International Journal of Colorectal Disease

, Volume 32, Issue 12, pp 1719–1724 | Cite as

Management of early anal cancer: need for guidelines and standardisation

  • Michael P. JonesEmail author
  • Susan Carroll
  • Jarad Martin
  • Richard Hillman
  • Andrew Grulich
  • Dianne O’Connell
  • Christopher Young
  • Isobel Mary Poynten
Original Article



The optimal management of early squamous cell carcinoma of the anal canal (AC) is yet to be determined. This study investigated current practice in the management of early AC.


A patterns of care survey was completed by Australian surgeons and radiation oncologists. Specific topics addressed were as follows: geographical location of practice, staging of disease, treatment approaches to T1N0 tumours and grade 3 anal intra-epithelial neoplasia (AIN3) lesions, radiotherapy planning, toxicities, follow-up and clinical trial involvement.


Sixty-four responses were obtained. For the management of T1N0 disease, half the respondents recommended standard dose chemo-radiotherapy (CRT) and one third recommended wide local excision (WLE). For the management of AIN3, half recommended WLE while a quarter advocated observation.


This study reveals a significant variation in the management of early AC. The development of guidelines specific to the treatment of early AC could standardise treatment while further research is required to define the optimal management of T1N0 AC and AIN.


Anal cancer Anal intra-epithelial neoplasia Chemo-radiotherapy 



Thank you to Mo Hammoud for constructing and managing the online survey. Thank you to General Surgeons Australia and the Royal Australian and New Zealand College of Radiologists, Faculty of Radiation Oncology for distributing the survey to their members.


The authors declare that no funding was received.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

For this type of study, formal consent is not required.

Ethical approval

The research related to human participants was in keeping with all relevant national regulations and institutional policies and was performed in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ ethics committee.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Michael P. Jones
    • 1
    • 2
    Email author
  • Susan Carroll
    • 3
    • 4
  • Jarad Martin
    • 2
    • 5
  • Richard Hillman
    • 6
  • Andrew Grulich
    • 7
  • Dianne O’Connell
    • 2
    • 8
    • 9
  • Christopher Young
    • 4
    • 10
  • Isobel Mary Poynten
    • 7
  1. 1.Department of Radiation OncologyPrincess Margaret Cancer CentreTorontoCanada
  2. 2.School of Medicine and Public HealthUniversity of NewcastleCallaghanAustralia
  3. 3.Department of Radiation OncologyChris O’Brien LifehouseCamperdownAustralia
  4. 4.Royal Prince Alfred HospitalCamperdownAustralia
  5. 5.Department of Radiation OncologyCalvary Mater NewcastleWaratahAustralia
  6. 6.St Vincent’s HospitalDarlinghurstAustralia
  7. 7.Kirby InstituteUniversity of New South WalesKensingtonAustralia
  8. 8.Cancer Research DivisionCancer Council NSWWoolloomoolooAustralia
  9. 9.Sydney School of Public HealthUniversity of SydneyCamperdownAustralia
  10. 10.The University of SydneyCamperdownAustralia

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