Tumor Board-Anal Gland Carcinoma

Ranjita Pallavi, MD Internal Medicine PGY 3

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

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

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).

For T2 and above and any N

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.

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

Thanks