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Anal Carcinoma
Paige Bennett, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Anal carcinoma
              • Uncommon cancer of anal canal and perianal skin, strongly associated with human papilloma virus
                • Similar risk factors to genital cancers
                • Majority are squamous cell carcinoma (adenocarcinoma rare)
                • Regional nodal metastases common
                • Distant metastases uncommon, usually liver if present
              • Above dentate line (upper 2/3 of anal canal)
                • Columnar epithelium
                  • Adenocarcinomas (rare)
                  • Treated similarly to rectal adenocarcinomas
                • Supplied by superior rectal artery
                  • Drained by portal venous circulation
                • Lymphatic drainage to perirectal and paravertebral lymph nodes
              • Below dentate line (lower 1/3 of anal canal)
                • Stratified squamous epithelium
                  • Squamous cell carcinomas
                • Supplied by inferior rectal artery
                  • Drained by systemic circulation
                • Lymphatic drainage to inguinal and femoral lymph nodes
            • Perianal skin cancers
              • Involve anal margin or perianal skin
              • Most commonly squamous cell carcinoma
              • Often treated similarly to squamous cell carcinoma of anus (chemoradiotherapy), as it is difficult to delineate anal margin vs. skin

          IMAGING

          • F-18 FDG PET/CT

            • CT

              • MR

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    • Staging, Grading, & Classification

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Ciombor KK et al: Diagnosis and diagnostic imaging of anal canal cancer. Surg Oncol Clin N Am. 26(1):45-55, 2017
                                  2. Houard C et al: Role of 18F-fluorodeoxyglucose positron emission tomography-computed tomography in post-treatment evaluation of anal carcinoma. J Nucl Med. ePub, 2017
                                  3. Gauthé M et al: Role of fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography in gastrointestinal cancers. Dig Liver Dis. 47(6):443-54, 2015
                                  4. Matalon SA et al: Anorectal cancer: critical anatomic and staging distinctions that affect use of radiation therapy. Radiographics. 35(7):2090-107, 2015
                                  5. Tonolini M et al: MRI and CT of anal carcinoma: a pictorial review. Insights Imaging. 4(1):53-62, 2013
                                  6. Shin SS et al: Preoperative staging of colorectal cancer: CT vs. integrated FDG PET/CT. Abdom Imaging. 33(3):270-7, 2008
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Definitions

                                            • Anal carcinoma
                                              • Uncommon cancer of anal canal and perianal skin, strongly associated with human papilloma virus
                                                • Similar risk factors to genital cancers
                                                • Majority are squamous cell carcinoma (adenocarcinoma rare)
                                                • Regional nodal metastases common
                                                • Distant metastases uncommon, usually liver if present
                                              • Above dentate line (upper 2/3 of anal canal)
                                                • Columnar epithelium
                                                  • Adenocarcinomas (rare)
                                                  • Treated similarly to rectal adenocarcinomas
                                                • Supplied by superior rectal artery
                                                  • Drained by portal venous circulation
                                                • Lymphatic drainage to perirectal and paravertebral lymph nodes
                                              • Below dentate line (lower 1/3 of anal canal)
                                                • Stratified squamous epithelium
                                                  • Squamous cell carcinomas
                                                • Supplied by inferior rectal artery
                                                  • Drained by systemic circulation
                                                • Lymphatic drainage to inguinal and femoral lymph nodes
                                            • Perianal skin cancers
                                              • Involve anal margin or perianal skin
                                              • Most commonly squamous cell carcinoma
                                              • Often treated similarly to squamous cell carcinoma of anus (chemoradiotherapy), as it is difficult to delineate anal margin vs. skin

                                          IMAGING

                                          • F-18 FDG PET/CT

                                            • CT

                                              • MR

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • General Features

                                                    • Staging, Grading, & Classification

                                                      CLINICAL ISSUES

                                                      • Presentation

                                                        • Demographics

                                                          • Natural History & Prognosis

                                                            • Treatment

                                                              DIAGNOSTIC CHECKLIST

                                                              • Consider

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Ciombor KK et al: Diagnosis and diagnostic imaging of anal canal cancer. Surg Oncol Clin N Am. 26(1):45-55, 2017
                                                                  2. Houard C et al: Role of 18F-fluorodeoxyglucose positron emission tomography-computed tomography in post-treatment evaluation of anal carcinoma. J Nucl Med. ePub, 2017
                                                                  3. Gauthé M et al: Role of fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography in gastrointestinal cancers. Dig Liver Dis. 47(6):443-54, 2015
                                                                  4. Matalon SA et al: Anorectal cancer: critical anatomic and staging distinctions that affect use of radiation therapy. Radiographics. 35(7):2090-107, 2015
                                                                  5. Tonolini M et al: MRI and CT of anal carcinoma: a pictorial review. Insights Imaging. 4(1):53-62, 2013
                                                                  6. Shin SS et al: Preoperative staging of colorectal cancer: CT vs. integrated FDG PET/CT. Abdom Imaging. 33(3):270-7, 2008