Join Oncology Explorers for an in-depth exploration of anal cancer workup and treatment, including the latest evidence and guidelines. Webinar will be interactive and include opportunities for audience participation and questions.
Anal Cancer
Summary
This comprehensive session conducted by experienced medical professionals explores the diagnosis and treatment of anal cancer. Participants will gain valuable knowledge on developing an appropriate workup plan for patients suspected of or diagnosed with anal cancer. They will learn how to craft apt treatment plans for both localized and metastatic anal cancer. The session also navigates through the risk factors, symptoms, and potential side effects of the disease, adding further depth to the participants' understanding. It also offers insights into various treatment strategies for metastatic anal cancer and analytical case studies. This session is a must-attend for professionals looking to bolster their expertise and deliver effective care to their patients.
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Description
Learning objectives
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Participants should be able to discuss the risk factors for the development of anal cancer, including the influence of HPV, HIV, chronic immunosuppression, sexual risk factors, and smoking.
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Participants should be able to recognize the symptoms of anal cancer, outline the necessary steps for diagnosis, including history-taking, physical exam, bloodwork, CT scan, and biopsy, and discuss the pros and cons of CT scans with or without contrast in this context.
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Participants should be able to identify the various treatment options for anal cancer based on the stage of the disease, including chemoradiation treatments such as the Wayne State/Nigro, Modified Nigro, and European/ACT-II models, and the role of cisplatin.
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Participants should be able to list potential side effects from anal cancer treatments and strategies to monitor for disease recurrence or failure after treatment.
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Participants should be able to evaluate cases of anal cancer, making decisions on the most important tests and treatments based on individual patient information.
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October 24 2024 Beatrice Preti bpreti@qmed.caBy the end of this session, participants should be able to… • Plan an appropriate workup for a patient with suspected or biopsy- confirmed anal cancer. • Plan an appropriate treatment plan for a patient with localised anal cancer. • Plan an appropriate treatment plan for a patient with metastatic anal cancer.• Assistant Professor, Emory University, Atlanta GA USA • Adjunct Professor, Western University, London ON Canada • PhD Candidate, Maastricht University, NetherlandsWhat are some risk factors for anal cancer? HPV HIV Other Sexual Risk MSM Factors Chronic Cigarette Smoking ImmunosuppressionSquamous Cell CarcinomaWhat are some symptoms of anal cancer?What tests would be included in the workup for anal cancer? History, Physical (Anoscopy), Full Tissue Biopsy Bloodwork CT Chest/Abdomen/Pelvis PET Scan (for most)HIV Testing Gynecologic Examination Fertility Counselling Poll! CT scans with or without contrast?Please write out your bloodwork order for a new patient with anal cancer .What is the treatment for localised anal cancer? Chaemoradiation Wayne State/Nigro Modified Nigro European/ACT-II Model •Infusional FU 1000 •Infusional FU 1000 •Infusional FU 1000 mg/m on days 1 mg/m on days 1 mg/m on days 1 to 4 and 29 to 32 to 4 and 29 to 32 to 4 and 29 to 32 •Mitomycin10 to •Mitоmуciո 10 •Mitοmycin12 15 mg/m on day mg/m on days 1 mg/m on day 1 1 only and 29 only (maximum 20 mg single dose) Chaemoradiation Wayne State/Nigro Modified Nigro European/ACT-II Model •Infusional FU 1000 •I28 Fractions 1000 •Infusional FU 1000 mg/m on days 1 mg(50.4 Gy)? 1 mg/m on days 1 to 4 and 29 to 32 to 4 and 29 to 32 to 4 and 29 to 32 •Mitomycin10 to •Mitоmуciո 10 •Mitοmycin12 15 mg/m on day mg/m on days 1 mg/m on day 1 1 only and 29 only (maximum 20 mg single dose) Chaemoradiation Wayne State/Nigro Modified Nigro European/ACT-II Model •Infusional FU 1000 •ICapecitabine 1000 •Infusional FU 1000 mg/m on days 1 mg/mvs 5-FUs 1 mg/m on days 1 to 4 and 29 to 32 to 4 and 29 to 32 to 4 and 29 to 32 •Mitomycin10 to •Mitоmуciո 10 •Mitοmycin12 15 mg/m on day mg/m on days 1 mg/m on day 1 1 only and 29 only (maximum 20 mg single dose)Cisplatin What are some side effects from this treatment patients might experience?HIV?Locoregional Recurrence/ Surgical Failure ResectionDREs from 8-12 weeks DRE, anoscopy, lymph node exam q3-6 months CT chest/abdo/pelvisannually x 3 yearsDREs from 8-12 weeks DRE, anoscopy, lymph node exam q3-6 months up to 26 weeks CT chest/abdo/pelvisannually x 3 yearsWhat is the treatment for metastatic anal cancer? First-Line Carboplatin + Paclitaxel First-Line Carboplatin( [AUC] 5 on day 1 every 28 days) Carboplatin + Paclitaxel + weekly расlitаxеl (80 mg/m on days 1, 8, and 15 every 28 days) Response Rate ~ 60% OS 20 mos Serious AEs ~ 36% Second-Line Nivolumab Pembrolizumab Other StudiedTherapies Cisplatin/5-FU Docetaxel + Cisplatin/5-FU Single agent (paclitaxel, irinotecan, 5-FU) Best Supportive Care FinalNote Rectal Anal Squamous Cell Adenocarcinoma Carcinoma Peri-anal Squamous CellCase 1 : Poll! • Mr J is a 35-year-old male with a new biopsy-proven anal cancer. Which of these tests would be MOST important for him?Case 2 : Poll! • Ms L completed chemoradiation for anal squamous cell carcinoma six months ago. She is complaining of increased bleeding. Anoscopy reveals local only disease recurrence. Which of these would be the most likely treatment recommended?Please write down one thing you learnt today.