Anal Cancer. A Comprehensive Guide

140 Pages·2019·3.269 MB·English

by  Jeffrey Meyer (ed.), Lisa Kachnic (ed.)

Anal Cancer
A Comprehensive Guide
Jeffrey Meyer
Lisa Kachnic
Editors
123
Anal Cancer
Jeffrey Meyer • Lisa Kachnic
Editors
Anal Cancer
A Comprehensive Guide
Editors
Jeffrey Meyer, MD, MS Lisa Kachnic, MD, FASTRO
Department of Radiation Oncology Department of Radiation Oncology
Johns Hopkins School of Medicine Vanderbilt University School of Medicine
Baltimore, MD, USA Nashville, TN, USA
ISBN 978-3-030-20252-1 ISBN 978-3-030-20253-8 (eBook)
https://doi.org/10.1007/978-3-030-20253-8
© Springer Nature Switzerland AG 2019
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
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The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
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The publisher, the authors, and the editors are safe to assume that the advice and information in this book
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This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
I dedicate this book to the many patients
that I have had the privilege to care for
during my career. They have all shaped me
into the physician and person I am today,
and I hope that I have positively touched
their lives in return.
Lisa Kachnic
Preface
A multidisciplinary team approach is paramount to the management of anal cancer;
however, due to its low incidence as compared to other solid cancers, there are lim-
ited comprehensive published treatment guidelines. This need has become increas-
ingly important over the past several years when we have seen advances in the
prevention, detection, radiation delivery, and systemic approaches including
immunotherapy.
As a result, it is currently very difficult for a clinician (either in training or in
practice) to gain experience and expertise in the multidisciplinary management of
this rare cancer. Anal Cancer: A Comprehensive Guide was created for the purpose
of centralizing the knowledge and experience of experts across a variety of disci-
plines. The authors provide an overview of the principles of disease pathogenesis,
anatomy, epidemiology, and staging, in addition to detailed established and cutting-
edge clinical approaches for the treatment of anal cancer. Foundations, current
evidence-b ased practices, and pathways for the future are the focus. Our vision is
that this book may be used to serve as a definitive and comprehensive resource for
the team-based management of all stages and histologies of anal cancer.
We thank our gracious contributors for lending their expertise toward the
improved care of our patients.
Baltimore, MD, USA Jeffrey Meyer
Nashville, TN, USA Lisa Kachnic
vii
Contents
1 Anatomy and Histology of the Anus . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Margaret H. Sundel, Lysandra Voltaggio, Ira L. Leeds,
and Sandy Hwang Fang
2 Epidemiology and Pathogenesis of Anal Cancer . . . . . . . . . . . . . . . . . 11
John David Roveda Jr and Clayton A. Smith
3 Staging and Initial Evaluation of Anal Cancer . . . . . . . . . . . . . . . . . . 33
Apar Gupta, Shang-Jui Wang, and Salma K. Jabbour
4 Treatment of Localized Anal Cancer: Chemoradiotherapy . . . . . . . . 47
James Byrne and Jennifer Y. Wo
5 Anal Cancer: Toxicities and Management . . . . . . . . . . . . . . . . . . . . . . 71
Shalini Moningi and Prajnan Das
6 Management of Local-Regional Anal Cancer Recurrence . . . . . . . . . 85
Shilpa S. Murthy and Elin R. Sigurdson
7 Treatment of Advanced Anal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Satya Das and Kristen Keon Ciombor
8 Treatment of Non-squamous Histologies in Anal Cancer . . . . . . . . . . 113
Matthew T. Ballo
9 Diagnosis and Management of Perianal Skin Tumors . . . . . . . . . . . . . 123
Monica Polcz, A. Bapsi Chakravarthy, and Christina Edwards Bailey
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
ix
Contributors
Christina  Edwards  Bailey, MD, MSCI Department of Surgery, Vanderbilt
University Medical Center, Nashville, TN, USA
Matthew T. Ballo, MD Department of Radiation Oncology, West Cancer Center,
Memphis, TN, USA
James Byrne, MD, PhD Harvard Radiation Oncology Program, Boston, MA,
USA
A. Bapsi Chakravarthy, MD, FASTRO Department of Radiation Oncology,
Vanderbilt University Medical Center, Nashville, TN, USA
Kristen  Keon  Ciombor, MD, MSCI Division of Hematology/Oncology,
Department of Internal Medicine, Vanderbilt University Medical Center, Nashville,
TN, USA
Prajnan Das, MD, MS, MPH Department of Radiation Oncology, University of
Texas MD Anderson Cancer Center, Houston, TX, USA
Satya  Das, MD Division of Hematology/Oncology, Department of Internal
Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
Sandy Hwang Fang, MD Department of Surgery, The Johns Hopkins University
School of Medicine, Baltimore, MD, USA
Apar Gupta, MD Department of Radiation Oncology, Robert Wood Johnson
University Hospital, New Brunswick, NJ, USA
Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Roberts
Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
Salma K. Jabbour, MD Department of Radiation Oncology, Robert Wood Johnson
University Hospital, New Brunswick, NJ, USA
Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Roberts
Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
xi
xii Contributors
Ira L. Leeds, MD, MBA, ScM Department of Surgery, The Johns Hopkins
University School of Medicine, Baltimore, MD, USA
Shalini Moningi, MD Department of Radiation Oncology, University of Texas
MD Anderson Cancer Center, Houston, TX, USA
Shilpa S. Murthy, MD, MPH Department of Surgical Oncology, Fox Chase
Cancer Center, Temple University, Philadelphia, PA, USA
Monica Polcz, MD Department of General Surgery, Vanderbilt University Medical
Center, Nashville, TN, USA
John David Roveda Jr, BS University of South Alabama College of Medicine,
Mobile, AL, USA
Elin R. Sigurdson, MD, PhD Department of Surgical Oncology, Fox Chase
Cancer Center, Temple University, Philadelphia, PA, USA
Clayton  A.  Smith, MD, PhD Department of Radiation Oncology, Ochsner
Medical Center, New Orleans, LA, USA
Margaret H. Sundel, BS Department of Surgery, The Johns Hopkins University
School of Medicine, Baltimore, MD, USA
Lysandra Voltaggio, MD Division of Gastrointestinal and Liver Pathology, Johns
Hopkins, Baltimore, MD, USA
Shang-Jui Wang, MD, PhD Department of Radiation Oncology, Robert Wood
Johnson University Hospital, New Brunswick, NJ, USA
Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Roberts
Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
Jennifer Y. Wo, MD Department of Radiation Oncology, Massachusetts General
Hospital, Harvard University School of Medicine, Boston, MA, USA
Chapter 1
Anatomy and Histology of the Anus
Margaret H. Sundel, Lysandra Voltaggio, Ira L. Leeds,
and Sandy Hwang Fang
Abbreviations
RAIR Rectoanal inhibitory reflex
S2–S4 Sacral nerves S2–S4
Definitions of the Anal Canal
The anal canal is the final portion of the large intestine, connecting the rectum to the
external opening of the anus. There are many ways to define the anal canal, each of
which relies on different anatomic landmarks (Table 1.1). The pelvic floor is the
muscular layer that separates the pelvic cavity from the perineal region and provides
support to the pelvic viscera. The dentate line (or pectinate line) is a visibly scal-
loped border overlying the anal columns of Morgagni, located at the embryological
transition from hindgut to proctodeum, i.e., the squamocolumnar junction. The
1–1.5 cm portion of the anal canal proximal to the dentate line is called the anal
pecten or transitional zone. The transitional zone contains a conglomeration of both
squamous epithelial cells and columnar cells. The anal sphincter complex is com-
posed of the internal and external anal sphincters. The anal verge is the terminal
portion of the anal canal, where the squamous epithelium of the canal (anoderm)
meets the perianal skin.
M. H. Sundel · I. L. Leeds · S. H. Fang (*)
Department of Surgery, The Johns Hopkins University School of Medicine,
Baltimore, MD, USA
e-mail: [email protected]; [email protected]; [email protected]
L. Voltaggio
Division of Gastrointestinal and Liver Pathology, Johns Hopkins, Baltimore, MD, USA
e-mail: [email protected]
© Springer Nature Switzerland AG 2019 1
J. Meyer, L. Kachnic (eds.), Anal Cancer,
https://doi.org/10.1007/978-3-030-20253-8_1