Professional Documents
Culture Documents
True Epidermis
ANATOMY
The anal canal is a 4-cm-long structure that passes downward
and backward from the rectal ampulla (level of pelvic floor) to
the anus (anal verge).
The distal end of the anal canal is at the level of the anal
verge, where the groove between the internal sphincter and
the subcutaneous part of the external sphincter is palpable.
Stage IIIB T4 N1 M0
Any T N3 M0
Any T N2 M0
Stage IV Any T Any N M1
PROGNOSIS
5 y survival-
T1 — 86 percent
T2 — 86 percent
T3 — 60 percent
T4 — 45 percent
N0 — 76 percent
N+ — 54 percent
Prognostic factors
Tumor size >5 cm , lymph nodes involvement, male sex are
associated with poor prognosis.
High expression of p53 associated with decreased DFS.
Also local control rates are lower with increased p53 expression.
High level of Ki 67 – longer DFS.
Combined-Modality Treatment
Combined-modality therapy was described initially by Nigro
and coworkers.
This was a preoperative regimen inspired by reports that 5-fl
uorouracil (5-FU) potentiated the effects of radiotherapy on
garointestinal tumors.
585 patients with SCC of anal canal & perianal skin were
randomized between radiation alone and radiation
combined with chemotherapy.
The radiation dose was 45 Gy , with a boost dose of 15 to
20 GY following 6-weeks break, based on response.
5-FU (1,000 mg/m2 per 24 hours for 4 days or 750 mg/m2
per 24 hours for 5 days) by continuous peripheral
intravenous infusion in the first and final weeks of
radiation treatment, plus mitomycin (12 mg/m2) by bolus
intravenous injection on day 1 of the first course of
chemotherapy.
3 year local Failure in the primary tumor or regional lymph
nodes -(39%) of chemoradiation , (61%) of radiation alone.