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    NCCN Guidelines Index Anal Table of Contents Discussion
    NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines?)
    Anal Carcinoma
    Version 1.2011 NCCN.org
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    Version 1.2011, 09/10/10 ? National Comprehensive Cancer Network, Inc. 2010, All rights reserved. The NCCN Guidelines? and this illustration may not be reproduced in any form without the express written permission of NCCN?.
    Printed by li jingzhong on 11/21/2010 7:29:14 PM. For personal use only. Not approved for distribution. Copyright ? 2010 National Comprehensive Cancer Network, Inc., All Rights Reserved.
    NCCN Guidelines? Version 1.2011 Panel Members Anal Carcinoma
    * Paul F. Engstrom, MD/Chair ? Fox Chase Cancer Center
    J. Pablo Arnoletti, MD ? University of Alabama at Birmingham Comprehensive Cancer Center Charles S. Fuchs, MD, MPH ? Dana-Farber/Brigham and Women's Cancer Center Jean L. Grem, MD ? UNMC Eppley Cancer Center at The Nebraska Medical Center James A. Knol, MD ? University of Michigan Comprehensive Cancer Center Lucille A. Leong, MD ? City of Hope Comprehensive Cancer Center Edward Lin, MD ? Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance Mary F. Mulcahy, MD ? Robert H. Lurie Comprehensive Cancer Center of Northwestern University Eric Rohren, MD, PhD ф The University of Texas MD Anderson Cancer Center David P. Ryan, MD ? Massachusetts General Hospital Cancer Center
    NCCN Guidelines Index Anal Table of Contents Discussion
    Sunil Sharma, MD ? Huntsman Cancer Institute at the University of Utah David Shibata, MD ? H. Lee Moffitt Cancer Center and Research Institute John M. Skibber, MD ? The University of Texas MD Anderson Cancer Center William Small, Jr., MD § Robert H. Lurie Comprehensive Cancer Center of Northwestern University Constantinos T. Sofocleous, MD, PhD ф Memorial Sloan-Kettering Cancer Center James Thomas, MD, PhD ? The Ohio State University Comprehensive Cancer Center - James Cancer Hospital & Solove Research Institutet
    * Al B. Benson, III, MD ? Robert H. Lurie Comprehensive Cancer Center of Northwestern University
    Emily Chan, MD, PhD ? Vanderbilt-Ingram Cancer Center Yi-Jen Chen, MD, PhD § City of Hope Comprehensive Cancer Center Michael A. Choti, MD, MBA ? The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Harry S. Cooper, MD 1 Fox Chase Cancer Center Raza A. Dilawari, MD ? St. Jude Children's Research Hospital/University of Tennessee Cancer Institute Peter C. Enzinger, MD ? Dana-Farber/Brigham and Women’s Cancer Center James W. Fleshman, Jr., MD ? Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
    * Alan P. Venook, MD ? ? UCSF Helen Diller Family Comprehensive Cancer Center
    Christopher Willett, MD § Duke Comprehensive Cancer Center NCCN Kristina M. Gregory, RN, MSN, OCN Susan J. Moench, PhD, PA-C
    Medical Oncology § Radiotherapy/Radiation oncology ? Surgery/Surgical oncology 1 Pathology ? Hematology/Hematology Oncology T Internal medicine ф Diagnostic/Interventional Radiology *Writing Committee Member
    *Leonard Saltz, MD ? ? T Memorial Sloan-Kettering Cancer Center
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    NCCN Guidelines Panel Disclosures
    Version 1.2011, 09/10/10 ? National Comprehensive Cancer Network, Inc. 2010, All rights reserved. The NCCN Guidelines? and this illustration may not be reproduced in any form without the express written permission of NCCN?.
    Printed by li jingzhong on 11/21/2010 7:29:14 PM. For personal use only. Not approved for distribution. Copyright ? 2010 National Comprehensive Cancer Network, Inc., All Rights Reserved.
    NCCN Guidelines? Version 1.2011 Table of Contents Anal Carcinoma
    NCCN Anal Carcinoma Panel Members Summary of the Guidelines Updates Workup and Treatment - Anal canal cancer (ANAL-1) Workup and Treatment - Anal margin lesions (ANAL-2) Follow-up Therapy and Surveillance (ANAL-3) Principles of Chemotherapy (ANAL-A) Principles of Radiation Therapy (ANAL-B) Staging (ST-1)
    NCCN Guidelines Index Anal Table of Contents Discussion
    Clinical Trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. To find clinical trials online at NCCN member institutions, click here: nccn.org/clinical_trials/physician.html
    NCCN Categories of Evidence and
    Consensus: All recommendations are Category 2A unless otherwise specified. See NCCN Categories of Evidence and Consensus
    The NCCN Guidelines? are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network? (NCCN?) makes no representations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way. The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network?. All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. ?2010.
    Version 1.2011, 09/10/10 ? National Comprehensive Cancer Network, Inc. 2010, All rights reserved. The NCCN Guidelines? and this illustration may not be reproduced in any form without the express written permission of NCCN?.
    Printed by li jingzhong on 11/21/2010 7:29:14 PM. For personal use only. Not approved for distribution. Copyright ? 2010 National Comprehensive Cancer Network, Inc., All Rights Reserved.
    NCCN Guidelines? Version 1.2011 Updates Anal Carcinoma
    Summary of changes in the 1.2010 version of the Anal Carcinoma Guidelines from the 2.2009 version include:
    NCCN Guidelines Index Anal Table of Contents Discussion
    ANAL-3 · Follow-up: “Biopsy only if clinical evidence of persistent disease after serial exams” deleted from the follow-up recommendations. · “Biopsy proven persistent disease” changed to “persistent disease.” · Complete remission: “chest x-ray, pelvic CT” changed to “chest/abd/pelvic imaging” · Surveillance: CT scan clarified as “Chest/abd/pelvic imaging annually x 3 y” · Regression on serial exams: DRE and anoscopy added to the surveillance recommendations. ANAL-B · Bullet 4: minimum radiation dose changed from 30.6 Gy to 36 Gy. · Bullet 7: reference added for RTOG contouring atlas. · Bullet 8 added to the page: “Side effect management: Female patients should be considered for vaginal dilators and instructed on the symptoms of vaginal stenosis. All male patients should be evaluated for erectile dysfunction and considered for early treatment intervention if necessary.” ST-1 · Staging updated according to the AJCC Cancer Staging Manual 7th Edition.
    Version 1.2011, 09/10/10 ? National Comprehensive Cancer Network, Inc. 2010, All rights reserved. The NCCN Guidelines? and this illustration may not be reproduced in any form without the express written permission of NCCN?.
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    Printed by li jingzhong on 11/21/2010 7:29:14 PM. For personal use only. Not approved for distribution. Copyright ? 2010 National Comprehensive Cancer Network, Inc., All Rights Reserved.
    NCCN Guidelines? Version 1.2011 Anal Canal Cancer
    CLINICAL PRESENTATION WORKUP · Digital rectal examination (DRE) · Inguinal lymph node evaluation > Biopsy or FNA if suspicious nodes · Chest x-ray or Chest CT · Anoscopy · Abdominal/pelvic CT or MRI · Consider HIV testing + CD4 level if indicated · Gynecological exam for women, including screening for cervical cancer · Consider PET-CT scan b CLINICAL STAGE PRIMARY TREATMENT g
    NCCN Guidelines Index Anal Table of Contents Discussion