Background and Study Aims: Endoscopic ultrasonography (EUS) is a technique
that is well established in gastroenterology for tumor staging, but so far
very few data have been reported concerning the staging of anal carcinomas
using EUS. The aim of this study is to underline the value of EUS in the st
aging and follow-up of anal carcinoma.
Patients and Methods: In this retrospective study, 30 consecutive patients
with carcinoma of the anal canal (nine men, 21 women) were examined using E
US, and the tumors were classified according to the 1985 TNM classification
. EUS was carried out either before the start of treatment (15 patients); a
fter the initial treatment in order to plan further treatment; or during fo
llow-up examinations (15 patients). The treatment given was based on the re
sults of the EUS examination.
Results: The following tumor stages were diagnosed: four lesions in stage u
T0, seven in stage uT1, seven in stage uT2, nine in stage uT3, and three in
stage uT4. In seven patients, suspect lymph nodes were also detected by EU
S. In all but three of the patients (lost to follow-up), EUS had a direct i
mpact on the treatment selected. Depending on the tumor stage, patients eit
her underwent surgery (four patients: one uT1, one uT2, two uT3); received
radiotherapy alone (five patients: three uT2, two uT3); combined chemoradio
therapy (eight patients: three uT2, three uT3, two uT4); interstitial boast
er radiotherapy (four patients: three uT1, one uT3); or no therapy at all (
six patients: four uT0, one uT3, one uT4), respectively. In two patients, t
he tumor was understaged at EUS: in one, a uT1 tumor proved to be a pT2 tum
or, and in the other, a uT3 tumor proved to be a pT4 tumor.
Conclusions: The advantage of EUS in the staging of anal cancer is that it
allows precise assessment of the depth of infiltration and tumor spread int
o adjacent tissue, facilitating the choice of stage-dependent treatment dec
isions-particularly in determining the extent of interstitial booster radio
therapy needed. It also allows follow-up examinations after the initial tre
atment, with fine-needle aspiration biopsies of suspicious areas. Wider acc
eptance of this method might further decrease the performance of extensive
surgery, with the impaired quality of life associated with rectal amputatio
n. In addition, it might allow improved quality control of the various trea
tment modalities.