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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
