Mitomycin in Anal Cancer: Still the Standard of Care

Abstract

A 52-year-old woman presents with a 2-month history of bright red blood per rectum. Her bleeding is associated with bowel movements and a sense of incomplete evacuation. She denies fecal incontinence or change in stool caliber. On digital rectal examination, the tumor is palpated approximately 3 cm from the anal verge, posterior and slightly to the right, positioned at the top of the anal canal and extending into the rectum, measuring approximately 2.5 cm. Additionally, a firm 1.5-cm left-sided inguinal node is palpated. The patient is then referred for colonoscopy, which reveals a mass in the anal canal; biopsy of the mass shows squamous cell carcinoma. Positron emission tomography–computed tomography (PET-CT) demonstrates thickening in the low rectum with [18F]fluorodeoxyglucose (FDG) avidity ( Figs 1 A, 1 B). The left inguinal node is visualized, as is a perirectal lymph node with associated FDG avidity ( Figs 1 C, 1 D). The patient is staged as having T2N3 squamous cell carcinoma of the anal canal ( Table 1 ). Her medical history is otherwise unremarkable, including for HIV, prior abnormal Papanicolaou smears, and other risk factors for human papillomavirus (HPV) exposure.