anal gland carcinoma
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Tumor Board-Anal Gland Carcinoma
Ranjita Pallavi, MD Internal Medicine PGY 3
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Biopsy results• Rectal biopsy - poorly differentated adeno, lymph node –
adenocarcinoma• Important points in IHC: stains performed
CK7,20, 5/6, chromogranin,synaptophysin , CEA,CDX-2, CD3,PAX-5 positive for CK7 and CEA, negative for CDX2 and the rest
K ras- unmutated
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Anal gland carcinoma (AGC)• normal anal glands express CK7 and are negative for CK20• This profile, however, is not sufficiently discriminative,
because a number of adenocarcinomas metastatic to the anal canal will have a similar profile. Also a significant proportion of rectal adenocarcinomas, 13% to 76%, are CK7 positive,whereas deep mucosal glands in the rectum are often CK20 negative.
• Uniformly negative CDX2 staining of normal and malignant anal glands may be used to differentiate AGC from rectal adenocarcinoma
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Anal gland carcinoma (AGC)
Wide local excision can be performed for small well-differentiated tumors.
APR in combination with neoadjuvant chemoradiationshould be used for lesions greater than 2 cm in size(T2).
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For T2 and above and any N
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Important points• anything bigger than 2 cm or not well differentiated even if
smaller, will get chemo/rad, then surgery , then adjuvant folfox.
• • Squamous anal canal chemo/radiation is the treatment and if
recurs locally goes for sx. Anal margin can be resected if t1n0 and rest same as anal canal.
• Radiation for squamous anal includes mitomycin. • Both are for approx 5 weeks.
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Important points• Metastatic treatment is different -cisplatin based in squamous.
• cetux being investigated as anal generally KRAS UNMUTATED
Adeno- FOLFOX/IRI,CETUX,PANITIMUMAB,AVASTIN,REGORAFINIB
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Thanks