Primary Site: Anal Carcinoma Results Individual patient data and evaluation of compliance is presented in the table below: Treatment consisted of external beam radiation combined with mitomycin and 5-fluorouracil in all 4 cases (100%) treated at Augusta Health. Three of the four cases employed an oral pro-drug of 5-fluorouracil (capecitabine) to avoid prolonged outpatient intravenous infusions, a practiced endorsed and consistent with NCCN guideline treatment recommendations. Recommendations Recommendations to improve the diagnosis, staging, therapy, and outcome of anal carcinoma in the future include: 1. Greater attention to cervical cancer screening with exam and PAP smear in females diagnosed with anal cancer 2. Encouragement of HPV vaccination in appropriate young persons (children ages 11-12, or all females 13-26 and males 13-21 not previously vaccinated – CDC website October 2019) by the Augusta Health system Discussion Patient evaluation and treatment of anal carcinoma generally complied closely to NCCN guidelines. Five patients (1 male, 4 female) were diagnosed and staged at Augusta Health in 2018; one patient was treated elsewhere, and could not be assessed for therapy. Notable findings included appropriate digital rectal examination in all cases (100%), documented lack of inguinal nodes by examination in 4 of 5 cases (80%), appropriate radiology staging studies in all cases (100%), and exclusion of HIV by serologic testing in 4 of 5 (80%) of cases. A notable deficiency was lack of documentation of cervical cancer screening in the 4 female cases (0%); this is a reasonable guideline recommendation considering the association of both cervical and anal carcinoma to HPV. Summary Anal carcinoma is an uncommon but important cancer associated with HPV that can be cured in a majority of patients with a combination of radiation and chemotherapy, with avoidance of morbid surgery. Efforts to closely adhere to curative evaluation and treatment should continue, and efforts to prevent by HPV vaccination should increase. 9 AUGUSTA HEALTH • CANCER PROGRAM ANNUAL REPORT 2019
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