Anal Carcinoma, Version 2.2023, NCCN Clinical Practice Guidelines in Oncology

Abstract

This discussion summarizes the NCCN Clinical Practice Guidelines for managing squamous cell anal carcinoma, which represents the most common histologic form of the disease. A multidisciplinary approach including physicians from gastroenterology, medical oncology, surgical oncology, radiation oncology, and radiology is necessary. Primary treatment of perianal cancer and anal canal cancer are similar and include chemoradiation in most cases. Follow-up clinical evaluations are recommended for all patients with anal carcinoma because additional curative-intent treatment is possible. Biopsy-proven evidence of locally recurrent or persistent disease after primary treatment may require surgical treatment. Systemic therapy is generally recommended for extrapelvic metastatic disease. Recent updates to the NCCN Guidelines for Anal Carcinoma include staging classification updates based on the 9th edition of the AJCC Staging System and updates to the systemic therapy recommendations based on new data that better define optimal treatment of patients with metastatic anal carcinoma.

Microsatellite Instability Is Insufficiently Used as a Biomarker for Lynch Syndrome Testing in Clinical Practice

“…The utility of MSI analysis as a biomarker for the selection of patients eligible for ICI treatment has been well documented, thereby enhancing its implementation in clinical practice. 15 , 17 , 23 - 27 Consequently, the number of patients evaluated for MSI continues to rise, providing a greater understanding of its prevalence in various tumor types. Since its approval in 2017 as an ICI predictive biomarker, the number of patients undergoing such a test has doubled in our laboratory, from <450 patients per year in 2016 to over 1,500 patients per year in 2022.…”

“… 2 , 3 , 16 Significantly, tumor MSI analysis could inform patient selection for inherited cancer susceptibility testing. 11 , 17 , 18 …”

Patient Navigation for Timely, Guideline-Adherent Adjuvant Therapy for Head and Neck Cancer: A National Landscape Analysis

“…Unlike the target 6-week interval between surgery and initiation of PORT for patients with HNC, the time interval for other CoC quality measures for timely adjuvant therapy is much longer, ranging from 4 months to 1 year following diagnosis or surgery for non-small cell lung cancer, colon cancer, and breast cancer. [51][52][53][54] Specialization of navigators within HNC might help them understand and work within the more urgent timeline necessary to identify and resolve barriers to timely care in this patient population.…”

Endoscopic intermuscular dissection of early anal cancer

“…This increase has closely mirrored the rise in human papillomavirus infections, the most important risk factor for anal cancer. According to international guidelines 2 3 4 , marginal/perianal lesions smaller than 2 cm without lymphatic involvement or metastatic spread can be curatively treated with complete local excision, thereby sparing patients the adverse effects of surgery or chemoradiotherapy. Here, we describe a case of early anal cancer which was successfully treated by endoscopic intermuscular dissection (EID).…”