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Annals of Oncology 2009 20(Supplement 4):iv57-iv60; doi:10.1093/annonc/mdp129
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

ESMO clinical recommendations

Anal cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow-up

R. Glynne-Jones1, J. Northover2, J. Oliveira3 and On behalf of the ESMO Guidelines Working Group*

1 Mount Vernon Centre for Cancer Treatment, Northwood
2 St. Mark's Hospital, Harrow, UK
3 Service of Medical Oncology, Portuguese Institute of Oncology, Lisbon, Portugal

* Correspondence to: ESMO Guidelines Working Group, ESMO Head Office, Via L. Taddei 4, CH-6962 Viganello-Lugano, Switzerland; E-mail: clinicalrecommendations@esmo.org

The first 10% of the full text of this article appears below.


   incidence
 
Squamous cell cancer (SCC) of the anus is a rare disease. The annual incidence is approximately 1 in 100 000, is higher in women than in men, and is increasing. Anal cancer is strongly associated with human papilloma virus (HPV) human immunodeficiency virus (HIV), and immune suppression in transplant recipients.


   diagnosis
 
Small, early cancers are sometimes diagnosed serendipitously following the removal of anal tags. More advanced lesions present as a mass, non-healing ulcers, pain, rectal bleeding, itching, discharge and faecal incontinence.

A relevant history to elicit symptoms and predisposing factors should be documented. Proctoscopy and examination under anaesthesia facilitates biopsy. Diagnosis requires histological confirmation.

anatomic definition
The anal canal extends from the anorectal junction, through the anorectal ring and ends at the anal margin. Immediately above . . . [Full Text of this Article]

histology

   staging and risk assessment
 
general points
radiological staging

   primary treatment of anal cancer
 

   radiotherapy technique and treatment fields
 

   postoperative chemoradiation
 

   toxicity and supportive care during chemo-radiotherapy
 

   response evaluation
 

   follow-up and surveillance
 

   salvage treatment
 

   palliative treatment
 

   level of evidence
 

   appendix I
 
TNM staging

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