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Is anal cancer more prevalent in men or women?
women
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What is the average age at diagnoses of anal cancer and there is an increased incidence in me <_____years of age attributed to __________.
60 years old, 45 years due to male homosexuality and anal intercourse.
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Etiological factors of anal cancer include:
- genital warts
- genital infections
- HPV
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________% of large bowel cancers are anal cancer?
1-2%
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Clinical presentation of anal cancer includes:
- rectal bleeding
- pain
- change in bowel habits
- sensation of a mass
- rectal discharge
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Detection and/or diagnosis of anal cancer is made through:
- physical exam
- anoscopy/and or proctoscopic exam
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Once a diagnosis of anal cancer has been made, the extent of the disease is evaluated with:
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The pathology os 80% of anal cancers is ________.
squamous cell
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The dentate line is where the cells change from _____above the line and _______below the line. The _______are at the dentate line and are very important to save so that the patient will not have to have an ostomy(with a bag).
columnar, squamous, sphincters
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Staging of anal cancer is with the ______ system and is based on size and ______ of invasion.Spread is by direct extension or _______. Above the dentate line lymphatic spread goes to the________ nodes. Below the dentate line lymphtic spread is to the ______ nodes.
- TNM, depth, lymphatics,
- internal iliac nodes
- inguinal nodes
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Surgery for anal cancer is saved for _____or if chemo/radiation__________.
salvage, fails
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Treatment for anal cancer is combination of _____ and chemotherapy which includes_____ and _______.
- radiation therapy
- 5-FU, mitomycin C
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RT treatment fields for anal cancer are ____ or ___field technique with ________to the ______nodes.
RT doses alone are _______ with shrinking fields to ______. Dose chemorads is ______ with shrinking fields to ________.
- AP/PA, 4 field technique, electrons to inguinal nodes
- 60-65 Gy /45 Gy
- 45 Gy / 5940-6940 cGy
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Why are electrons used for the inguinal nodes?
Inguinal nodes are very superficial &photons are skin sparing (unless flashing). Electrons, however, deposit there energy right at the surface.
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What organs are ar risk when treated the anus with radiation therapy, and what are the tissue tolerance doses?
What is the rationale behind treating with a full bladder?
- Bladder-6000 cGy
- small bowel-4000 cGy
- Femoral heads- 5000 cGy
- When the bladder is full, it gets the small bowel out of the way. This isa good idea because the bladder can withstand more dose than the small bowel.
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RT position for treating anal cancer is supine with a marker on the _______. Borders of the treatment portal are as follows:
Superior: lower border of the _______joints.
Inferior: _____cm distal to the primary tumor
Lateral: inclusion of the _____nodes.
- anal verge
- sacroiliac
- 3 cm
- inguinal nodes
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Side effects of RT for anal cancer are severe and often the patient needs pain medication. Because of skin flash, _____ ____ is the #1 side effect and often leads to skin breakdown. Other side effects include ______ and _______due to irradiation of the small bowel, and lowered blood counts due to ____________.
- moist desquamation
- N&V Diarrhea
- Bone marrow suppression
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The anal canal is _______cm long.
3-4
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The lymph node systems involved with anal cancer are:
external and internal iliac nodes , inferior mesenteric
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STAGING for ANAL CANCER
(for info only)***not on test
T stage
T1 - 2 cm or less
T2 - 2 - 5 cm
T3 - >5 cm
T4
- invades adjacent organ, e.g. vagina, urethra, bladder. (invasion of
the rectal wall, perirectal skin, subcutaneous tissue, or sphincter
muscle is not included as T4.)
N Stage
N0 - no lymph nodes
N1 - perirectal lymph nodes
N2 - unilateral internal iliac or (unilateral) inguinal lymph nodes or both
N3 - perirectal AND inguinal lymph nodes; and/or bilateral internal iliac; and/or (bilateral) inguinal lymph nodes
- Staging
- 0 - Tis
- I - T1 N0
- II - T2-3 N0
- IIIA - T1-3 N1, T4 N0
- IIIB - T4 N1, Any N2, Any N3
- IV - M1
- Basically:
- Stages I-II: no nodes
- Stage IIIA-either spread to one node site or invasion of an ajacent organ (local spread)
- Stage IIIB-spread to two nodal sites or invasion of adjacent organ and spread to one nodal site(regional spread)
- Stage IV- metastasized
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What does IAS and EAS stand for on the picture, and what kind of cells are above and below the dentate line?
- IAS:internal anal sphincter
- EAS:esternal anal sphincter
- Above dentate line: columnar
- Below dentate line: squamous
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