Anal Kanser
Özet
Anal kanserler nadir görülmekle birlikte, tüm gastrointestinal sistem malignitelerinin yaklaşık %3’ünü oluşturur. Anal kanserli hastaların yaklaşık %80’inde HPV saptanmış olup, bu vakaların %70’inde HPV tip 16 tespit edilmiştir. Primer anal kanal kanserlerinin yaklaşık %80’i skuamöz hücrelidir. Anal kanserde belirtiler spesifik olmamakla birlik, parlak kırmızı rektal kanama, kaşıntı, ağrı gibi şikayetler görülebilir. Tanı anında hastaların yaklaşık %60 ileri evrede olmaktadır. Anal kanser şüphesi durumunda ilk olarak dijital rektal muayene ve anoskopik muayene yapılmalıdır. Anal kanal ve perianal bölgedeki şüpheli lezyonlardan biyopsi alınması gereklidir. Pelvik lenf nodlarının değerlendirilmesi amacıyla pelvik bilgisayarlı tomografi (BT) veya pelvik manyetik rezonans görüntüleme (MRG) kullanılabilir. Metastatik olmayan anal kanser tedavisinde günümüzde ilk olarak eş zamanlı kemoradyoterapi kullanılır. Radyoterapiye eş zamanlı uygulanan kemoterapi rejimi FU/mitomisindir. Alternatif diğer rejim ise 5FU/sisplatindir. Anal kanserli hastaların tedavi sonrası dijital rektal muayene, anoskopik değerlendirme ve inguinal lenf nodu palpasyonu dahil olmak üzere 5 yıl boyunca her 3 ila 6 ayda bir değerlendirilmesi önerilmektedir. Kontrastlı toraks, abdomen ve pelvik BT veya kontrastsız toraks BT ve kontrastlı abdominal/pelvik MRG, evre II-III hastalığı olan hastalarda 3 yıl boyunca önerilir. Metastatik anal kanal SCC'li hastaların çoğu için, önerilen birinci basamak tedavi rejimi paklitaksel karboplatin kombinasyonudur. Metastatik anal kanserde sistemik tedaviye (kemoterapi, immünoterapi) yanıt her 8-12 haftada bir klinik muayene ve görüntüleme ile değerlendirilmelidir.
Anal cancers are rare, accounting for approximately 3% of all gastrointestinal malignancies. Human papillomavirus (HPV) is detected in about 80% of patients with anal cancer, with HPV type 16 identified in 70% of these cases. Approximately 80% of primary anal canal cancers are squamous cell carcinomas. Although the symptoms of anal cancer are nonspecific, patients may present with complaints such as bright red rectal bleeding, pruritus, and pain. At the time of diagnosis, approximately 60% of patients are in advanced stages. For suspected anal cancer, the initial diagnostic approach should include digital rectal examination and anoscopic evaluation. Biopsy of suspicious lesions in the anal canal and perianal region is essential. To evaluate pelvic lymph nodes, pelvic computed tomography (CT) or magnetic resonance imaging (MRI) can be utilized.
In the treatment of non-metastatic anal cancer, concurrent chemoradiotherapy remains the first-line approach. The chemoradiotherapy regimen typically includes 5-fluorouracil (5-FU) and mitomycin. Alternatively, a combination of 5-FU and cisplatin can also be used. Post-treatment follow-up for anal cancer patients should include digital rectal examination, anoscopic evaluation, and palpation of inguinal lymph nodes every 3 to 6 months for 5 years. Additionally, contrast-enhanced CT of the chest, abdomen, and pelvis or non-contrast chest CT with contrast-enhanced abdominal and pelvic MRI is recommended for up to 3 years in patients with stage II-III disease.
For most patients with metastatic anal canal squamous cell carcinoma (SCC), the recommended first-line treatment is a combination of paclitaxel and carboplatin. In metastatic anal cancer, response to systemic therapy (chemotherapy or immunotherapy) should be assessed every 8 to 12 weeks through clinical examination and imaging studies.
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