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Anal cancer
Symptoms and signs
Local
About 25% of newly diagnosed patients with anal cancer do not
have symptoms. Bleeding or palpable mass occurs in 50% of patients. Pain
or spasm is a symptom in 40% of cases. Sensation of a mass (not
palpable) occurs in 25% and pruritus in 15%. Coexistent conditions (ie,
anal fistula, anal fissure, or hemorrhoids) are common. A high index
of suspicion in the presence of a mass is warranted.
Physical examination should include digital anorectal examination,
anoscopy, proctoscopy, and palpation of inguinal lymph nodes.
Anorectal examination may have to be performed under sedation or
general anesthesia in patients with severe pain and anal spasm.
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Metastasis
The regional nodes for the anal canal are now considered to be
the perirectal (anorectal, perirectal and lateral sacral), the
internal iliac (hypogastric), and the inguinal (superficial and
deep). All other nodal groups represent sites of distant metastasis.
Tumors that arise in the anal canal usually spread initially to the
anorectal and perirectal nodes, and those that arise at the anal
margin spread to the superficial inguinal nodes.
Different patient series estimate regional lymph node metastasis
as ranging from 20-40%.
Extrapelvic metastases at the time of first presentation are not
common and are identified in fewer than 5%. Metastases occur as
the sole site of failure in approximately 10% after successful
treatment of the primary cancer and regional nodes. Metastases may
occur via the portal or systemic venous systems or via lymphatics.
They are found most frequently in the liver, lungs, and extrapelvic
lymph nodes and occasionally in bone, skin, brain, and other sites.
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