Reporting Anal Cancer

Anal carcinoma is an uncommon, but curable malignancy. Cancer Research UK statistics state there are around 1,500 new anal cancer cases in the UK every year, that’s around 4 every day (2016-2018), with anal cancer accounting for less than 1% of all new cancer cases in the UK. Its incidence has increased significantly in the past 20 years and incidence rates are projected to rise by 14% in the UK between 2023-2025 and 2038-2040.

Anal sphincter preservation with chemoradiotherapy is standard treatment for most patients with anal cancer, but anal cancer remains challenging to treat and imaging plays a vital role for treatment planning. This course comprises of three tutorials where we discuss anal anatomy, tumour localisation and staging, patterns of uptake on FDG PET-CT, radiotherapy planning, and patient management, as well as, the challenging role of PET-CT imaging for response assessment.

PET-CT Scans Performed 2022-2023

At our institution, anal cancer accounts for 2% of all PET-CT scans performed.

The evidence-based indications for use of PET-CT in the UK 2016 list two indications for FDG PET-CT in anal cancer:

1. Staging in patients with T2-T4 anal tumours suitable for radical treatment.
2. Re-staging/re-assessment in patients treated with radical chemoradiotherapy.

The use of PET-CT in these indications will be studied in detail in this course, which is comprised of three modules, followed by a case-based assessment.

• Tutorial One: Anal anatomy, patterns of FDG uptake and imaging guided follow-up pathway
• Tutorial Two: FDG PET-CT staging and radiotherapy planning in anal cancers
• Tutorial Three: Response assessment and future directions

Suitable for radiologists and nuclear medicine physicians who intend to train to report PET-CT, or who otherwise encounter these studies in their practice and wish to increase their confidence, for example in the role of a presenting radiologist at an MDT (Multi-Disciplinary Team).

Learning Objectives

• Describe the anal anatomy and use of its specific terminology
• Explain the rationale behind the need for accurate tumour localisation and staging
• Describe patterns of uptake on FDG PET-CT imaging
• Discuss the key role of dedicated anal cancer MDT-driven pathways for accurate patient management

Please note: To mark this course as complete on your Learning Dashboard and access your certificate of completion, you must finish all learning modules and submit the course evaluation.

References:

1. Evidence-based indications for the use of PET-CT in the United Kingdom 2022
2. Cancer Research UK. Accessed November 2023.
3. Uronis HE, Bendell JC. (2007) Anal Cancer: An Overview. The Oncologist. 12(5):524–34.