The clinical implications of a staging system for carcinoma of the anus

During the past 20 years, several treatment regimens have been proposed for the management of squamous cell carcinoma of the anus. Our results confirm the general impression that a wide abdominoperineal resection is the treatment of choice, although some good results have been obtained with the use of radium implants and megavoltage radiotherapy in isolated instances. In our series, two patients survived nine years with this form of treatment. To dissipate much of the confusion that surrounds the terminology of those tumors arising in the anal region, we concur with Morson's suggestion that they should be designated as keratinizing and nonkeratinizing. There was no statistically difference in survival rate between tumors arising in the anal canal and in the perianal skin. The importance of delimitating the extent of the disease, before any form of treatment is attempted, has been emphasized, and our staging system has been presented. Finally, the question concerning the management of inguinal node metastases has been further developed with special emphasis on their different significance whether they appear early or late in the course of the disease.