Objectives
  • To be able to perform specialist assessment, treatment and counselling of patients with anal cancer

Awareness
  • Recognition of specific lifestyle and epidemiological risk factors, viral infections and premalignant conditions for anal cancer

  • Awareness of different prognostic factors

  • Appreciation of the importance of the multimodality approach, including radiotherapy to treat patients with anal cancer

  • Appreciation of the importance of adequate imaging techniques to allow for exact pretreatment staging

  • Appreciation of the use of surgery as salvage option for patients with treatment-refractory or relapsed anal cancers

Knowledge
  • Familiarity with the implication of the different stages of anal cancer in order to select the appropriate treatment strategies

  • Understanding of the protective value of human papilloma virus (HPV) vaccinations for the development of anal cancers

  • Understanding of the pattern of metastases of anal cancer

  • Familiarity with the complexity of anal cancer therapy in patients with active human immunodeficiency virus (HIV) infections

  • Familiarity with the indications and diagnostic tools available for anal cancer (such as endoscopy with or without endoscopic ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET)/CT imaging) and their implications for an appropriate therapeutic strategy

  • Understanding of the importance of cancer precursor lesions and premalignant conditions for the development of anal cancer

  • Familiarity with the risk assessment of prognostic factors, especially the TNM staging system for anal cancer

  • Familiarity with the indications and value of the multimodality approach of radiation therapy and chemotherapy in non-metastatic anal cancer

  • Familiarity with the role of surveillance protocols and the appropriate interval from the completion of radio-chemotherapy as definitive treatment to first restaging evaluation

  • Understanding of the role of chemotherapy in the management of patients with recurrent and metastatic cancer

  • Familiarity with the value of salvage surgery after primary definitive radio-chemotherapy in localised anal cancer

  • Understanding of symptoms and complications that derive from disease progression and those that are treatment-associated in the context of being familiar with supportive and palliative care settings

Skills
  • Ability to contribute actively to a variety of anal cancer scenarios and patient presentations

  • Ability to discuss critically the treatment options and recommendations for various phases of the disease (early and metastatic disease)

  • Ability to perform a history and physical examination in anal patients with cancer

  • Ability to follow individual patients with anal cancer throughout their patient history from initial diagnosis to hospice care

  • Ability to contribute to discussions on general management strategies in order to understand all the considerations on which treatment to use and which sequence to select for the multidisciplinary strategy

  • Ability to prescribe chemotherapeutic agents considering their potential interactions with radiation therapy

  • Ability to understand the long-term complications of definitive radio-chemotherapy in anal cancer

  • Ability to recognise conditions or clinical prognostic factors such as performance status, tumour load, number of metastases, prior radio-chemotherapy, concomitant diseases and other previous therapies that are important for considering when to start and to stop a treatment or switch to another option

  • Ability to manage side effects of various chemotherapeutic agents

  • Ability to educate patients in the importance of lifestyle factors, viral infections and the preventative value of HPV vaccinations of anal cancer