Anal Cancer

Epithelium type

Squamocolumnar

Viral risk factor

HPV 16 & 18

Incidence

Increasing; 9440 cases

More common in women

Race/Gender risk factor

White women and black men

Risk factors

• HPV-16(universal among gay men)

• Other cancers associated with HPV

• HIV infection

• Smoking

• Anal sex

• Lowered immunity

Prevention

• HPV vaccination (boys and girls 11-12; females 13-26; males 13-21; MSM 26)

• Condom use

• Treatment of HIV

• Smoking cessation

Diagnosis

• Biopsy

• CT of Chest/ABD/Pelvis or MRI of Pelvis

• Anoscopy

• Rigid proctosigmoidoscopy

• Endoscopy

• HIV test

• Transrectal/Endorectal US

• Gynecological exam for women

Staging

Most are clinical staging due to limit of surgery as primary treatment

Survival for Stage I

80%

Survival for Stage IV

35%

Management

• local excision only for grade 1 well diff.

• Radiation

• Systemic

Radiation

Definitive therapy for Stages 1-3 w/ concurrent chemotherapy

Systemic Therapy - Stage 1-3

5-FU/mitomycin w/ radiation

Systemic Treatment for Stages IV

Cisplatin, 5-FU, FOLFOX, Carboplatin/Paclitaxel

Systemic Palliative Immunotherapy

Nivolumab/Pembrolizumab