Anal cancer

Abstract

Squamous cell cancer (SCC) of the anus is rare and accounts for only 2-4% of all lower alimentary tract malignancies. A multidisciplinary approach is essential with close co-operation and communication required between radiologist, surgeon, medical oncologist, radiation oncologist, pathologist and nursing specialists. An indolent natural history and a low rate of distant metastases means anal cancer is usually amenable to loco-regional treatment. Randomized controlled studies in Europe and the United States have confirmed that synchronous chemoradiation (SCRT), using mitomycin and 5-fluorouracil as the primary modality, is superior to radiotherapy alone in the treatment of anal cancer. Local control has improved but the relative 5-year survival rate has changed little for patients treated in the last two decades. The aim of this chapter is to summarize the available evidence and to define the role of imaging, chemoradiation-based, chemotherapy and surgical treatment options. We hope this chapter provides a useful and practical update. © 2011 Springer-Verlag Berlin Heidelberg.