Anal Cancer: What to Do When Local Excision Does Not Achieve Adequate Margins — T1–T2 Well-Differentiated Perianal Disease

This protocol applies to patients with T1,N0 well-differentiated perianal (anal margin) cancer not involving the sphincter, or select smaller T2,N0 perianal cancers not involving the sphincter, in whom initial surgical management has already been undertaken.

Previous treatment — failure condition

The standard initial approach for this population is local excision with adequate margins, where adequacy is defined as histologically negative surgical margins of 1 cm. This protocol becomes relevant when that goal was not achieved — specifically, when excised margins are found to be inadequate on pathological assessment.

Next-line approach — partial summary

When surgical margins are inadequate following local excision, re-excision is the preferred next step. Alternative approaches may be considered in situations where re-excision is not feasible. The complete protocol specifies the available options and the conditions under which each applies.

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References

DOI: 10.6004/jnccn.2023.0030

Primary treatment of patients with T1,N0 well-differentiated or select smaller T2,N0 perianal (anal margin) cancer that does not involve the sphincter is by local excision with adequate margins.

If the margins are not adequate, re-excision is the preferred treatment option.

Local RT with or without continuous infusion 5-FU/mitomycin, mitomycin/capecitabine, or 5-FU/cisplatin (category 2B) can be considered as alternative treatment options when surgical margins are inadequate.

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