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Malignant tumours of the anal canal

Malignant tumours of the anal canal. Incidence. 2% of colorectal cancer ( rare ). Uncommon tumour Usually squamous cell carcinoma It can occur at any age but common in old age. Predisposing conditions. 1-Anal condylomata caused by human papilloma virus 2- HIV infection

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Malignant tumours of the anal canal

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  1. Malignant tumours of the anal canal

  2. Incidence • 2% of colorectal cancer (rare). • Uncommon tumour • Usually squamous cell carcinoma • It can occur at any age but common in old age

  3. Predisposing conditions 1-Anal condylomata caused by human papilloma virus 2- HIV infection 3- Anal intraepithelial neoplasia (AIN). 4-Crohn's disease

  4. Pathological types 1-Squamous cell carcinoma (30%): • In relation to perianal warts ,HIV or long standing fistula in ano. 2- Basaloid carcinoma • Cloacogenic carcinoma • Non keratinized squamous cell carcinoma 3- Mucoepidermoid carcinoma

  5. 4-Basal cell carcinoma 5- Melanoma • Very poor prognosis 6- Lymphoma 7- Kaposi tumour 8-Paget's disease

  6. Clinical picture • Symptoms: 1-Rectal bleeding 2-Mucous discharge 3-Tenesmus 4-Sensation of a lump in the anus 5-Mass in the inguinal region

  7. Signs • Rectal examination • Ulcer: hard ,tender and easily bleeds • The lesion may fungate to the perianal skin or may induce anal fistula

  8. Investigations 1-For diagnosis • Biopsy is essential 2- To search for metastasis 3-For the general fitness

  9. Treatment 1- At the anal verge • Local excision with 2.5 cm safety margin • -Inguinal lymph node block dissection if there is lymph node metastasis

  10. 2- At the anal canal • Chemo-radiation • combination of chemotherapy (5.FU+mitomycin) and radiotherapy (interstitial or intracavitary) • If inguinal lymph node is involved block inguinal lymph node dissection. • Curative or help in downstaging • Abdomino perineal excision in: 1- Tumour more than 5cm 2- Failed chemo-radiation

  11. 3- Advanced cancer may in need for defunctioning colostomy

  12. Thank you

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