Anal Path

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Last updated 7:12 PM on 9/13/26
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19 Terms

1
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epidemiology

  • 1-2% of lower GI ca.

  • women

  • 60 y/o median, 30-90 y/o


2
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anatomy

  • 3-4cm length

  • lined w/ stratified squamous epithelium up to dentate/pectinate line

  • mucosa becomes cuboidal into columnar epithelium in rectum


3
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etiology

  • HPV16

  • gen. warts, infections, anal intercourse

  • immunosuppression


4
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lymphatics

  • perirectal & anorectal

  • internal iliac & lat. sacral nodes, inf. mesenteric (above dentate)

  • inguinal nodes (10-30%) (below dentate)


5
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routes of spread

direct extension to surrounding tissues

  • sphincter mucles

  • rectal wall

  • perianal skin

  • vaginal septum

  • prostate gland

  • sacrum coccyx


6
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distant met sites

lung & liver

7
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signs & symptoms

RECTAL BLEEDING (bright red), pain, change in bowel habits, mass sensation, pruritus

8
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detection & diagnosis

DRE, palpation of inguinal nodes, anoscopy/proctoscopy & biopsy, CT MRI PET CXR transrectal US

9
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histopathology

SCC 80%, adenocarcinoma in anal glands

10
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tx techniques

combination RT & chemo for local control & colostomy-free survival

11
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chemo

  • 5-FU and mitomycin C

  • cisplatin & 5-FU for fewer side effects


12
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RT technique

  • VMAT

  • traditional: 4 field or AP/PA w electron fields for inguinal nodes (15MeV)

  • 60-65 Gy (large primary fields 45 Gy)

  • 30-45 Gy for inguinal nodes


13
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positioning

frog legged, bolus over anus

14
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PTV tx borders - Pelvic Field

  • anus, perineum, pelvic nodes (external & internal iliac, presacral, inguinal)

  • sup: L5-S1

  • inf; anus w/ 3cm margin around anus & tumor

  • lat: inguinal nodes


15
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CTV tx borders - Lower Pelvic Field

  • anus, perineum, external iliac, inguinal

  • sup: bottom of sacroiliac joints

  • inf: anus w/ 3cm margin anus & tumor

  • lat: inguinal nodes


16
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GTV tx borders - boost field

primary tumor & grossly pos. nodes w/ 2-2.5cm margin

17
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reactions to tx

  • perineal skin reactions

  • moist desquamation

  • N/V/D

  • bone marrow suppression

  • low blood counts


18
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prognosis - 5 year survival rate

  • localized: 79%

  • locally advanced: 59%

  • metastatic: 30%

  • overall 65%


19
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OARs

  • testes: 1

  • small bowel: 45

  • femoral head & neck: 52

  • rectum: 60

  • bladder: 65

  • vagina: 90