Anal Cancer. A Comprehensive Guide

Preface
Contents
Contributors
Chapter 1: Anatomy and Histology of the Anus
	Definitions of the Anal Canal
	Pelvic Floor and Anal Sphincter Musculature
	Innervation of Sphincter Musculature
	Histology of the Anal Canal and Perianal Skin
	Vascular Supply
	Lymphatic Drainage
	References
Chapter 2: Epidemiology and Pathogenesis of Anal Cancer
	Introduction
	Incidence of Anal Cancer
	Risk Factors for Anal Squamous Cell Carcinoma
		HPV Infection
		HIV
		Non-HIV Immunosuppression
		Cigarette Smoking
	Pathogenesis
		HPV-Positive Anal SCC
			Mechanisms of Immunity and Immune Evasion
		HPV-Negative Anal SCC
	Screening for Anal Dysplasia and Anal Cancer
		Screening Modalities
			Digital Anorectal Examination
			Anal Papanicolaou Test
			HPV Testing
			High-Resolution Anoscopy
	Management of Anal Dysplasia
		Topical Therapies
			Trichloroacetic Acid (TCA)
			5-Fluorouracil (5FU)
			Immune Modulating Therapy
			Cidofovir
		Non-topical Therapies
			Infrared Coagulation
			Electrocautery Ablation
			Cryotherapy
	Conclusion
	References
Chapter 3: Staging and Initial Evaluation of Anal Cancer
	Initial Diagnosis
	Pathologic Evaluation
	Laboratory Evaluation
	Screening for Comorbid Conditions
		Colorectal Cancer Screening
		HIV Screening
		Gynecological Cancer Screening in Females
		Genitourinary Cancer Screening in Males
	Radiographic Assessment of Primary Tumor
	Assessment of Nodal Metastases
	Assessment of Distant Metastases
	Staging
	Conclusion
	References
Chapter 4: Treatment of Localized Anal Cancer: Chemoradiotherapy
	Introduction
	Role of Surgery: Prior to and After the Introduction of Chemoradiotherapy
	Results of Nigro and Colleagues
	Chemoradiation Versus Radiation Therapy Alone
	Role of Cisplatin as an Alternative to Mitomycin C
	Role of Capecitabine as an Alternative to Infusional 5FU
	Roles of Dose Escalation and Dose De-Escalation
	The Role of Intensity-Modulated Radiation Therapy
	Details of Chemoradiation Treatment: Simulation
	Details of Chemoradiation Treatment: Planning and Daily Treatments
	Proton and Charged Particle Therapy
	Treatment of Persistent Disease
	Role of Targeted Therapies in Combination with Definitive Chemoradiation
	Ongoing and Developing Trials
	Conclusions
	References
Chapter 5: Anal Cancer: Toxicities and Management
	Introduction
	Toxicities from Surgery
	Toxicities from Chemotherapy
	Acute Toxicities from Radiation Therapy
		Dermatologic Toxicity
		Diarrhea
		Hematologic Toxicity
		Nausea
		Fatigue
		Urinary Dysfunction
		Pain
		Anorectal Dysfunction and Proctitis
	Late Toxicities from Chemoradiation
		Gastrointestinal Dysfunction
		Chronic Skin Changes
		Sexual Dysfunction
		Fistulas and/or Ulcers
		Pelvic Fractures
		Secondary Malignancies
	Conclusion
	References
Chapter 6: Management of Local-Regional Anal Cancer Recurrence
	Introduction
	Locoregional Failure
	Inguinal Nodes
	Salvage Surgery for HIV-Positive Patients
	Conclusion
	References
Chapter 7: Treatment of Advanced Anal Cancer
	Introduction
	Chemotherapy
		Platinum-Doublet Therapy for Metastatic Anal Squamous Cell Carcinoma
		Beyond Platinum-Doublet Therapy in Metastatic Anal Squamous Cell Carcinoma
	Targeted Therapy
		Anti-EGFR Antibodies in the Treatment of Metastatic Anal Squamous Cell Carcinoma
	Immunotherapy for the Treatment of Metastatic Anal Squamous Cell Carcinoma
		Checkpoint Inhibitors
		Adoptive T-Cell Transfer
		Vaccines
	Oligometastatic Disease in Anal Squamous Cell Carcinoma
	Summary
	References
Chapter 8: Treatment of Non-squamous Histologies in Anal Cancer
	Epidemiology
	Treatment of Specific Histologies
		Anal Melanoma
		Adenocarcinoma of the Anal Canal
		Neuroendocrine Tumors
		Sarcomas
		Metastatic Tumors to the Anus
	References
Chapter 9: Diagnosis and Management of Perianal Skin Tumors
	Introduction
	Anatomy and Histology of the Anoderm
	Perianal Skin Tumors
		Initial Evaluation
		Squamous Cell Carcinomas of the Perianal Skin
		Paget’s Disease
		Basal Cell Carcinoma
		Rhabdomyosarcoma
		Metastases
	Conclusion
	References
Index