Staging and Management of Inguinal Nodes

The clinicopathologic spectrum of anal cancer in KwaZulu-Natal Province, South Africa

“…The advanced nature of the disease, poor treatment completion rates, and failure to return for treatment in our setting makes it impossible to reach the goal of eventual resection, complete response to therapy and the management of synchronous and metachronous lymph node metastases [23,24] in the majority of cases. The biological behaviour of the tumours themselves [26,27,40,44] as well as anatomical factors such as close proximity to the anal sphincter, profuse blood supply and an abundant lymphatic drainage with consequent early lymphatic involvement of the deep pelvic nodes [41,44] make cure rates for anal canal carcinoma lower than anal margin tumours.…”

“…The standard protocol utilises external beam radiotherapy to the pelvis to a dose of 45 Gray followed by a tumour boost to 59.4 Gray in 1.8 Gray fractions. An electron boost to the inguinal area [23,24] is indicated for histology/cytology proven inguinal node disease. Concurrent chemotherapy used is weekly intravenous Cisplatin and 5-fluorouracil orally or intravenously.…”

Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) – Anal Cancer

“…However, this may not be necessary if the lymph node is avid on 18‐FDG PET/CT or there is high clinical suspicion of involvement, based on MRI characteristics. The staging and management of inguinal lymph nodes was reviewed in the ACPGBI Position Statement for Anal Cancer (Branagan, ). Sentinel node biopsy is not an established staging tool in patients with anal cancer.…”