2. Biopsy results
• Rectal biopsy - poorly differentated adeno, lymph node –
adenocarcinoma
• Important points in IHC: stains performed
CK7,20, 5/6, chromogranin,synaptophysin , CEA,CDX-2,
CD3,PAX-5
positive for CK7 and CEA, negative for CDX2 and the rest
K ras- unmutated
3.
4.
5. Anal gland carcinoma (AGC)
• normal anal glands express CK7 and are negative for CK20
• This profile, however, is not sufficiently discriminative,
because a number of adenocarcinomas metastatic to the anal
canal will have a similar profile. Also a significant proportion of
rectal adenocarcinomas, 13% to 76%, are CK7
positive,whereas deep mucosal glands in the rectum are often
CK20 negative.
• Uniformly negative CDX2 staining of normal and malignant
anal glands may be used to differentiate AGC from rectal
adenocarcinoma
6.
7.
8. Anal gland carcinoma (AGC)
Wide local excision can be performed for small well-
differentiated tumors.
APR in combination with neoadjuvant chemoradiation
should be used for lesions greater than 2 cm in size(T2).
11. Important points
• anything bigger than 2 cm or not well differentiated even if
smaller, will get chemo/rad, then surgery , then adjuvant
folfox.
•
• Squamous anal canal chemo/radiation is the treatment and if
recurs locally goes for sx. Anal margin can be resected if t1n0
and rest same as anal canal.
• Radiation for squamous anal includes mitomycin.
• Both are for approx 5 weeks.
12. Important points
• Metastatic treatment is different -cisplatin based in squamous.
• cetux being investigated as anal generally KRAS UNMUTATED
Adeno-
FOLFOX/IRI,CETUX,PANITIMUMAB,AVASTIN,REGORAFINIB
