Anal cancer

Anal cancer

Anal Cancer

Which cytotoxic regimens are used in metastatic anal SCC ?

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DCF, Cis/5FU, Carbo/paclitaxel

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Is there phase 3 data supporting the use of any cytotoxic regimen for metastatic anal SCC ?

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No, only phase II

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What clinical benefit rate has been reported with pembrolizumab in advanced anal SCC ?

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58% from KEYNOTE-028

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Anal Cancer

Is there randomized phase 3 data to support the use of nivolumab or pembrolizumab in advanced anal SCC ?

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No, only phase 1/2 data

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Anal Cancer

Does the addition of panitumumab to 5FU/Mitomycin plus radiotherapy increase response rate and OS in squamous anal CA?

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No, only adds toxicity

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Anal cancer

Which anal cancer can be managed with surgery alone?

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T1 lesion smaller than 2 cm

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Anal cancer

How do you treat metastatic anal squamous cell carcinoma?

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Same regimens as other squamous cell carcinomas

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Anal cancer

Can cisplatin replace mitomycin with radiotherapy for definitive anal cancer treatment?

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No

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Is mitomycin necessary with 5-FU and concurrent with radiotherapy ?

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Yes, without mitomycin there is lower three-year colostomy free survival

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Anal cancer

How is the treatment for HIV positive patients different than not HIV-positive patients with anal cancer ?

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No difference

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Anal cancer

What is the role of induction chemotherapy prior to chemotherapy radiotherapy for anal cancer ?

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No survival advantage

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Anal cancer

How do you manage T1 N0 M0 perianal skin cancer?

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Wide local excision

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Anal cancer

How do you surgically manage adenocarcinoma of the anus?

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Same as rectal–abdominoperineal resection

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Anal cancer

Which chemotherapy agents are effective for metastatic anal cancer?

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5-FU and cisplatin

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Anal cancer

What should prompt surgical resection of anal cancer?

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Persistent disease at 26 weeks
Progressive disease during therapy

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Anal cancer

What is the treatment for rectal squamous cell carcinoma?

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Same treatment as anal cancer

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What defines stage III anal cancer?

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N1 disease or T4

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What is the only difference in treatment between T1 and T2 versus T3 and T4 anal cancer?

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T3 and T4 requires a radiation boost

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Anal cancer

What is the chemotherapy regimen for anal cancer?

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5-fluorouracil 1000 mg/m2 day 1-4 and day 29-32
Mitomycin 15 mg/m2 day 1 and day 29

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Anal cancer

The presence of which microscopic features defines the anal verge?

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Presence of hair follicles

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What defines T3 anal cancer?

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Lesion larger > 5 cm

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What defines N1 versus N2 disease for anal cancer?

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N1 perirectal lymph nodes
N2 inguinal or iliac lymph nodes

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How is the treatment for primary rectal squamous cell carcinoma different than anal cancer?

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No difference

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What 3 cell types comprised the anus?

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Columnar, transitional, squamous

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Which surgery should be performed for progressive anal cancer?

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Abdominoperineal resection

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Anal cancer

What is the role of 5-fluorouracil + cisplatin + radiotherapy for anal cancer ?

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Shown to be inferior to the 5-FU + mitomycin + radiotherapy

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Is there a phase 3 data supporting the use of immunotherapy in advanced anal cancer?

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No–only phase 2 data

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Anal Cancer # 2

What risk factor increases the risk of developing anal cancer 40 fold?

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HIV

Anal Cancer # 2
Anal Cancer # 2

Which chemotherapy regimen is used for definitive treatment of anal cancer?

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5-fluorouracil plus mitomycin

Anal Cancer # 2
Anal Cancer # 2

What is the definitive treatment modality for anal cancer?

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Concurrent chemoradiotherapy

Anal Cancer # 2
Anal Cancer # 2

When is surgery employed for anal cancer?

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Salvage therapy only

Anal Cancer # 2
Anal Cancer # 2

Which preventative measure can lower the risk of anal cancer by 75%?

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Quadravalent HPV vaccine to HPV 6, 11, 16, 18

Anal Cancer # 2
Anal Cancer # 2

What skin lesion are risk factors for anal cancer?

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Condylomata

Anal Cancer # 2
Anal Cancer # 2

Which HPV virus is implicated in anal cancer?

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HPV 16

Anal Cancer # 2
Anal Cancer Part 3

What is the disease control rate with nivolumab in advanced anal cell cancer?

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More than 90%

Anal Cancer Part 3
Anal Cancer

Does PD-L1 expression correlate well with nivolumab response rates for advacned anal cancer?

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Yes

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Anal Cancer

Which chemotherapy doublet is most commonly utilized for advanced anal cell cancer?

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Taxane – Platinum doublet

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Anal Cancer

Which clinical trial established the role of paclitaxel plus carboplatinum as first-line chemotherapy for advanced anal cell cancer?

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InterAACT trial comparing it to cisplatin plus infusional 5-FU/Lv

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Anal Cancer

What is the advantage of paclitaxel plus carboplatin versus cisplatin plus 5-FU in advanced anal cell cancer?

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Improved overall survival

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Anal Cancer

Which triplet chemotherapy regimen has the most data supporting its use in advanced anal cell cancer?

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DCF -docetaxel/cisplatin/5-FU

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Anal Cancer

Is a rectal squamous cell carcinoma treated with a rectal cancer regimen or an anal cancer regimen?

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Rectal cancer with concurrent chemoradiation

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Anal Cancer

What is the definitive management of true perianal skin cancer?

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Wide local excision with negative margins -This spares the sphincter muscles

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Anal Cancer

Does adenocarcinoma of the anus portend a better or worse prognosis than SCC ?

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Worse

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Anal Cancer

How is adenocarcinoma of the anus managed ?

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Similar to a rectal cancer

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What is the recommended management of recurrent anal cancer?

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Abdominal perineal resection

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Anal Cancer

What is the approximate 5 year survival in patients with recurrent squamous cell carcinoma of the anus who undergo APR ?

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Approximately 50%

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At least how many months should one wait after definitive therapy for anal cancer prior to declaring recurrent/persistent disease with a + PET/CT?

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6 months

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What is post-treatment surveillance of anal cancer comprised of?

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Digital rectal exam/inguinal node palpation for up to 12 weeks following definitive therapy followed by DRE/inguinal node palpation/anoscopy/CT and/or MRI every 3 to 6 months for 5 years

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Anal Cancer

What is the role of prophylactic inguinal lymphadenectomy for anal cancer?

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Reserved for persistent/recurrent disease

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Anal Cancer

When is local excision appropriate for anal cancer?

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Small T1 tumors

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Anal Cancer

What size cut-off is appropriate for local excision of T1 tumors of the anus?

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1 cm and less and predominantly superficial

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Anal Cancer #2

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Anal Cancer #2

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Where is the most common site of metastatic disease for anal cancer?

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Liver

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Which treatment modality has the most robust data supporting its use for anal cancer related liver metastases?

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Surgical resection

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Anal Cancer

Which immunotherapy agents are most commonly utilized for advanced anal cell cancer?

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Nivolumab and pembrolizumab

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