Materiały źródłowe

• #1 Anal Cancer: Symptoms, Causes, Treatment & Prognosis

  https://my.clevelandclinic.org/health/diseases/6151-anal-cancer

  Anal cancer (also known as carcinoma of the anal canal) is an uncommon type of cancer that develops in your anus tissues or the lining of your anal canal. […] Healthcare providers can cure anal cancer if they detect and treat it early on. […] A healthcare provider will ask you about your symptoms, including how long you’ve had them. […] Your provider will do a digital rectal examination. They’ll do an anal Pap test or biopsy to obtain cells for a medical pathologist to examine under a microscope. […] Healthcare providers use cancer staging systems to plan treatment and set prognoses, or what you can expect to happen after treatment. […] Providers treat anal cancer with external beam radiation therapy (EBRT). […] Healthcare providers often combine chemotherapy and radiation therapy as initial anal cancer treatment.

• #2 Diagnosis and Diagnostic Imaging of Anal Canal Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10174401/

  Anal canal cancer is a relatively uncommon malignancy, with an incidence of approximately 30,000 cases annually worldwide. Owing to the unique location and anatomy of this malignancy, careful examination and diagnostic procedures are necessary for optimal staging and treatment. […] This article focuses on the underlying anatomy of the anorectal region, important imaging characteristics of the anus, common clinical presentations of anal canal cancer, and the diagnostic procedures required for adequate staging and treatment of this cancer type. […] Patients diagnosed with anal canal cancer often present with anorectal pain or bleeding, but these symptoms occur in only approximately one-half of patients. Other clinical manifestations of anal canal cancer include anorectal fullness, pruritus, and change in bowel habits.

• #3 Anal Cancer: Diagnosis

  https://livinghealthy.hawaiipacifichealth.org/Wellness/Cholesterol/34,18978-2

  If your healthcare provider thinks you might have anal cancer, certain exams and tests will be needed to be sure. Diagnosing anal cancer starts with your healthcare provider asking you questions. You’ll be asked about your health history, your symptoms, risk factors, and family history of disease. […] A physical exam will be done. This includes a digital rectal exam (DRE). During a DRE, your healthcare provider puts a gloved, lubricated finger into your rectum. The inside of the anus and the lower part of your rectum can be checked. Tissue changes might be felt, like hard or lumpy areas. […] If your healthcare provider feels anything abnormal during a DRE, or if you have symptoms that could be caused by anal cancer, tests will be done to learn more. One or more of these tests might be used:

• #4 Anal Cancer Symptoms, Diagnosis and Treatment | Froedtert & MCW

  https://www.froedtert.com/anal-cancer-symptoms-treatment

  Anal cancer is considered rare. […] Anal cancer develops when cancer cells form in the tissues of the anus or anal canal (the tube at the end of the rectum) and start growing and dividing in an uncontrolled way. […] That makes early detection especially important. […] Tests used to diagnose anal cancer include a rectal exam, anoscopy (exam that looks inside your anus with a special scope), and imaging with a CT scan, an MRI and often, a PET scan. […] An accurate diagnosis from the start is essential in choosing the best treatment options for anal cancer. […] If you’re at increased risk, talk with your doctor about getting an anal cancer screening, which involves a swab of the anal lining. […] If something concerning is found with screening, most anal cancers will be diagnosed by having a tissue biopsy taken.

• #5 Diagnosis and Diagnostic Imaging of Anal Canal Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10174401/

  Anal canal cancer is a relatively uncommon malignancy, with an incidence of approximately 30,000 cases annually worldwide. Owing to the unique location and anatomy of this malignancy, careful examination and diagnostic procedures are necessary for optimal staging and treatment. […] This article focuses on the underlying anatomy of the anorectal region, important imaging characteristics of the anus, common clinical presentations of anal canal cancer, and the diagnostic procedures required for adequate staging and treatment of this cancer type. […] Patients diagnosed with anal canal cancer often present with anorectal pain or bleeding, but these symptoms occur in only approximately one-half of patients. Other clinical manifestations of anal canal cancer include anorectal fullness, pruritus, and change in bowel habits.

• #6 Anal cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-cancer/diagnosis-treatment/drc-20354146

  Tests and procedures used to diagnose anal cancer include: […] During a digital rectal exam, a healthcare professional inserts a gloved, lubricated finger into your anus. The health professional feels the anal canal and rectum for growths or other signs of cancer. […] During an anoscopy, a healthcare professional inserts a thin, flexible tube with a light through the anal canal and rectum. This tube is called an anoscope. A lens on the anoscope allows a healthcare professional to examine the inside of the anal canal. […] Imaging tests make pictures of the body. They can show the location and size of the cancer. Tests might include ultrasound, X-ray, MRI, CT scan and positron emission tomography scan, which also is called a PET scan. […] A biopsy is a procedure to remove a sample of tissue for testing in a lab. The sample is often collected during an anoscopy. Special tools can go through the anoscope to collect the cells. The sample is tested in a lab to see if it is cancer. Other special tests give more details about the cancer cells. Your healthcare team uses this information to make a treatment plan.

• #7 Anal Cancer: Diagnosis

  https://healthlibrary.orovillehospital.com/Library/DiseasesConditions/Pediatric/Infectious/34,18978-2

  How is anal cancer diagnosed? If your healthcare provider thinks you might have anal cancer, certain exams and tests will be needed to be sure. Diagnosing anal cancer starts with your healthcare provider asking you questions. You’ll be asked about your health history, your symptoms, risk factors, and family history of disease. […] A physical exam will be done. This includes a digital rectal exam (DRE). During a DRE, your healthcare provider puts a gloved, lubricated finger into your rectum. The inside of the anus and the lower part of your rectum can be checked. Tissue changes might be felt, like hard or lumpy areas. […] If your healthcare provider feels anything abnormal during a DRE, or if you have symptoms that could be caused by anal cancer, tests will be done to learn more. One or more of these tests might be used:

• #8 Anal Cancer: Diagnosis

  https://livinghealthy.hawaiipacifichealth.org/Wellness/Cholesterol/34,18978-2

  If your healthcare provider thinks you might have anal cancer, certain exams and tests will be needed to be sure. Diagnosing anal cancer starts with your healthcare provider asking you questions. You’ll be asked about your health history, your symptoms, risk factors, and family history of disease. […] A physical exam will be done. This includes a digital rectal exam (DRE). During a DRE, your healthcare provider puts a gloved, lubricated finger into your rectum. The inside of the anus and the lower part of your rectum can be checked. Tissue changes might be felt, like hard or lumpy areas. […] If your healthcare provider feels anything abnormal during a DRE, or if you have symptoms that could be caused by anal cancer, tests will be done to learn more. One or more of these tests might be used:

• #9 Anal cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-cancer/diagnosis-treatment/drc-20354146

  Tests and procedures used to diagnose anal cancer include: […] During a digital rectal exam, a healthcare professional inserts a gloved, lubricated finger into your anus. The health professional feels the anal canal and rectum for growths or other signs of cancer. […] During an anoscopy, a healthcare professional inserts a thin, flexible tube with a light through the anal canal and rectum. This tube is called an anoscope. A lens on the anoscope allows a healthcare professional to examine the inside of the anal canal. […] Imaging tests make pictures of the body. They can show the location and size of the cancer. Tests might include ultrasound, X-ray, MRI, CT scan and positron emission tomography scan, which also is called a PET scan. […] A biopsy is a procedure to remove a sample of tissue for testing in a lab. The sample is often collected during an anoscopy. Special tools can go through the anoscope to collect the cells. The sample is tested in a lab to see if it is cancer. Other special tests give more details about the cancer cells. Your healthcare team uses this information to make a treatment plan.

• #10 Anal Cancer: Diagnosis

  https://healthlibrary.brighamandwomens.org/Search/34,18978-2?TRILIBIS_EMULATOR_UA=nghts+%3Fcmp%3Dhrgn

  Anoscopy. For this test, your healthcare provider puts a short, lighted tube (called an anoscope) into your anus to look at it and the lining of your lower rectum. The tube is about 3 to 4 inches long. It’s lubricated before it’s put in. You’re awake for this, and it usually doesn’t hurt. […] Proctoscopy. This test is done using a longer lighted tool (a proctoscope) to look at the inside of your anus and rectum. The lower part of your large intestine (called the sigmoid colon) can also be seen. The proctoscope is about 10 inches long. Again, the tube is lubricated before it’s put in. You may need to use laxatives to empty your bowels before this test. Medicines might be used to make you sleepy during a proctoscopy. Sometimes tiny pieces of changed tissue can be taken out with tools inside the proctoscope. This is called a biopsy.

• #11 Anal Cancer: Diagnosis

  https://healthlibrary.brighamandwomens.org/Search/34,18978-2?TRILIBIS_EMULATOR_UA=nghts+%3Fcmp%3Dhrgn

  Anoscopy. For this test, your healthcare provider puts a short, lighted tube (called an anoscope) into your anus to look at it and the lining of your lower rectum. The tube is about 3 to 4 inches long. It’s lubricated before it’s put in. You’re awake for this, and it usually doesn’t hurt. […] Proctoscopy. This test is done using a longer lighted tool (a proctoscope) to look at the inside of your anus and rectum. The lower part of your large intestine (called the sigmoid colon) can also be seen. The proctoscope is about 10 inches long. Again, the tube is lubricated before it’s put in. You may need to use laxatives to empty your bowels before this test. Medicines might be used to make you sleepy during a proctoscopy. Sometimes tiny pieces of changed tissue can be taken out with tools inside the proctoscope. This is called a biopsy.

• #12 Anal Cancer: Diagnosis

  https://healthlibrary.brighamandwomens.org/Search/34,18978-2?TRILIBIS_EMULATOR_UA=nghts+%3Fcmp%3Dhrgn

  Colonoscopy. This test uses a longer flexible tube that can see the anus, rectum, and entire colon. You will need to take laxatives before this test to clean out the colon. And you will typically be given medicine to make you sleepy so you will not feel anything. Biopsies can be taken through the endoscope if anything suspicious is seen. […] Biopsy. If your provider sees any tissue changes that could be cancer, a biopsy may be needed. During a biopsy, your provider takes a small piece (called a sample) of tissue from your anus. The tissue is sent to a lab. There, its checked under a microscope and tests are done by a pathologist. This is a doctor who specializes in diagnosing diseases by looking at body tissues and fluids. A biopsy is the only way to know for sure if a change seen in the anus is cancer (malignant) or not cancer (benign).

• #13 Anal Cancer: Diagnosis

  https://livinghealthy.hawaiipacifichealth.org/Wellness/Cholesterol/34,18978-2

  If your healthcare provider thinks you might have anal cancer, certain exams and tests will be needed to be sure. Diagnosing anal cancer starts with your healthcare provider asking you questions. You’ll be asked about your health history, your symptoms, risk factors, and family history of disease. […] A physical exam will be done. This includes a digital rectal exam (DRE). During a DRE, your healthcare provider puts a gloved, lubricated finger into your rectum. The inside of the anus and the lower part of your rectum can be checked. Tissue changes might be felt, like hard or lumpy areas. […] If your healthcare provider feels anything abnormal during a DRE, or if you have symptoms that could be caused by anal cancer, tests will be done to learn more. One or more of these tests might be used:

• #14 Tests for Anal Cancer | Diagnosing Anal Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/anal-cancer/detection-diagnosis-staging/how-diagnosed.html

  Some people at high risk for anal cancer are diagnosed by screening tests, such as the digital rectal exam and/or anal Pap test. […] If anal cancer is suspected, exams and tests will be needed to confirm the diagnosis. If cancer is found, more tests will be done to help determine the extent (stage) of the cancer. […] If a change or growth is seen during an endoscopic exam, your doctor will need to take out a piece of it to see if it’s cancer. This is called a biopsy. […] Biopsies may be needed to check for cancer spread to nearby lymph nodes. […] Imaging tests might be done for a number of reasons both before and after a diagnosis of anal cancer, including: To help find cancer, To learn how far cancer has spread, To help see if treatment is working, To look for signs of cancer coming back after treatment.

• #15 Anal cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-cancer/diagnosis-treatment/drc-20354146

  Tests and procedures used to diagnose anal cancer include: […] During a digital rectal exam, a healthcare professional inserts a gloved, lubricated finger into your anus. The health professional feels the anal canal and rectum for growths or other signs of cancer. […] During an anoscopy, a healthcare professional inserts a thin, flexible tube with a light through the anal canal and rectum. This tube is called an anoscope. A lens on the anoscope allows a healthcare professional to examine the inside of the anal canal. […] Imaging tests make pictures of the body. They can show the location and size of the cancer. Tests might include ultrasound, X-ray, MRI, CT scan and positron emission tomography scan, which also is called a PET scan. […] A biopsy is a procedure to remove a sample of tissue for testing in a lab. The sample is often collected during an anoscopy. Special tools can go through the anoscope to collect the cells. The sample is tested in a lab to see if it is cancer. Other special tests give more details about the cancer cells. Your healthcare team uses this information to make a treatment plan.

• #16 Anal Cancer: Diagnosis

  https://healthlibrary.brighamandwomens.org/Search/34,18978-2?TRILIBIS_EMULATOR_UA=nghts+%3Fcmp%3Dhrgn

  Colonoscopy. This test uses a longer flexible tube that can see the anus, rectum, and entire colon. You will need to take laxatives before this test to clean out the colon. And you will typically be given medicine to make you sleepy so you will not feel anything. Biopsies can be taken through the endoscope if anything suspicious is seen. […] Biopsy. If your provider sees any tissue changes that could be cancer, a biopsy may be needed. During a biopsy, your provider takes a small piece (called a sample) of tissue from your anus. The tissue is sent to a lab. There, its checked under a microscope and tests are done by a pathologist. This is a doctor who specializes in diagnosing diseases by looking at body tissues and fluids. A biopsy is the only way to know for sure if a change seen in the anus is cancer (malignant) or not cancer (benign).

• #17 Tests for Anal Cancer | Diagnosing Anal Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/anal-cancer/detection-diagnosis-staging/how-diagnosed.html

  Some people at high risk for anal cancer are diagnosed by screening tests, such as the digital rectal exam and/or anal Pap test. […] If anal cancer is suspected, exams and tests will be needed to confirm the diagnosis. If cancer is found, more tests will be done to help determine the extent (stage) of the cancer. […] If a change or growth is seen during an endoscopic exam, your doctor will need to take out a piece of it to see if it’s cancer. This is called a biopsy. […] Biopsies may be needed to check for cancer spread to nearby lymph nodes. […] Imaging tests might be done for a number of reasons both before and after a diagnosis of anal cancer, including: To help find cancer, To learn how far cancer has spread, To help see if treatment is working, To look for signs of cancer coming back after treatment.

• #18 Anal Cancer Diagnosis | Sarah Cannon

  https://sarahcannon.com/for-patients/learn-about-cancer/anal-cancer/diagnosis.dot

  Anal cancer does not always have symptoms. However, anal cancers form in a part of your body that the doctor can see and reach easily. A rectal exam can find many anal cancers. In this exam, your doctor will insert a gloved finger into the anus. He or she will be checking for lumps or growths. […] Your doctor may also do an anal Pap test. This is similar to the Pap smear done to check for cervical cancer in women. In the anal Pap, your doctor swabs the lining of the anus. Then he or she looks at the cells under the microscope. This test is often done routinely for people who are high risk for anal cancer. […] If your doctor finds something suspicious, you may need to have a biopsy. […] In order to make a cancer diagnosis, a doctor needs to collect a sample of the tumor cells to be tested and examined in a lab by a pathologist. A pathologist is a doctor who identifies cancer and other diseases by studying cells under a microscope. After the pathologist studies a sample, he or she prepares a pathology report that explains the findings. Doctors use these reports to diagnose and stage cancer.

• #19 Anal cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-cancer/diagnosis-treatment/drc-20354146

  If you’re diagnosed with anal cancer, you may have other tests to see if the cancer has spread. These tests help your healthcare team find out the extent of your cancer, also called the stage. Cancer staging tests often involve imaging tests. The tests might look for signs of cancer in your lymph nodes or in other parts of your body. Your healthcare team uses the results of your cancer staging tests to help create your treatment plan. […] The stages of anal cancer range from 1 to 4. The lowest number means that the cancer is small and only in the anal canal. A higher stage means the cancer is more advanced. A stage 4 anal cancer has spread to other areas of the body.

• #20 Tests for Anal Cancer | Diagnosing Anal Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/anal-cancer/detection-diagnosis-staging/how-diagnosed.html

  Some people at high risk for anal cancer are diagnosed by screening tests, such as the digital rectal exam and/or anal Pap test. […] If anal cancer is suspected, exams and tests will be needed to confirm the diagnosis. If cancer is found, more tests will be done to help determine the extent (stage) of the cancer. […] If a change or growth is seen during an endoscopic exam, your doctor will need to take out a piece of it to see if it’s cancer. This is called a biopsy. […] Biopsies may be needed to check for cancer spread to nearby lymph nodes. […] Imaging tests might be done for a number of reasons both before and after a diagnosis of anal cancer, including: To help find cancer, To learn how far cancer has spread, To help see if treatment is working, To look for signs of cancer coming back after treatment.

• #21 Tests for Anal Cancer | Diagnosing Anal Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/anal-cancer/detection-diagnosis-staging/how-diagnosed.html

  CT scans use x-rays to make detailed cross-sectional images of your body. This is a common test for people with anal cancer. This test can help tell if the cancer has spread into the lymph nodes or to other parts of the body, such as the liver, lungs, or other organs. […] MRI can also be used to look at abnormal areas in the liver or the brain and spinal cord that could be cancer spread. […] PET/CT scans can be useful: If your doctor thinks the cancer might have spread but doesn’t know where. They can show spread of cancer to the liver, bones, lymph nodes in the pelvis, or other organs.

• #22 Anal Cancer – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/anal-cancer

  Computed Tomography (CT) of the Abdomen and Pelvis: CT uses x-rays to determine the amount of cancer spread and to create pictures of the chest, abdomen, and pelvis. […] PET/CT: Positron emission tomography (PET) is a type of nuclear medicine scan that uses a small amount of radioactive material to image body functions. […] Anal cancer is curable when found early. Treatment options depend on the: type of cancer cell present, stage of the cancer, tumor location, patient’s human immunodeficiency virus (HIV) status, recurrence of the cancer following treatment, patient’s preference and overall health. […] The primary goal of treatment is to cure the disease and preserve anal function with the best possible quality of life. […] There are two types of standard treatment for anal cancer of the anal canal: radiation therapy and chemotherapy.

• #23 Anal Cancer – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/tumors-of-the-gastrointestinal-tract/anal-cancer

  Anal cancer accounts for an estimated 9760 cases and about 1870 deaths in the United States annually. The main symptom is bleeding with defecation. Diagnosis is by endoscopy. […] Diagnosis of Anal Cancer: Sigmoidoscopy or colonoscopy, Biopsy. A flexible sigmoidoscopy or rigid anoscopy or sigmoidoscopy is done to evaluate the area. Skin biopsy by a dermatologist or surgeon might be needed for lesions near the squamocolumnar junction (Z line). Whenever rectal bleeding occurs, even in patients with obvious hemorrhoids or known diverticular disease, coexisting cancer must be ruled out. Once anal cancer is diagnosed, staging by CT of the chest, abdomen, and pelvis; MRI; or positron emission tomography (PET) is required to rule out metastatic disease.

• #24 Anal Cancer – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/anal-cancer

  Anal cancer, also known as anal carcinoma, is cancer of the anus. To help diagnose this condition, your doctor will perform a digital rectal exam and anoscopy. Your doctor may also order an MRI, CT, PET/CT, or an endoanal ultrasound. […] To diagnose the cause of symptoms, your doctor may perform: Digital Rectal Exam (DRE): This test examines the lower rectum and the prostate gland in males to check for abnormalities in size, shape, or texture. […] Anoscopy: This procedure uses a special camera at the end of a tube that allows the doctor to see inside the anus and rectum. […] Magnetic Resonance Imaging (MRI) of the Pelvis: MRI uses a magnetic field and radiofrequency pulses to produce detailed pictures of the internal organs. […] Endoanal ultrasound: This imaging procedure uses high frequency sound waves generated from a device inserted into the anus and rectum.

• #25 Diagnosis and Diagnostic Imaging of Anal Canal Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10174401/

  Further information about the primary tumor, such as anal cancer size, depth, sphincter involvement, and local lymph node involvement, can be elicited from endoanal ultrasound or MRI, if desired. […] With respect to MRI, the recent widespread success of this imaging modality for rectal cancer staging could benefit anal cancer staging given the similar tumor location. […] Once evaluation of the primary tumor has been completed, computed tomography of the chest, abdomen, and pelvis should be performed to evaluate for lymphadenopathy and distant metastasis. […] 18F-fluorodeoxyglucose PET/computed tomography can also identify suspicious lymph nodes or distant metastases not detected by physical examination, and pretreatment PET/computed tomography maximum standardized uptake value is strongly associated with primary tumor stage and histology.

• #26 Diagnosis and Diagnostic Imaging of Anal Canal Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10174401/

  In addition to imaging, patients with a new diagnosis of anal cancer should undergo basic laboratory studies, including a complete blood count, renal and hepatic function tests, and HIV status, if not already known. […] Staging of anal canal cancers follows the American Joint Committee on Cancer/Union Internationale Contre le Cancer system and is determined by size of the primary tumor, presence of local invasion, presence of regional lymphadenopathy, and presence of metastatic disease. […] Staging clearly impacts necessary treatment and prognosis in this tumor type. […] Primary invasive anal cancer is readily depicted on high-resolution MRI as an intermediate signal intensity mass. […] Because chemoradiotherapy is the mainstay of treatment, an accurate anatomic depiction of the radial as well as craniocaudal extent of tumor enables optimal radiotherapy planning and permits a baseline series of imaging for comparison with posttreatment scans to verify response and to monitor the treated tumor and nodal deposits for any suspected recurrence.

• #27 Diagnosis and Diagnostic Imaging of Anal Canal Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10174401/

  In addition to imaging, patients with a new diagnosis of anal cancer should undergo basic laboratory studies, including a complete blood count, renal and hepatic function tests, and HIV status, if not already known. […] Staging of anal canal cancers follows the American Joint Committee on Cancer/Union Internationale Contre le Cancer system and is determined by size of the primary tumor, presence of local invasion, presence of regional lymphadenopathy, and presence of metastatic disease. […] Staging clearly impacts necessary treatment and prognosis in this tumor type. […] Primary invasive anal cancer is readily depicted on high-resolution MRI as an intermediate signal intensity mass. […] Because chemoradiotherapy is the mainstay of treatment, an accurate anatomic depiction of the radial as well as craniocaudal extent of tumor enables optimal radiotherapy planning and permits a baseline series of imaging for comparison with posttreatment scans to verify response and to monitor the treated tumor and nodal deposits for any suspected recurrence.

• #28 Anal Cancer – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/anal-cancer

  Computed Tomography (CT) of the Abdomen and Pelvis: CT uses x-rays to determine the amount of cancer spread and to create pictures of the chest, abdomen, and pelvis. […] PET/CT: Positron emission tomography (PET) is a type of nuclear medicine scan that uses a small amount of radioactive material to image body functions. […] Anal cancer is curable when found early. Treatment options depend on the: type of cancer cell present, stage of the cancer, tumor location, patient’s human immunodeficiency virus (HIV) status, recurrence of the cancer following treatment, patient’s preference and overall health. […] The primary goal of treatment is to cure the disease and preserve anal function with the best possible quality of life. […] There are two types of standard treatment for anal cancer of the anal canal: radiation therapy and chemotherapy.

• #29 Anal Cancer Diagnosis | Roswell Park Comprehensive Cancer Center – Buffalo, NY

  https://www.roswellpark.org/cancer/anal/diagnosis

  Computed Tomography (CT): A series of detailed pictures are taken from various angles and put together by a computer to offer a detailed picture inside the body. […] Magnetic resonance imaging (MRI): A type of imaging that uses a magnet, radio waves and a computer to create a picture inside the body. […] Abdominal/Pelvic CT or MRI: For cases of anal cancer this determines extent of disease and whether other organs or lymph nodes are involved. […] Chest CT: This determines if cancer has spread to the lungs. […] Positron Emission Tomography (PET): A small amount of radioactive glucose or sugar is injected and the PET scanner can picture where glucose is being used in the body. […] Fine needle aspiration biopsy: Determines whether lymph nodes contain cancer. […] Human immunodeficiency virus (HIV) testing: HIV positive people are more likely to develop anal cancer, and more likely to relapse after treatment.

• #30 Diagnosis and Diagnostic Imaging of Anal Canal Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10174401/

  Further information about the primary tumor, such as anal cancer size, depth, sphincter involvement, and local lymph node involvement, can be elicited from endoanal ultrasound or MRI, if desired. […] With respect to MRI, the recent widespread success of this imaging modality for rectal cancer staging could benefit anal cancer staging given the similar tumor location. […] Once evaluation of the primary tumor has been completed, computed tomography of the chest, abdomen, and pelvis should be performed to evaluate for lymphadenopathy and distant metastasis. […] 18F-fluorodeoxyglucose PET/computed tomography can also identify suspicious lymph nodes or distant metastases not detected by physical examination, and pretreatment PET/computed tomography maximum standardized uptake value is strongly associated with primary tumor stage and histology.

• #31 Diagnosis and Diagnostic Imaging of Anal Canal Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10174401/

  Further information about the primary tumor, such as anal cancer size, depth, sphincter involvement, and local lymph node involvement, can be elicited from endoanal ultrasound or MRI, if desired. […] With respect to MRI, the recent widespread success of this imaging modality for rectal cancer staging could benefit anal cancer staging given the similar tumor location. […] Once evaluation of the primary tumor has been completed, computed tomography of the chest, abdomen, and pelvis should be performed to evaluate for lymphadenopathy and distant metastasis. […] 18F-fluorodeoxyglucose PET/computed tomography can also identify suspicious lymph nodes or distant metastases not detected by physical examination, and pretreatment PET/computed tomography maximum standardized uptake value is strongly associated with primary tumor stage and histology.

• #32 Anal Cancer – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/anal-cancer

  Anal cancer, also known as anal carcinoma, is cancer of the anus. To help diagnose this condition, your doctor will perform a digital rectal exam and anoscopy. Your doctor may also order an MRI, CT, PET/CT, or an endoanal ultrasound. […] To diagnose the cause of symptoms, your doctor may perform: Digital Rectal Exam (DRE): This test examines the lower rectum and the prostate gland in males to check for abnormalities in size, shape, or texture. […] Anoscopy: This procedure uses a special camera at the end of a tube that allows the doctor to see inside the anus and rectum. […] Magnetic Resonance Imaging (MRI) of the Pelvis: MRI uses a magnetic field and radiofrequency pulses to produce detailed pictures of the internal organs. […] Endoanal ultrasound: This imaging procedure uses high frequency sound waves generated from a device inserted into the anus and rectum.

• #33 Diagnosis and Diagnostic Imaging of Anal Canal Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10174401/

  Further information about the primary tumor, such as anal cancer size, depth, sphincter involvement, and local lymph node involvement, can be elicited from endoanal ultrasound or MRI, if desired. […] With respect to MRI, the recent widespread success of this imaging modality for rectal cancer staging could benefit anal cancer staging given the similar tumor location. […] Once evaluation of the primary tumor has been completed, computed tomography of the chest, abdomen, and pelvis should be performed to evaluate for lymphadenopathy and distant metastasis. […] 18F-fluorodeoxyglucose PET/computed tomography can also identify suspicious lymph nodes or distant metastases not detected by physical examination, and pretreatment PET/computed tomography maximum standardized uptake value is strongly associated with primary tumor stage and histology.

• #34 Anal cancer | Causes, Symptoms & Treatments | Cancer Council

  https://www.cancer.org.au/cancer-information/types-of-cancer/anal-cancer

  Anal cancer is a rare cancer. […] Tests to diagnose anal cancer may include: […] The doctor will conduct a digital anorectal examination (DARE) by inserting a gloved finger into your anus to check for any swelling or lumps. […] Your doctor will insert a narrow instrument called a sigmoidoscope or colonoscope into your anus to see the lining of the anal canal and to take a tissue sample (biopsy) that will be sent to a laboratory for testing. […] If anal cancer is detected, you may have scans to see if the cancer has spread to other parts of your body. […] A magnetic resonance imaging (MRI) scan uses a powerful magnet and radio waves to create 3D pictures of areas inside the body. […] An ultrasound probe is inserted through the anus into your rectum. […] A computerised tomography (CT) scan uses x-rays and a computer to create a detailed picture of an area inside the body. […] After a diagnosis of anal cancer, you may feel upset, confused, anxious or upset. […] Anal cancer is rare so your specialist will probably recommend treatment in a specialist centre by a range of health professionals.

• #35 Diagnosis and Diagnostic Imaging of Anal Canal Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10174401/

  In addition to imaging, patients with a new diagnosis of anal cancer should undergo basic laboratory studies, including a complete blood count, renal and hepatic function tests, and HIV status, if not already known. […] Staging of anal canal cancers follows the American Joint Committee on Cancer/Union Internationale Contre le Cancer system and is determined by size of the primary tumor, presence of local invasion, presence of regional lymphadenopathy, and presence of metastatic disease. […] Staging clearly impacts necessary treatment and prognosis in this tumor type. […] Primary invasive anal cancer is readily depicted on high-resolution MRI as an intermediate signal intensity mass. […] Because chemoradiotherapy is the mainstay of treatment, an accurate anatomic depiction of the radial as well as craniocaudal extent of tumor enables optimal radiotherapy planning and permits a baseline series of imaging for comparison with posttreatment scans to verify response and to monitor the treated tumor and nodal deposits for any suspected recurrence.

• #36 Anal Cancer Diagnosis | Sarah Cannon

  https://sarahcannon.com/for-patients/learn-about-cancer/anal-cancer/diagnosis.dot

  Once anal cancer has been diagnosed, it’s important to know the stage of the cancer. The stage indicates how serious it is. The stage of anal cancer depends on the size of the cancer, lymph node involvement, and if there is any distant spread of the tumor. Knowing the stage helps the doctor plan the right course of treatment. A pathologist determines the stage by looking at the cells that are collected during the biopsy process. […] The TNM staging system is used for all types of cancer, not just anal cancer. The letters TNM describe the amount and spread of cancer in the body. For anal cancer, T indicates how far the tumor penetrates into the anal wall, N indicates whether the cancer has spread to surrounding lymph nodes, and M indicates metastasis, which means that cancer has spread to other body parts.

• #37 Diagnosis of anal cancer | About bowel cancer | Bowel Cancer UK

  https://www.bowelcanceruk.org.uk/about-bowel-cancer/anal-cancer/diagnosis-and-staging-of-anal-cancer/

  Knowing what stage a cancer is at will help the doctors decide on the most appropriate treatment pathway for you. […] Doctors assign the stage of the cancer by combining the T, N, M. […] Stage 1: the cancer only affects the anus and is smaller than 2cm in size. It has not begun to spread into the sphincter muscle. […] Stage 2: the cancer is bigger than 2cm in size, but has not spread into the lymph nodes or other parts of the body. […] Stage 3: the cancer is larger than 5cm and has spread into the lymph nodes, or to nearby organs such as the vagina or bladder. […] Stage 4: the cancer has spread to other more distant parts of the body, e.g. the liver.

• #38 Diagnosis of anal cancer | About bowel cancer | Bowel Cancer UK

  https://www.bowelcanceruk.org.uk/about-bowel-cancer/anal-cancer/diagnosis-and-staging-of-anal-cancer/

  Knowing what stage a cancer is at will help the doctors decide on the most appropriate treatment pathway for you. […] Doctors assign the stage of the cancer by combining the T, N, M. […] Stage 1: the cancer only affects the anus and is smaller than 2cm in size. It has not begun to spread into the sphincter muscle. […] Stage 2: the cancer is bigger than 2cm in size, but has not spread into the lymph nodes or other parts of the body. […] Stage 3: the cancer is larger than 5cm and has spread into the lymph nodes, or to nearby organs such as the vagina or bladder. […] Stage 4: the cancer has spread to other more distant parts of the body, e.g. the liver.

• #39 Diagnosis of anal cancer | About bowel cancer | Bowel Cancer UK

  https://www.bowelcanceruk.org.uk/about-bowel-cancer/anal-cancer/diagnosis-and-staging-of-anal-cancer/

  Knowing what stage a cancer is at will help the doctors decide on the most appropriate treatment pathway for you. […] Doctors assign the stage of the cancer by combining the T, N, M. […] Stage 1: the cancer only affects the anus and is smaller than 2cm in size. It has not begun to spread into the sphincter muscle. […] Stage 2: the cancer is bigger than 2cm in size, but has not spread into the lymph nodes or other parts of the body. […] Stage 3: the cancer is larger than 5cm and has spread into the lymph nodes, or to nearby organs such as the vagina or bladder. […] Stage 4: the cancer has spread to other more distant parts of the body, e.g. the liver.

• #40 Anal Cancer | Huntsman Cancer Institute | University of Utah Health

  https://healthcare.utah.edu/huntsmancancerinstitute/gi-cancer/anal-cancer

  These are the stages of anal cancer: […] Stage 0 cancers are often called carcinoma in situ. For anal cancer, stage 0 means there are abnormal cells on the innermost lining of the anus. These abnormal cells may become cancer cells and spread. […] Cancer cells have formed and the tumor is 2 centimeters or smaller. […] The tumor is larger than 2 centimeters. […] The cancer has spread to lymph nodes or nearby organs. […] The cancer has spread to distant parts of the body such as the liver or lungs. […] When cancer spreads from where it started to another part of the body, it is called metastasis. These metastatic cancer cells are the same type of cancer as the primary tumor. For example, if anal cancer spreads to the bone, the cancer cells in the bone are actually anal cancer cells. The disease is metastatic anal cancer, not bone cancer.

• #41 Diagnosis of anal cancer | About bowel cancer | Bowel Cancer UK

  https://www.bowelcanceruk.org.uk/about-bowel-cancer/anal-cancer/diagnosis-and-staging-of-anal-cancer/

  Knowing what stage a cancer is at will help the doctors decide on the most appropriate treatment pathway for you. […] Doctors assign the stage of the cancer by combining the T, N, M. […] Stage 1: the cancer only affects the anus and is smaller than 2cm in size. It has not begun to spread into the sphincter muscle. […] Stage 2: the cancer is bigger than 2cm in size, but has not spread into the lymph nodes or other parts of the body. […] Stage 3: the cancer is larger than 5cm and has spread into the lymph nodes, or to nearby organs such as the vagina or bladder. […] Stage 4: the cancer has spread to other more distant parts of the body, e.g. the liver.

• #42 Diagnosis and Diagnostic Imaging of Anal Canal Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10174401/

  In addition to imaging, patients with a new diagnosis of anal cancer should undergo basic laboratory studies, including a complete blood count, renal and hepatic function tests, and HIV status, if not already known. […] Staging of anal canal cancers follows the American Joint Committee on Cancer/Union Internationale Contre le Cancer system and is determined by size of the primary tumor, presence of local invasion, presence of regional lymphadenopathy, and presence of metastatic disease. […] Staging clearly impacts necessary treatment and prognosis in this tumor type. […] Primary invasive anal cancer is readily depicted on high-resolution MRI as an intermediate signal intensity mass. […] Because chemoradiotherapy is the mainstay of treatment, an accurate anatomic depiction of the radial as well as craniocaudal extent of tumor enables optimal radiotherapy planning and permits a baseline series of imaging for comparison with posttreatment scans to verify response and to monitor the treated tumor and nodal deposits for any suspected recurrence.

• #43 Diagnosis and Diagnostic Imaging of Anal Canal Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10174401/

  In addition to imaging, patients with a new diagnosis of anal cancer should undergo basic laboratory studies, including a complete blood count, renal and hepatic function tests, and HIV status, if not already known. […] Staging of anal canal cancers follows the American Joint Committee on Cancer/Union Internationale Contre le Cancer system and is determined by size of the primary tumor, presence of local invasion, presence of regional lymphadenopathy, and presence of metastatic disease. […] Staging clearly impacts necessary treatment and prognosis in this tumor type. […] Primary invasive anal cancer is readily depicted on high-resolution MRI as an intermediate signal intensity mass. […] Because chemoradiotherapy is the mainstay of treatment, an accurate anatomic depiction of the radial as well as craniocaudal extent of tumor enables optimal radiotherapy planning and permits a baseline series of imaging for comparison with posttreatment scans to verify response and to monitor the treated tumor and nodal deposits for any suspected recurrence.

• #44 Anal Cancer Diagnosis | Roswell Park Comprehensive Cancer Center – Buffalo, NY

  https://www.roswellpark.org/cancer/anal/diagnosis

  Computed Tomography (CT): A series of detailed pictures are taken from various angles and put together by a computer to offer a detailed picture inside the body. […] Magnetic resonance imaging (MRI): A type of imaging that uses a magnet, radio waves and a computer to create a picture inside the body. […] Abdominal/Pelvic CT or MRI: For cases of anal cancer this determines extent of disease and whether other organs or lymph nodes are involved. […] Chest CT: This determines if cancer has spread to the lungs. […] Positron Emission Tomography (PET): A small amount of radioactive glucose or sugar is injected and the PET scanner can picture where glucose is being used in the body. […] Fine needle aspiration biopsy: Determines whether lymph nodes contain cancer. […] Human immunodeficiency virus (HIV) testing: HIV positive people are more likely to develop anal cancer, and more likely to relapse after treatment.

• #45 Anal Cancer Diagnosis | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/anal-cancer/anal-cancer-diagnosis.html

  If you have symptoms that may signal anal cancer, your doctor will examine you and ask you questions about your health, your lifestyle, including smoking and drinking habits, and your family history. […] Your doctor will first conduct one or more of the following tests to determine if you have anal cancer. These tests can include: […] A biopsy: if your doctor discovers any abnormalities in your anus or rectum, he or she may remove a small sample of tissue (a biopsy) to undergo further testing in a laboratory. Looking at the tissue under a microscope allows your doctor to determine if there are cancer cells present. […] If you are diagnosed with anal cancer, you may have to undergo additional tests to determine if your cancer has spread (metastasized). […] There are a few different tests to determine if your cancer has spread: […] Fine-needle aspiration biopsy: In a fine-needle aspiration biopsy, a tiny needle is placed into a lymph node, and cells are removed and looked at with a microscope. A positive lymph node biopsy indicates the cancer has spread to your lymph nodes.

• #46 Diagnosis and Diagnostic Imaging of Anal Canal Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10174401/

  Many patients with anal cancer come to the attention of physicians with complaints of hemorrhoidal-type bleeding or pain, and about one-half are not diagnosed until more than 24 months after symptom onset. […] Because the symptoms of anal cancer can mimic those of more common, benign conditions, the diagnosis of anal cancer is often delayed. […] In patients with worrisome anorectal complaints, a thorough physical examination, including visual inspection of the perirectal area and a digital rectal reexamination, must be undertaken. […] After a complete physical examination has been performed, histologic diagnosis of anal cancer is generally determined through biopsies obtained during an examination under anesthesia with anoscopy or proctosigmoidoscopy; this is also often necessary to ensure patient tolerance of a complete examination.

• #47

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8572542/

  If anal cancer is suspected, histopathological confirmation shall be sought once the abovementioned examinations have been performed and documented. If a cancer of the anal margin measuring up to 2 cm in diameter is suspected and the sphincter apparatus and adjacent organs have not been infiltrated, the entire lesion should be removed already at the time of confirmation of the diagnosis as an excisional biopsy with a safety margin of 0.5 cm. […] For patients with stage IIIII disease, combined chemoradiation is the gold standard: Stage IIIII anal cancer shall be treated with combined chemoradiation. There are no studies comparing surgical versus radiation oncology treatment for cancer of the anal margin; however, there is consensus among the guideline group that performing excision alone with an adequate safety margin (0.5 cm) can be considered for stage IIA cancer of the anal margin.

• #48 Anal Cancer | Knight Cancer Institute | OHSU

  https://www.ohsu.edu/knight-cancer-institute/anal-cancer

  Dr. Charles Lopez and physician assistant Jeff Donovan, talking Dr. Charles Lopez (left), with physician assistant Jeff Donovan, is on our team of expert doctors for patients with anal cancer. At the OHSU Knight Cancer Institute, you receive care for anal cancer from a team of specialists. We offer you: HRA (high-resolution anoscopy) to catch cancers and pre-cancers early. […] Anal cancer starts in the anus, the last part of the digestive tract. […] The five-year relative survival rate for anal cancer is 71%, according to the National Cancer Institute. The rate is 85% if the cancer is caught early. […] HPV (human papillomavirus) causes more than 90% of anal cancers, according to the National Cancer Institute. […] Our team will do a thorough physical exam and tests that may include: Digital rectal exam: Your doctor will use a gloved, lubricated finger to carefully feel the anus for warts or other masses. Anal Pap smear: We collect a cell sample by gently scraping the anus with a plastic tool. We look at the cells under a microscope to check for signs of cancer. Anoscopy: We use a short, hollow tube with a light, called an anoscope, to look at the lining of the anus.

• #49

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8572542/

  The majority of anal cancers (89100%) are induced by persistent infection with human papillomaviruses (HPV). Persistent HPV infections, and thus also the development of anal cancer, are promoted by increased exposure to anal HPV infections and/or immunodeficiency. This is also reflected in a sometimes significantly increased incidence of anal cancer in certain subpopulations compared to the general population, particularly in HIV-positive individuals, men who have sex with men (MSM), women diagnosed with gynecological cancers and precancerous lesions, as well as in the case of iatrogenic immunosuppression. Therefore, the guideline recommends the screening of at-risk patients and draws the readers attention to the recommendations of the Standing Commission on Vaccination at the Robert Koch Institute for prophylactic HPV vaccination of all girls and boys.

• #50

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8572542/

  In the case of complete remission 26 weeks following the start of chemoradiation, an MRI of the pelvis should be performed to confirm findings and establish a baseline for follow-up. In the case of complete remission, biopsy for histopathological confirmation of response shall not be performed. […] Follow-up should be performed over a 5-year period and shall begin following successful completion of treatment. Successful completion of treatment is defined as follows: histopathologically confirmed R0 resection or complete remission 26 weeks after the start of chemoradiation. […] In the case of local residual or recurrent tumor following primary chemoradiation without distant metastasis, surgical resection with curative intent shall be performed. Abdominoperineal resection is the standard procedure for local recurrence or residual cancer of the anal canal following primary chemoradiation.

• #51

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8572542/

  In the case of complete remission 26 weeks following the start of chemoradiation, an MRI of the pelvis should be performed to confirm findings and establish a baseline for follow-up. In the case of complete remission, biopsy for histopathological confirmation of response shall not be performed. […] Follow-up should be performed over a 5-year period and shall begin following successful completion of treatment. Successful completion of treatment is defined as follows: histopathologically confirmed R0 resection or complete remission 26 weeks after the start of chemoradiation. […] In the case of local residual or recurrent tumor following primary chemoradiation without distant metastasis, surgical resection with curative intent shall be performed. Abdominoperineal resection is the standard procedure for local recurrence or residual cancer of the anal canal following primary chemoradiation.

• #52

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8572542/

  In the case of complete remission 26 weeks following the start of chemoradiation, an MRI of the pelvis should be performed to confirm findings and establish a baseline for follow-up. In the case of complete remission, biopsy for histopathological confirmation of response shall not be performed. […] Follow-up should be performed over a 5-year period and shall begin following successful completion of treatment. Successful completion of treatment is defined as follows: histopathologically confirmed R0 resection or complete remission 26 weeks after the start of chemoradiation. […] In the case of local residual or recurrent tumor following primary chemoradiation without distant metastasis, surgical resection with curative intent shall be performed. Abdominoperineal resection is the standard procedure for local recurrence or residual cancer of the anal canal following primary chemoradiation.

• #53 Diagnosis and Diagnostic Imaging of Anal Canal Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10174401/

  The combination of clinical follow-up assessment, serial imaging, and careful comparison with the initial posttreatment baseline has enabled the earlier diagnosis of recurrence and the consequent radical salvage of pelvic recurrence. […] Anal canal cancer is a tumor type that depends on accurate anatomic staging for optimal treatment planning and cure. […] In addition to standard diagnostic procedures, including history and physical, laboratory assessment, and endoscopy, modern radiologic imaging techniques are extremely helpful in the assessment of this cancer.

• #54 Anal cancer explained: symptoms, diagnosis and treatment | MD Anderson Cancer Center

  https://www.mdanderson.org/cancerwise/9-common-anal-cancer-questions.h00-159464790.html

  Patients typically experience side effects for up to six months after treatment ends. […] Weve developed an in-house circulating DNA blood test to detect the presence of HPV and identify patients at high risk for recurrence. […] MD Anderson is one of the leading institutions in the United States for treating patients with anal cancer.

• #55 Anal cancer explained: symptoms, diagnosis and treatment | MD Anderson Cancer Center

  https://www.mdanderson.org/cancerwise/9-common-anal-cancer-questions.h00-159464790.html

  Patients typically experience side effects for up to six months after treatment ends. […] Weve developed an in-house circulating DNA blood test to detect the presence of HPV and identify patients at high risk for recurrence. […] MD Anderson is one of the leading institutions in the United States for treating patients with anal cancer.

• #56 Diagnosis and Diagnostic Imaging of Anal Canal Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10174401/

  The combination of clinical follow-up assessment, serial imaging, and careful comparison with the initial posttreatment baseline has enabled the earlier diagnosis of recurrence and the consequent radical salvage of pelvic recurrence. […] Anal canal cancer is a tumor type that depends on accurate anatomic staging for optimal treatment planning and cure. […] In addition to standard diagnostic procedures, including history and physical, laboratory assessment, and endoscopy, modern radiologic imaging techniques are extremely helpful in the assessment of this cancer.

• #57 Anal Cancer Symptoms, Diagnosis and Treatment | Froedtert & MCW

  https://www.froedtert.com/anal-cancer-symptoms-treatment

  Anal cancer is considered rare. […] Anal cancer develops when cancer cells form in the tissues of the anus or anal canal (the tube at the end of the rectum) and start growing and dividing in an uncontrolled way. […] That makes early detection especially important. […] Tests used to diagnose anal cancer include a rectal exam, anoscopy (exam that looks inside your anus with a special scope), and imaging with a CT scan, an MRI and often, a PET scan. […] An accurate diagnosis from the start is essential in choosing the best treatment options for anal cancer. […] If you’re at increased risk, talk with your doctor about getting an anal cancer screening, which involves a swab of the anal lining. […] If something concerning is found with screening, most anal cancers will be diagnosed by having a tissue biopsy taken.

• #58 The Radiology Assistant : Anal cancer staging

  https://radiologyassistant.nl/abdomen/anal-cancer-2/anal

  The recommended MRI protocol mainly consists of high resolution T2W imaging in multiple planes with a slice thickness of 3 mm. Diffusion-weighted imaging is mainly crucial in the restaging and follow-up setting because it increases the sensitivity of MRI to help detect areas of vital residual tumor within the fibrotically changed tumor bed.

• #59 Anal cancer explained: symptoms, diagnosis and treatment | MD Anderson Cancer Center

  https://www.mdanderson.org/cancerwise/9-common-anal-cancer-questions.h00-159464790.html

  Patients typically experience side effects for up to six months after treatment ends. […] Weve developed an in-house circulating DNA blood test to detect the presence of HPV and identify patients at high risk for recurrence. […] MD Anderson is one of the leading institutions in the United States for treating patients with anal cancer.

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