The anal canal is approximately 4 cm in length extending from the anorectal junction to the anal verge. Anal cancers are rare and mostly squamous cell carcinomas arising from the anal transitional zone. Risk factors include HPV infection and immunosuppression. Combined chemoradiotherapy is the standard first-line treatment and results in high response rates and organ preservation compared to radiation alone. Salvage surgery may be considered for select cases after failed nonsurgical treatment or as primary treatment for those who cannot tolerate chemoradiotherapy. Prognosis depends on tumor stage, with 5-year survival rates ranging from 45-86% depending on depth of invasion and nodal involvement.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Please find the power point on Carcinoma of rectum. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
Colorectal cancer is most common GI cancer
The rectum is the most frequent site involved
Adenoma-carcinoma sequence: Arises from adenoma in stepwise progression
Please find the power point on Carcinoma of rectum. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
Colorectal cancer is most common GI cancer
The rectum is the most frequent site involved
Adenoma-carcinoma sequence: Arises from adenoma in stepwise progression
Evaluation and management of Stage III Non-Small Cell Carcinoma Lung including Radiotherapy planning. On a Radiation Oncologist Perspective. MD Radiotherapy discussion - CMC, Vellore
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...eshaasini
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...NainaAnon
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Clinics of Oncology | Oncology Journals | Open Access JournalEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. ANATOMY Anal Canal= 4 cm mucosa lined
region from junction of the puborectalis
portion of the levator ani muscle and
the external anal sphincter, and extends
distally to the anal verge
Transitional zone- from glandular
(columnar) to squamous mucosa- at
dentate line
Anal Margin- begins at the anal
verge. It represents the transition from
the squamous mucosa to the epidermis-
lined perianal skin.
Rectal
glandular
mucosa
Transitional
Squamous
True Epidermis
3. ANATOMY
The anal canal is a 4-cm-long structure that passes downward
and backward from the rectal ampulla (level of pelvic floor) to
the anus (anal verge).
The proximal border of the anal canal clinically corresponds
to the anal sphincter at the level of the puborectalis muscle
(palpable as the anorectal ring on digital rectal examination).
This is where the rectum enters the puborectalis sling, made
by fibers from both sides.
The distal end of the anal canal is at the level of the anal
verge, where the groove between the internal sphincter and
the subcutaneous part of the external sphincter is palpable.
This also is the level of the squamous-mucocutaneous
junction and the perianal skin.
4.
5. Epidemiology and Risk Factors
Squamous cell carcinoma of the anus is rare and least prevalent GI
malignancy & accounts for only 1 – 2 % of all large bowel malignancy.
Ratio of 1:2 for men to women with median age at diagnosis is 60 yrs.
Geographical variation- heighest in caucasian female
lowest in asian males
6. Risk Factors
- HPV infection.
- HIV seropositivity and low CD 4 count (twice)
- Cigarette smoking
- Anoreceptive intercourse (homosexual male 15 times)
- Immune suppresion following transplant
- anal warts.
7. Natural History
Most anal cancers are believed to arise from precancerous
changes(i.e. AIN) of the anal canal and peri anal skin
epithelium
High-grade AIN Squamous cell cancers in most instances.
However, it has been estimated that approximately 5% of
cases with AIN III progress to invasive cancer over multiyear
period.
Squamous cell cancers spread.
8. Clinical Presentation and Workup
Rectal bleeding- 45% of patients
Pain or sensation of mass- 30%
No symptoms- 20%
Pruritus ani or bleeding plaques associated with anal margin
skin cancers- Paget’s disease.
Sensation of mass or fullness and tenesmus
Physical exam- perrectal and nodes.
Biopsy- used to differentiate squamous cell (anal ca) from
adenocarcinoma (rectal ca) .
9. Vaccine prevention- two vaccines- best long term approach
for reducing long term risk.
Boys 11-12 yrs
Girls 13 to 26 yrs
11. It follows that two distinct categories of tumors
arise in the anal region.
Tumors that develop from mucosa (columnar,
transitional, or squamous) are true anal canal
cancers tumors
that arise from skin at or distal to the squamous-
mucocutaneous junction are termed anal margin
tumors
12. WHO Classification of Anal Cancer
Anal canal
Squamous cell carcinoma
- Keratinizing (below dentate)
- Nonkeratinizing (above dentate)
- Basaloid (transitional)
Adenocarcinoma
- Rectal type
- Of anal glands
- Within anorectal fistula
Small cell carcinoma
Undifferentiated
Anal margin
Squamous cell carcinoma
Giant condyloma
Basal cell carcinoma
Others (Melanoma)
Bowen's disease (SCC in situ)
Paget's disease (Intraepithelial
adenocarcinoma)
13. STAGING
PRIMARY TUMOR (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor =2 cm in greatest dimension
T2 Tumor >2 cm but =5 cm in greatest dimension
T3 Tumor >5 cm in greatest dimension
T4 Tumor of any size invades adjacent organ(s) (e.g., vagina,
urethra, bladder)
Direct invasion of the rectal wall, perirectal skin,
subcutaneous tissue, or the sphincter muscle(s) is not
classified as T4
14. REGIONAL LYMPH NODES (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in perirectal lymph node(s)
N2 Metastasis in unilateral internal iliac and/or inguinal
lymph node(s)
N3 Metastasis in perirectal and inguinal lymph nodes and/or
bilateral internal iliac and/or inguinal lymph node
15. AJCC stage groups
Stage I T1 N0 M0
Stage II T2 N0 M0
T3 N0 M0
Stage IIIA T1 N1 M0
T2 N1 M0
T3 N1 M0
T4 N0 M0
Stage IIIB T4 N1 M0
Any T N3 M0
Any T N2 M0
Stage IV Any T Any N M1
19. Prognostic factors
Tumor size >5 cm , lymph nodes involvement, male sex are
associated with poor prognosis.
High expression of p53 associated with decreased DFS.
Also local control rates are lower with increased p53 expression.
High level of Ki 67 – longer DFS.
20. Combined-Modality Treatment
Combined-modality therapy was described initially by Nigro
and coworkers.
This was a preoperative regimen inspired by reports that 5-fl
uorouracil (5-FU) potentiated the effects of radiotherapy on
garointestinal tumors.
This regimen consisted of delivering 30 Gy in 15 fractions to
the primary tumor and pelvic lymph nodes with concurrent 5-
FU (1000 mg/m2 as a 4-day continuous infusion) and
mitomycin C (MTC) (15 mg/m2 bolus injection)
chemotherapy, and APR 6 weeks after completion of the
protocol.
21. Promising early results, however, suggested that surgery may
not be necessary.
The series of Nigro and colleagues included 31 patients who
underwent surgery and 73 who received chemoradiotherapy
alone.
Twenty-two of the 31 surgical specimens had no evidence of
disease (NED) on histopathologic examination, and on long-
term follow-up evaluation, an NED rate of 79% was found for
the surgical patients, compared with 82% NED for patients
receiving combined-modality treatment.
Overall death rates were 6% in patients with tumors smaller
than 4 cm and 26% for those larger than 4 cm
22. The trials conducted by the
( combined modality therapy Vs radiation alone )
- United Kingdom Coordinating Committee for Cancer
Research (UKCCCR)
- European Organization for Research on Treatment of
Cancer (EORTC)
- Both showed statistically significant advantages in
-- the rate of control of the primary cancer
-- colostomy-free survival rates
23. UKCCCR ACT I trial
585 patients with SCC of anal canal & perianal skin were
randomized between radiation alone and radiation
combined with chemotherapy.
The radiation dose was 45 Gy , with a boost dose of 15 to
20 GY following 6-weeks break, based on response.
5-FU (1,000 mg/m2
per 24 hours for 4 days or 750 mg/m2
per 24 hours for 5 days) by continuous peripheral
intravenous infusion in the first and final weeks of
radiation treatment, plus mitomycin (12 mg/m2
) by bolus
intravenous injection on day 1 of the first course of
chemotherapy.
24. 3 year local Failure in the primary tumor or regional lymph
nodes -(39%) of chemoradiation , (61%) of radiation alone.
Acute toxicity, particularly hematologic, skin, gastrointestinal,
and genitourinary, was increased in the combined modality
arm .
Late morbidity was comparable in each group.
No statistically significant advantage was seen in terms of
overall survival
25. EORTC STUDY
Included 103 patients with T3-4N0-3 or T1-2N1-3
The radiation dose was 45 Gy , with a boost dose of 15 to 20
GY following 6-weeks break, based on response
Chemotherapy consisted of 5-FU (750 mg/m2
per 24 hours by
continuous infusion for 5 days) in the first and fifth week of
radiation, and a single bolus injection of mitomycin (15
mg/m2
) on day 1 of the first course of 5-FU only.
Surgery was reserved for the patients with less than a partial
response.
Concurrent CTRT group has higher complete response(80 vs
54%),locoregional control(68 vs 50%),colostomy free (72 vs
40%)
Acute and late toxicity rates were similar
26. U.S. RTOG–ECOG trial (RTOG 87–04/
ECOG 1289)
The need for MMC in combined-modality therapy of anal
cancers was evaluated
This was the first study comparing two methods of
chemoradiotherapy in patients with anal cancer. One study
arm used 5-FU alone with radiotherapy, and the other arm
used 5-FU and MMC with radiotherapy.
showed that colostomy free survival (71 vs 59%) and disease free survival
rate(73 vs 51%) were significantly higher in patient receiving MMC and
significantly lower colostomy (9 vs 22%) and local failure rate(16 vs 34%)
The investigators concluded that despite the greater toxicity,
the use of MTC in a definitive complete response regimen for
anal cancer was justified.
27.
28. ACT II trial
randomized trial of 950 non-HIV infected patients with anal
SCC .
Treatment consisted of RT in both arms (50.4 Gy in 28
fractions) with concurrent infusional 5-FU (1000 mg/m2 per
day on days 1 to 4 and 29 to 32) and either cisplatin (60
mg/m2 on days 1 and 29) or mitomycin (12 mg/m2 day 1 only).
There was a second randomization to receive or not receive
maintenance chemotherapy starting four weeks after
chemoradiotherapy (two courses of cisplatin plus 5-FU,
administered four weeks apart).
29. RESULTS
patients receiving mitomycin had more acute grade 3 or 4
hematologic toxicity (25 versus 13 percent), but no higher rates of
febrile neutropenia (3.1 versus 3.2 percent) during
chemoradiotherapy.
Rates of grade 3 or 4 nonhematologic toxicity were similar (61
versus 65 percent).
The complete response rate at six months (the primary endpoint)
was 95 percent with both cisplatin and mitomycin, and
the three-year colostomy rate was not significantly different (13.7
versus 11.3 percent).
Three year RFS was similar with or without the use of
maintenance therapy (75 percent for both arms) as was overall
survival (84 versus 85 percent).
30. ACCORD 03
307 patients with stage II and III anal cancers randomized to
one of four treatment arms:
-Group 1- 5FU & cisplatin f/b EBRT 45 GY+ 5FU & Cisplatin
->rest ->15 GY
-Group 2- 5FU & cisplatin f/b EBRT 45 GY+ 5FU & Cisplatin
->rest ->20 -25 GY
-Group 3- EBRT 45 GY+ 5FU & Cisplatin ->rest ->15 GY
-Group 4- EBRT 45 GY+ 5FU & Cisplatin ->rest ->20 -25
GY
31. Results-no significant difference in 5 yr colostomy free
survival (70 to 82%), no significant differences were seen
between the arms in terms of LRF and OS.
Conclusion-induction CT does not improve outcomes, with
the role of radiation dose escalation remaining uncertain, but
the combination of induction CT and radiation dose
escalation should be explored further.
32. Radical resection
For intermediate-stage primary anal canal cancer who -
- Cannot tolerate radiation therapy or chemoradiation
- Incontinent because of irreversible damage of the
sphincters
- Anovaginal fistula
- Prior pelvic radiation treatment (most frequently for
carcinoma of the cervix)
- Active inflammatory bowel disease affecting the rectum
or anal region
- Failure of chemoradiation or radiation and less
frequently, complications of the initial treatment.
33. SALVAGE SURGERY
Salvage Surgery
APR = abdominoperineal resection
Pelvic exenteration = multiviseral resection with urinary and
fecal diversion
Salvage surgery is recommended in patient with chronically
persistent disease or recurrence.
Salvage APR is associated with five-year survival rates from
30 to 70%,with DFS ranging from 30 to 40%.
Tumor size >5 cm, inguinal lymph node involvement, positive
surgical margin, male sex, adjacent organ involvement are the
factors associated with poor overall survival after salvage
surgery.
34. Extrapelvic metastases
Reported in up to about 10-17% of patients
Median survival time - 8 to 12 months
The combination studied most extensively, and the most
effective, is 5-FU and cisplatin.
The usual regimen is a 4- or 5-day continuous infusion of 5-
FU (1,000 mg/m2
per 24 hours) plus a bolus infusion of
cisplatin (100 mg/m2
) on day 1 or 2, repeated at 4 weekly
intervals as tumor response and toxicity permit.
35. A patient with metastatic cancer who received 12 cycles of
5-FU and cisplatin had been free of cancer for more than 3
years at the time of reporting.
Other combinations, including mitomycin and 5-FU, and
bleomycin, vincristine, and high-dose methotrexate
produced few responses.
36. Adenocarcinomas
Comprise about 5% of cancers of the anal canal.
Small female preponderance.
The majority develop in rectal mucosa, which extends
below the upper muscular boundary of the canal.
No recognized association with high-risk HPV or
immunosuppression.
The most useful prognostic factors are T category and N
category.
Overall 5-year survival rates following all treatments have
generally been less than 50%.
37. Locoregional control is problematic.
Risk of distant metastases higher than for squamous cell
cancers
Treated similarly to adenocarcinomas which arise in the
rectum with surgery remaining as a cornerstone therapy and
neoadjuvant radiation therapy or combined modality therapy
generally implimented in patients with T3 or T4 and/or N+
disease
38. Melanoma of anal canal
It’s a rare disease, 1% of all malignant melanoma & 0.5%of
all anal malignancy.
Bleeding perrectum is most common c/f.
Surgery is the cornerstone for the treatment of anal
melanoma, traditionally surgeons use more redical approach
in form of APR with radical lymphnodes dissection
Kiran et al 109 patients , reported no significant difference
b/w patient treated by APR or local resection.
39. Anal Margin Cancers
Anal margin cancers includes the area extending from the
anal verge radially 5cm outward on perianal skin.
More common in 7th
and 8th
decade with slight female
preponderance.
Treat similar to skin cancer.
WLE for T1 and N0 can be excised with a 1-cm margin.
T3 and T4 lesions- radiation to both inguinal regions and
the pelvis, along with 5-FU and mitomycin C.
APR should be reserved for patients with recurrent
disease following CTRT or recurrence not amenable to
local excision.
40. The regional nodes for the perianal skin are the inguinal
nodes.
Perirectal or pelvic node metastases are very uncommon.
The risk of inguinal node metastases is about 10%,
associated mainly with category T3 or T4 tumors, or
poorly differentiated cancers.
Elective inguinal nodal irradiation has been suggested for
those categories only.
41. Perianal Cancers
Bowen's Disease and Paget's Disease
About half the cases of anal Paget's disease are associated
with a synchronous or metachronous internal malignancy,
often a colorectal adenocarcinoma.
High local recurrence rate .
May become invasive .
Wide local excision, with intraoperative microscopic control
of margins.
42. Local recurrence can often be managed by further local
excision.
Other less-established treatments
-- Topical chemotherapy
-- Topical immune modifiers such as imiquimod
-- Photodynamic therapy.
Radiation therapy, or radiation and chemotherapy -
reserved for patients with recurrent or invasive disease in
whom adequate excision would entail sacrifice of anorectal
function.
Abdominoperineal resection may be necessary to control
extensive or recurrent disease.