhavna Gami ◽

Paul Ziprin ◽

Robert D Goldin ◽

Michael Osborn ◽

Linda Greene ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Human Papillomavirus ◽

Cell Carcinoma ◽

Anal Cancer ◽

Squamous Cell ◽

Cell Transformation ◽

Intraepithelial Neoplasia ◽

Hpv Infection ◽

Number Of Patients ◽

Prospective Database

353 Background: In the U.K., the annual incidence of anal cancer is up to 1.5 per 100,000 per year. Anal intra-epithelial neoplasia (AIN) is believed to be a precursor to squamous cell carcinoma whose incidence is still undetermined. This cell transformation has been associated with human papillomavirus (HPV) infections, in particular HPV 16 and 18. Our aim was to determine the frequency of progression to squamous cell carcinoma (SCC) of the anus in patients with known AIN. Methods: Study subjects with diagnosis of AIN from January 1st 1997 to January 1st 2009 were identified from a prospective database in a single hospital trust. The incidence of a subsequent diagnosis of anal SCC was determined from the local pathology and anal cancer database and cross referenced with the regional cancer database, Thames Cancer Registry. Results: We identified 397 patients (303 males) diagnosed with AIN in the database and HPV infection was identified in n= 395 patients. 15 (4%) patients were diagnosed with anal SCC a median of 5 months, Interquartile range 27 (2- 29 months) after their initial diagnosis. The distribution of AIN 1, 2 and 3 at presentation was 2, 1 and 12 respectively. Of interest, number of patients developed other HPV related cancers during the study period, such as vulva (n=8), cervical (n=3) and penile cancers (n=1). Conclusions: The incidence of anal cancer is higher in patients with known AIN compared to the general population. This justifies surveillance of these patients for anal and other HPV related intraepithelial neoplasia, however the nature of this, anoscopy or clinical examination alone, has yet to be determined.

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Squamous Cell Carcinoma in situ of the Anal Canal with HPV Infection, Report of a Case

Nippon Daicho Komonbyo Gakkai Zasshi ◽

10.3862/jcoloproctology.59.448 ◽

2006 ◽

Vol 59 (8) ◽

pp. 448-451

Author(s):

T. Kobayashi ◽

Y. Nishimura ◽

K. Amikura ◽

H. Sakamoto ◽

Y. Tanaka

Keyword(s):

Squamous Cell Carcinoma ◽

Anal Canal ◽

Cell Carcinoma ◽

Squamous Cell ◽

Carcinoma In Situ ◽

Hpv Infection

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A Case Report of Squamous Cell Carcinoma in the Anal Canal with HPV Infection.

Nippon Daicho Komonbyo Gakkai Zasshi ◽

10.3862/jcoloproctology.46.265 ◽

1993 ◽

Vol 46 (3) ◽

pp. 265-268

Author(s):

N. Yasuda ◽

M. Shibusawa ◽

K. Numabe ◽

M. Murakami ◽

Y. Tunoda ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Case Report ◽

Anal Canal ◽

Cell Carcinoma ◽

Squamous Cell ◽

Hpv Infection

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Phase II study of capecitabine in substitution of 5-FU in the chemoradiotherapy regimen for patients with squamous cell carcinoma of the anal canal.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.560 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 560-560 ◽

Cited By ~ 1

Author(s):

Suilane Coelho Ribeiro ◽

Camila Motta Venchiarutti Moniz ◽

Rachel Riechelmann ◽

Giovanni Mendonca Bariani ◽

Maria Ignez Braghiroli ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Anal Canal ◽

Cell Carcinoma ◽

Anal Cancer ◽

Squamous Cell ◽

Performance Status ◽

Complete Response ◽

Primary Objective ◽

Stage Ii ◽

Grade 3

560 Background: Squamous cell carcinoma (SCC) of the anal canal is an uncommon malignancy accounting for 1-5% of intestinal tumors; however, its incidence has been increasing. Treatment for stage II and III anal canal SCC is infusional 5-fluorouracil associated with mitomycin and radiotherapy, since 1974. More convenient treatments for patients are needed. Methods:Patients with SCC of anal cancer T2-4N0M0 or T (any) N1-3M0, with good performance status, normal blood, and renal function were treated with capecitabine 825 mg/m2 12/12hs during radiotherapy associated with a single dose of mitomycin 15 mg/m2 on day 1. Primary objective was local control rate at 6 months determined by clinical examination and radiological assessment. Sample size was calculated using Fleming single stage design. Results: From November/2010 to August/2013 42 patients were initially included, however 36 patients were assessed. Fifteen patients (41.7%) were stage II, 8 patients (22.2%) stage IIIA, and 13 patients (36.1%) stage IIIB. Four patients (11.1%) were HIV-positive, while 32 (88.9%) were HIV-negative. Thirty-two patients finished the treatment, 4 patients are still in treatment. Median follow-up was 18.7 months. Among patients who finished the treatment and were reevaluated at 6 months 4 patients (13.3%) presented partial response, 25 patients (83.3%) had complete response, and 1 patient developed liver metastasis (3.3%). Regarding grade 3-4 toxicities, 7 patients (21.8%) had grade 3 radiodermitis, 1 patient (3.1%) had grade 3 diarrhea, 2 patients (6.2%) had grade 3-4 thrombocytopenia, 3 (9.3%) had lymphopenia and one patient had grade 3 leukopenia. One HIV+ patient had septic shock, pneumonia, herpetic encephalitis and macrophage activation syndrome. Colostomy was required in 2 patients before the beginning of the treatment and 2 patients after the treatment because of local failure, corresponding to a colostomy rate of 12.5%. Conclusions: Capecitabine and mytomicin with radiotherapy seem to be a safe treatment for SCC of the anal cancer.

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Post-treatment surveillance in locally advanced squamous cell carcinoma (SCCA) of the anal canal: A global subspecialist survey.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.573 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 573-573 ◽

Cited By ~ 1

Author(s):

Cathy Eng ◽

Richard A. Adams ◽

Lisa A. Kachnic ◽

Prajnan Das ◽

Randy Devereux Ernst ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Anal Canal ◽

Cell Carcinoma ◽

Anal Cancer ◽

Squamous Cell ◽

Working Group ◽

Locally Advanced ◽

Anal Carcinoma ◽

International Consensus ◽

Curative Intent

573 Background: Squamous cell carcinoma of the anal canal will be diagnosed in 28,000 individuals globally. Considered a rare cancer, the incidence of anal carcinoma continues to rise annually. Majority of patients present with locally advanced disease in which concurrent chemoradiation (CRT) will be provided with curative intent. The Anal Cancer IRCI Working Group was created to pursue novel approaches to the diagnosis, treatment, and surveillance of patients. Yet, surveillance following completion of CRT is not well established and varies as per NCCN (v2.2015) and ESMO guidelines. Methods: A 22-question survey provided to anonymous international GI subspecialists in various fields. Questions pertained to timing and type of diagnostic imaging, surveillance interval, approach to detection of complete response (CR), and prevention of sexual dysfunction. Results: Survey distribution was initiated in March 2015 and still ongoing. Thus far, 96 physicians responded. Conclusions: Carcinoma of the anal canal continues to rise in incidence annually. Surveillance following completion of CRT is warranted; however, global variability in practice patterns for surveillance exists. As such, the IRCI Anal Cancer Working Group intends to provide an international consensus surveillance statement. [Table: see text]

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