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Adenocarcinomas, on the other hand, behave quite differently and should be treated like rectal cancers.

Lymphatic drainage of anal cancers depends on the location of the tumor in relation to the dentate line.

PET scanning seemed to detect more inguinal disease, with abnormal nodes noted in 29% of all groins as compared with 16% for CT scan.

Not surprisingly, HIV-positive patients had a higher incidence of PET-positive inguinal nodes (44% versus 16%).

Most patients with squamous cell carcinoma of the anal canal present with rectal bleeding.

Diagnosis can be delayed because this bleeding is often ascribed to hemorrhoids.

A 63-year-old man with a past medical history significant for HIV managed with highly active antiretroviral therapy (HAART) (last CD4 count, 458) and anal squamous cell carcinoma in situ resected in 2000 presented for a routine colonoscopy in July 2006.

The examination revealed a 12-mm nodule in the rectum, which was biopsied; pathology revealed invasive squamous cell carcinoma.

PET scan performed 1 month after completion of therapy did not provide useful information, because there was residual activity noted in 12 of 18 (67%) patients and only three of these 12 (25%) have recurred. [3] reported a study of 41 consecutive patients with anal carcinoma, including nine HIV-positive patients, who underwent both whole-body FDG-PET scan and abdominal and pelvic CT scan prior to therapy.

Regional nodes are considered to be the inguinal, internal iliac, and perirectal (anorectal, perirectal, and lateral sacral) nodes.

Tumors below the dentate line drain to the inguinal and femoral nodes while tumors above the dentate line drain to the perirectal and paravertebral nodes, a pattern similar to that seen with rectal cancers.

HIV infection is also associated with anal cancer; there are increasing numbers of HIV-positive patients being diagnosed with the disease.

Treatment of anal cancer prior to the 1970s involved abdominoperineal resection, but the standard of care is now concurrent chemoradiation therapy, with surgery reserved for those patients with residual disease.

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