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Tittel Engelsk tittel Versjon Status
Utgiver(e) Publikasjonstype
  • Norsk tittel - Retningslinjer for diagnostikk, behandling og oppfølging av analkreft (analcancer)
  • Engelsk tittel - Anal cancer
  • Versjon - Versjon 2
  • Status - Publisert
  • IS-nr - IS-2488
  • ISBN - ISBN- 978-82-8081-443-2
  • DOI -
  • Revisjonsdato -
  • Neste revisjon -
  • Publikasjonsdato - 10.12.2019
  • Utløpsdato -
  • Utgiver(e) - Helsedirektoratet
  • Redaktør -
  • Publikasjonstype - Nasjonale retningslinjer
  1. Larsen IK, red. Cancer in Norway 2017 – Cancer incidence, mortality, survival and prevalence in Norway. Oslo: Cancer Registry of Norway; 2018. Tilgjengelig fra: 
  2. Guren MG, Aagnes B, Nygard M, Dahl O, Moller B. Rising Incidence and Improved Survival of Anal Squamous Cell Carcinoma in Norway, 1987–2016. Clin Colorectal Cancer 2019;18(1):e96-e103.
  3. Islami F, Ferlay J, Lortet-Tieulent J, Bray F, Jemal A. International trends in anal cancer incidence rates. Int J Epidemiol 2017;46(3):924–38.
  4. Kræfens Bekæmpelse [nettside]. København: Kræftens Bekæmpelse [oppdatert 2016; lest 23. aug 2016]. Tilgjengelig fra: 
  5. Krzowska-Firych J, Lucas G, Lucas C, Lucas N, Pietrzyk L. An overview of Human Papillomavirus (HPV) as an etiological factor of the anal cancer. J Infect Public Health 2019;12(1):1–6.
  6. zur Hausen H. Papillomaviruses causing cancer: evasion from host-cell control in early events in carcinogenesis. J Natl Cancer Inst 2000;92(9):690–8.
  7. Gilbert DC, Serup-Hansen E, Linnemann D, Hogdall E, Bailey C, Summers J, et al. Tumour-infiltrating lymphocyte scores effectively stratify outcomes over and above p16 post chemo-radiotherapy in anal cancer. Br J Cancer 2016;114(2):134–7.
  8. Serup-Hansen E, Linnemann D, Skovrider-Ruminski W, Hogdall E, Geertsen PF, Havsteen H. Human papillomavirus genotyping and p16 expression as prognostic factors for patients with American Joint Committee on Cancer stages I to III carcinoma of the anal canal. J Clin Oncol 2014;32(17):1812–7.
  9. Bruland O, Fluge O, Immervoll H, Balteskard L, Myklebust M, Skarstein A, et al. Gene expression reveals two distinct groups of anal carcinomas with clinical implications. Br J Cancer 2008;98(7):1264–73.
  10. Mai S, Welzel G, Ottstadt M, Lohr F, Severa S, Prigge ES, et al. Prognostic Relevance of HPV Infection and p16 Overexpression in Squamous Cell Anal Cancer. Int J Radiat Oncol Biol Phys 2015;93(4):819–27.
  11. Meulendijks D, Tomasoa NB, Dewit L, Smits PH, Bakker R, van Velthuysen ML, et al. HPV-negative squamous cell carcinoma of the anal canal is unresponsive to standard treatment and frequently carries disruptive mutations in TP53. Br J Cancer 2015;112(8):1358–66.
  12. Rodel F, Wieland U, Fraunholz I, Kitz J, Rave-Frank M, Wolff HA, et al. Human papillomavirus DNA load and p16INK4a expression predict for local control in patients with anal squamous cell carcinoma treated with chemoradiotherapy. Int J Cancer 2015;136(2):278–88.
  13. Castor M, da Silva HJ, Gondim Martins DB, de Mello RJ. HPV and precancerous lesions of anal canal in women: systematic review. Int J Colorectal Dis 2012;27(3):271–6.
  14. Machalek DA, Poynten M, Jin F, Fairley CK, Farnsworth A, Garland SM, et al. Anal human papillomavirus infection and associated neoplastic lesions in men who have sex with men: a systematic review and meta-analysis. Lancet Oncol 2012;13(5):487–500.
  15. Shiels MS, Pfeiffer RM, Chaturvedi AK, Kreimer AR, Engels EA. Impact of the HIV epidemic on the incidence rates of anal cancer in the United States. J Natl Cancer Inst 2012;104(20):1591–8.
  16. Hemminki K, Liu X, Ji J, Sundquist J, Sundquist K. Autoimmune disease and subsequent digestive tract cancer by histology. Ann Oncol 2012;23(4):927–33.
  17.  Sunesen KG, Norgaard M, Thorlacius-Ussing O, Laurberg S. Immunosuppressive disorders and risk of anal squamous cell carcinoma: a nationwide cohort study in Denmark, 1978–2005. Int J Cancer 2010;127(3):675–84.
  18. Coffey K, Beral V, Green J, Reeves G, Barnes I. Lifestyle and reproductive risk factors associated with anal cancer in women aged over 50 years. Br J Cancer 2015;112(9):1568–74.
  19. Daling JR, Madeleine MM, Johnson LG, Schwartz SM, Shera KA, Wurscher MA, et al. Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer. Cancer 2004;101(2):270–80.
  20. Humant papillomavirus (HPV), genitale infeksjoner – veileder for helsepersonell. Smittevernveilederen [nettdokument]. Oslo: Folkehelseinstituttet [oppdatert 21. feb 2016; lest 23. aug 2016]. Tilgjengelig fra:
  21. Nilsen E, Alfsen CG, Feiring B, Skjeldestad FE, Steen R, Sæterdal I. Vaksiner mot humant papillomavirus (HPV): vurdering av effekt av profylaktiske HPV-vaksiner. Oslo: Nasjonalt kunnskapssenter for helsetjenesten; 2007. Rapport fra Kunnskapssenteret Nr 5–2007. Tilgjengelig fra: 
  22. HPV og HPV-vaksine [nettside]. Oslo: Folkehelseinstituttet [oppdatert 2016; lest 23. aug. 2016]. Tilgjengelig fra: 
  23. Lam JU, Rebolj M, Dugue PA, Bonde J, von Euler-Chelpin M, Lynge E. Condom use in prevention of Human Papillomavirus infections and cervical neoplasia: systematic review of longitudinal studies. J Med Screen 2014;21(1):38–50.
  24. Winer RL, Hughes JP, Feng Q, O’Reilly S, Kiviat NB, Holmes KK, et al. Condom use and the risk of genital human papillomavirus infection in young women. N Engl J Med 2006;354(25):2645–54.
  25. HPV-test gir enklere screening mot livmorhalskreft for 9 av 10 kvinner mellom 34 og 69 år [nettdokument]. Oslo: Kreftregisteret [oppdatert 2013; lest 23. aug. 2016]. Tilgjengelig fra: 
  26. Bosman FT, Carneiro F, Hruman RH, Theise ND, red. WHO Classification of Tumours of the Digestive System. 4. utg. Lyon: International Agency for Research on Cancer; 2010.
  27. Liu Y, Sigel K, Gaisa MM. Human Papillomavirus Genotypes Predict Progression of Anal Low-Grade Squamous Intraepithelial Lesions. J Infect Dis 2018;218(11):1746–52.
  28. Gautier M, Brochard C, Lion A, Henno S, Mallet AL, Bodere A, et al. High-grade anal intraepithelial neoplasia: Progression to invasive cancer is not a certainty. Dig Liver Dis 2016;48(7):806–11.
  29. Zidar N, Langner C, Odar K, Hošnjak L, Kamaradova K, Daum O, et al. Anal verrucous carcinoma is not related to infection with human papillomaviruses and should be distinguished from giant condyloma (Buschke-Lowenstein tumour). Histopathology 2017;70(6):938–45.
  30. Macaya A, Munoz-Santos C, Balaguer A, Barbera MJ. Interventions for anal canal intraepithelial neoplasia. Cochrane Database Syst Rev 2012;12:CD009244.
  31. Alam NN, White DA, Narang SK, Daniels IR, Smart NJ. Systematic review of guidelines for the assessment and management of high-grade anal intraepithelial neoplasia (AIN II/III). Colorectal Dis 2016;18(2):135–46.
  32. Pineda CE, Welton ML. Management of anal squamous intraepithelial lesions. Clin Colon Rectal Surg 2009;22(2):94–101.
  33. Fox PA, Nathan M, Francis N, Singh N, Weir J, Dixon G, et al. A double-blind, randomized controlled trial of the use of imiquimod cream for the treatment of anal canal high-grade anal intraepithelial neoplasia in HIV-positive MSM on HAART, with long-term follow-up data including the use of open-label imiquimod. AIDS 2010;24(15):2331–5.
  34. Richel O, de Vries HJ, van Noesel CJ, Dijkgraaf MG, Prins JM. Comparison of imiquimod, topical fluorouracil, and electrocautery for the treatment of anal intraepithelial neoplasia in HIV-positive men who have sex with men: an open-label, randomised controlled trial. Lancet Oncol 2013;14(4):346–53.
  35. Ajani JA, Winter KA, Gunderson LL, Pedersen J, Benson AB, 3rd, Thomas CR, Jr., et al. Prognostic factors derived from a prospective database dictate clinical biology of anal cancer: the intergroup trial (RTOG 98–11). Cancer 2010;116(17):4007–13.
  36. Bentzen AG, Guren MG, Wanderas EH, Frykholm G, Tveit KM, Wilsgaard T, et al. Chemoradiotherapy of anal carcinoma: survival and recurrence in an unselected national cohort. Int J Radiat Oncol Biol Phys 2012;83(2):e173–80.
  37. Gunderson LL, Moughan J, Ajani JA, Pedersen JE, Winter KA, Benson AB, 3rd, et al. Anal carcinoma: impact of TN category of disease on survival, disease relapse, and colostomy failure in US Gastro­intestinal Intergroup RTOG 98–11 phase 3 trial. Int J Radiat Oncol Biol Phys 2013;87(4):638–45.
  38. Kochhar R, Plumb AA, Carrington BM, Saunders M. Imaging of anal carcinoma. AJR Am J Roentgenol 2012;199(3):W335–44.
  39. Roach SC, Hulse PA, Moulding FJ, Wilson R, Carrington BM. Magnetic resonance imaging of anal cancer. Clin Radiol 2005;60(10):1111–9.
  40. Salerno G, Daniels I, Heald RJ, Brown G, Moran BJ. Management and imaging of low rectal carcinoma. Surg Oncol 2004;13(2–3):55–61.
  41. Koh DM, Dzik-Jurasz A, O’Neill B, Tait D, Husband JE, Brown G. Pelvic phased-array MR imaging of anal carcinoma before and after chemoradiation. Br J Radiol 2008;81(962):91–8.
  42. Goh V, Gollub FK, Liaw J, Wellsted D, Przybytniak I, Padhani AR, et al. Magnetic resonance imaging assessment of squamous cell carcinoma of the anal canal before and after chemoradiation: can MRI predict for eventual clinical outcome? Int J Radiat Oncol Biol Phys 2010;78(3):715–21.
  43. Stoker J, Rociu E, Wiersma TG, Lameris JS. Imaging of anorectal disease. Br J Surg 2000;87(1):10–27.
  44. Parikh J, Shaw A, Grant LA, Schizas AM, Datta V, Williams AB, et al. Anal carcinomas: the role of endoanal ultrasound and magnetic resonance imaging in staging, response evaluation and follow-up. Eur Radiol 2011;21(4):776–85.
  45. Wade DS, Herrera L, Castillo NB, Petrelli NJ. Metastases to the lymph nodes in epidermoid carcinoma of the anal canal studied by a clearing technique. Surg Gynecol Obstet 1989;169(3):238–42.
  46. Brown G, Richards CJ, Bourne MW, Newcombe RG, Radcliffe AG, Dallimore NS, et al. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 2003;227(2):371–7.
  47. Kim JH, Beets GL, Kim MJ, Kessels AG, Beets-Tan RG. High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? Eur J Radiol 2004;52(1):78–83.
  48. McMahon CJ, Rofsky NM, Pedrosa I. Lymphatic metastases from pelvic tumors: anatomic classification, characterization, and staging. Radiology 2010;254(1):31–46.
  49. Magdeburg B, Fried M, Meyenberger C. Endoscopic ultrasonography in the diagnosis, staging, and follow-up of anal carcinomas. Endoscopy 1999;31(5):359–64.
  50. Otto SD, Lee L, Buhr HJ, Frericks B, Hocht S, Kroesen AJ. Staging anal cancer: prospective comparison of transanal endoscopic ultrasound and magnetic resonance imaging. J Gastrointest Surg 2009;13(7):1292–8.
  51. Lund JA, Sundstrom SH, Haaverstad R, Wibe A, Svinsaas M, Myrvold HE. Endoanal ultrasound is of little value in follow-up of anal carcinomas. Dis Colon Rectum 2004;47(6):839–42.
  52. Guidelines for the management of anal cancer. I: Guidelines for the management of colorectal cancer. 3. utg. London: The Association of Coloproctology of Great Britain and Ireland; 2007. s. 68–95. Tilgjengelig fra: 
  53. Benson AB, Venook AP, Al-Hawary MM, Cederquist L, Chen YJ, Ciombor KK, et al. Anal Carcinoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2018;16(7):852–71.
  54. Glynne-Jones R, Nilsson PJ, Aschele C, Goh V, Peiffert D, Cervantes A, et al. Anal cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014;25 Suppl 3:iii10–20.
  55. Bhuva NJ, Glynne-Jones R, Sonoda L, Wong WL, Harrison MK. To PET or not to PET? That is the question. Staging in anal cancer. Ann Oncol 2012;23(8):2078–82.
  56. Nguyen BT, Joon DL, Khoo V, Quong G, Chao M, Wada M, et al. Assessing the impact of FDG-PET in the management of anal cancer. Radiother Oncol 2008;87(3):376–82.
  57. Wells IT, Fox BM. PET/CT in anal cancer – is it worth doing? Clin Radiol 2012;67(6):535–40.
  58. Nasjonal handlingsplan for kreft 2015–2017. Oslo: Helsedirektoratet; 2015. IS-2298. Tilgjengelig fra:
  59. Croke JM, El-Sayed S. Multidisciplinary management of cancer patients: chasing a shadow or real value? An overview of the literature. Curr Oncol 2012;19(4):e232–8.
  60. Glynne-Jones R, Nilsson PJ, Aschele C, Goh V, Peiffert D, Cervantes A, et al. Anal cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Radiother Oncol 2014;111(3):330–9.
  61. Brierley JD, Gospodarowicz MK, Wittekin C, red. TNM Classification of Malignant Tumours. 8. utg. New York: John Wiley & Sons; 2017.
  62. Shida D, Kanemitsu Y, Hamaguchi T, Shimada Y. Introducing the eighth edition of the tumor-node-metastasis classification as relevant to colorectal cancer, anal cancer and appendiceal cancer: a comparison study with the seventh edition of the tumor-node-metastasis and the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma. Jpn J Clin Oncol 2019;49(4):321–8.
  63. Nigro ND. An evaluation of combined therapy for squamous cell cancer of the anal canal. Dis Colon Rectum 1984;27(12):763–6.
  64. Nigro ND, Vaitkevicius VK, Considine B, Jr. Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum 1974;17(3):354–6.
  65. Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet 1996;348(9034):1049–54.
  66. Bartelink H, Roelofsen F, Eschwege F, Rougier P, Bosset JF, Gonzalez DG, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol 1997;15(5):2040–9.
  67. Balamucki CJ, Zlotecki RA, Rout WR, Newlin HE, Morris CG, Kirwan JM, et al. Squamous cell carci­noma of the anal margin: the university of Florida experience. Am J Clin Oncol 2011;34(4):406–10.
  68. Fuchshuber PR, Rodriguez-Bigas M, Weber T, Petrelli NJ. Anal canal and perianal epidermoid cancers. J Am Coll Surg 1997;185(5):494–505.
  69. Hatfield P, Cooper R, Sebag-Montefiore D. Involved-field, low-dose chemoradiotherapy for early-stage anal carcinoma. Int J Radiat Oncol Biol Phys 2008;70(2):419–24.
  70. Leon O, Hagberg O, Johnsson A. Primary surgery with or without postoperative radiotherapy in early stage squamous cell carcinoma in the anal canal and anal margin. Acta Oncol 2018;57(9):1209–15.
  71. Leon O, Guren M, Hagberg O, Glimelius B, Dahl O, Havsteen H, et al. Anal carcinoma – Survival and recurrence in a large cohort of patients treated according to Nordic guidelines. Radiother Oncol 2014;113(3):352–8.
  72. Ajani JA, Winter KA, Gunderson LL, Pedersen J, Benson AB, 3rd, Thomas CR, Jr., et al. Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA 2008;299(16):1914–21.
  73. Gunderson LL, Winter KA, Ajani JA, Pedersen JE, Moughan J, Benson AB, 3rd, et al. Long-term update of US GI intergroup RTOG 98–11 phase III trial for anal carcinoma: survival, relapse, and colostomy failure with concurrent chemoradiation involving fluorouracil/mitomycin versus fluorouracil/cisplatin. J Clin Oncol 2012;30(35):4344–51.
  74. James RD, Glynne-Jones R, Meadows HM, Cunningham D, Myint AS, Saunders MP, et al. Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2 x 2 factorial trial. Lancet Oncol 2013;14(6):516–24.
  75. Johnsson A, Leon O, Gunnlaugsson A, Nilsson P, Hoglund P. Determinants for local tumour control probability after radiotherapy of anal cancer. Radiother Oncol 2018;128(2):380–6.
  76. Muirhead R, Partridge M, Hawkins MA. A tumor control probability model for anal squamous cell carcinoma. Radiother Oncol 2015;116(2):192–6.
  77. Kachnic LA, Tsai HK, Coen JJ, Blaszkowsky LS, Hartshorn K, Kwak EL, et al. Dose-painted intensity-modulated radiation therapy for anal cancer: a multi-institutional report of acute toxicity and response to therapy. Int J Radiat Oncol Biol Phys 2012;82(1):153–8.
  78. Leon O, Guren MG, Radu C, Gunnlaugsson A, Johnsson A. Phase I study of cetuximab in combination with 5-fluorouracil, mitomycin C and radiotherapy in patients with locally advanced anal cancer. Eur J Cancer 2015;51(18):2740–6.
  79. Henkenberens C, Toklu H, Tamme C, Bruns F. Clinical Value of Squamous Cell Carcinoma Antigen (SCCAg) in Anal Cancer – A Single-Center Retrospective Analysis. Anticancer Res 2016;36(6):3173–7.
  80. Lepinoy A, Lescut N, Puyraveau M, Caubet M, Boustani J, Lakkis Z, et al. Evaluation of a 36 Gy elective node irradiation dose in anal cancer. Radiother Oncol 2015;116(2):197–201.
  81. Glynne-Jones R, Sebag-Montefiore D, Adams R, McDonald A, Gollins S, James R, et al. «Mind the gap»--the impact of variations in the duration of the treatment gap and overall treatment time in the first UK Anal Cancer Trial (ACT I). Int J Radiat Oncol Biol Phys 2011;81(5):1488–94.
  82. Thind G, Johal B, Follwell M, Kennecke HF. Chemoradiation with capecitabine and mitomycin-C for stage I-III anal squamous cell carcinoma. Radiat Oncol 2014;9:124.
  83. Glynne-Jones R, Meadows H, Wan S, Gollins S, Leslie M, Levine E, et al. EXTRA--a multicenter phase II study of chemoradiation using a 5 day per week oral regimen of capecitabine and intravenous mitomycin C in anal cancer. Int J Radiat Oncol Biol Phys 2008;72(1):119–26.
  84. Meulendijks D, Dewit L, Tomasoa NB, van Tinteren H, Beijnen JH, Schellens JH, et al. Chemoradiotherapy with capecitabine for locally advanced anal carcinoma: an alternative treatment option. Br J Cancer 2014;111(9):1726–33.
  85. Deenen MJ, Dewit L, Boot H, Beijnen JH, Schellens JH, Cats A. Simultaneous integrated boost-intensity modulated radiation therapy with concomitant capecitabine and mitomycin C for locally advanced anal carcinoma: a phase 1 study. Int J Radiat Oncol Biol Phys 2013;85(5):e201–7.
  86. Hodges JC, Das P, Eng C, Reish AG, Beddar AS, Delclos ME, et al. Intensity-modulated radiation therapy for the treatment of squamous cell anal cancer with para-aortic nodal involvement. Int J Radiat Oncol Biol Phys 2009;75(3):791–4.
  87. Fish R, Sanders C, Adams R, Brewer J, Brookes ST, DeNardo J, et al. A core outcome set for clinical trials of chemoradiotherapy interventions for anal cancer (CORMAC): a patient and health-care professional consensus. Lancet Gastroenterol Hepatol 2018;3(12):865–73.
  88. Myerson RJ, Garofalo MC, El Naqa I, Abrams RA, Apte A, Bosch WR, et al. Elective clinical target volumes for conformal therapy in anorectal cancer: a radiation therapy oncology group consensus panel contouring atlas. Int J Radiat Oncol Biol Phys 2009;74(3):824–30.
  89. Ng M, Leong T, Chander S, Chu J, Kneebone A, Carroll S, et al. Australasian Gastrointestinal Trials Group (AGITG) contouring atlas and planning guidelines for intensity-modulated radiotherapy in anal cancer. Int J Radiat Oncol Biol Phys 2012;83(5):1455–62.
  90. Taylor A, Rockall AG, Reznek RH, Powell ME. Mapping pelvic lymph nodes: guidelines for delineation in intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 2005;63(5):1604–12.
  91. DeFoe SG, Kabolizadeh P, Heron DE, Beriwal S. Dosimetric parameters predictive of acute gastrointestinal toxicity in patients with anal carcinoma treated with concurrent chemotherapy and intensity-modulated radiation therapy. Oncology 2013;85(1):1–7.
  92. Ng M, Ho H, Skelton J, Guerrieri M, Guiney M, Chao M, et al. Intensity-modulated Radiotherapy for Anal Cancer: Dose-Volume Relationship of Acute Gastrointestinal Toxicity and Disease Outcomes. Clin Oncol (R Coll Radiol) 2018;30(10):634–41.
  93. Kachnic LA, Winter K, Myerson RJ, Goodyear MD, Willins J, Esthappan J, et al. RTOG 0529: a phase 2 evaluation of dose-painted intensity modulated radiation therapy in combination with 5-fluorouracil and mitomycin-C for the reduction of acute morbidity in carcinoma of the anal canal. Int J Radiat Oncol Biol Phys 2013;86(1):27–33.
  94. Brown E, Cray A, Haworth A, Chander S, Lin R, Subramanian B, et al. Dose planning objectives in anal canal cancer IMRT: the TROG ANROTAT experience. J Med Radiat Sci 2015;62(2):99–107.
  95. Franco P, Arcadipane F, Ragona R, Mistrangelo M, Cassoni P, Munoz F, et al. Volumetric modulated arc therapy (VMAT) in the combined modality treatment of anal cancer patients. Br J Radiol 2016;89(1060):20150832.
  96. Chuong MD, Freilich JM, Hoffe SE, Fulp W, Weber JM, Almhanna K, et al. Intensity-Modulated Radiation Therapy vs. 3D Conformal Radiation Therapy for Squamous Cell Carcinoma of the Anal Canal. Gastrointest Cancer Res 2013;6(2):39–45.
  97. DeFoe SG, Beriwal S, Jones H, Rakfal S, Heron DE, Kabolizadeh P, et al. Concurrent chemotherapy and intensity-modulated radiation therapy for anal carcinoma--clinical outcomes in a large National Cancer Institute-designated integrated cancer centre network. Clin Oncol (R Coll Radiol) 2012;24(6):424–31.
  98. Dasgupta T, Rothenstein D, Chou JF, Zhang Z, Wright JL, Saltz LB, et al. Intensity-modulated radiotherapy vs. conventional radiotherapy in the treatment of anal squamous cell carcinoma: a propensity score analysis. Radiother Oncol 2013;107(2):189–94.
  99. Ben-Josef E, Moughan J, Ajani JA, Flam M, Gunderson L, Pollock J, et al. Impact of overall treatment time on survival and local control in patients with anal cancer: a pooled data analysis of Radiation Therapy Oncology Group trials 87–04 and 98–11. J Clin Oncol 2010;28(34):5061–6.
  100. Julie DR, Goodman KA. Advances in the Management of Anal Cancer. Curr Oncol Rep 2016;18(3):20.
  101. Bese NS, Hendry J, Jeremic B. Effects of prolongation of overall treatment time due to unplanned interruptions during radiotherapy of different tumor sites and practical methods for compensation. Int J Radiat Oncol Biol Phys 2007;68(3):654–61.
  102. The Royal College of Radiologists. The timely delivery of radical radiotherapy: standards and guidelines for the management of unscheduled treatment interruptions. 4. utg. London: The Royal College of Radiologist; 20019. Tilgjengelig fra: 
  103. Erridge SC, Kerr GR, Downing D, Duncan W, Price A. The effect of overall treatment time on the sur­vival and toxicity of radical radiotherapy for cervical carcinoma. Radiother Oncol 2002;63(1):59–66.
  104. Dutta SW, Alonso CE, Waddle MR, Khandelwal SR, Janowski EM, Trifiletti DM. Squamous cell carcinoma of the rectum: Practice trends and patient survival. Cancer Med 2018;7(12):6093–103.
  105. Jeong BG, Kim DY, Kim SY. Concurrent chemoradiotherapy for squamous cell carcinoma of the rectum. Hepatogastroenterology 2013;60(123):512–6.
  106. Musio D, De Felice F, Manfrida S, Balducci M, Meldolesi E, Gravina GL, et al. Squamous cell carcinoma of the rectum: The treatment paradigm. Eur J Surg Oncol 2015;41(8):1054–8.
  107. Dyson T, Draganov PV. Squamous cell cancer of the rectum. World J Gastroenterol 2009;15(35):4380–6.
  108. Guerra GR, Kong CH, Warrier SK, Lynch AC, Heriot AG, Ngan SY. Primary squamous cell carcinoma of the rectum: An update and implications for treatment. World J Gastrointest Surg 2016;8(3):252–65.
  109. Peron J, Bylicki O, Laude C, Martel-Lafay I, Carrie C, Racadot S. Nonoperative management of squamous-cell carcinoma of the rectum. Dis Colon Rectum 2015;58(1):60–4.
  110. Sturgeon JD, Crane CH, Krishnan S, Minsky BD, Skibber JM, Rodriguez-Bigas MA, et al. Definitive Chemoradiation for Squamous Cell Carcinoma of the Rectum. Am J Clin Oncol 2017;40(2):163–6.
  111. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995;31(5):1341–6.
  112. Chan RJ, Webster J, Chung B, Marquart L, Ahmed M, Garantziotis S. Prevention and treatment of acute radiation-induced skin reactions: a systematic review and meta-analysis of randomized controlled trials. BMC Cancer 2014;14:53.
  113. Kumar S, Juresic E, Barton M, Shafiq J. Management of skin toxicity during radiation therapy: a review of the evidence. J Med Imaging Radiat Oncol 2010;54(3):264–79.
  114. Bahng AY, Dagan A, Bruner DW, Lin LL. Determination of prognostic factors for vaginal mucosal toxicity associated with intravaginal high-dose rate brachytherapy in patients with endometrial cancer. Int J Radiat Oncol Biol Phys 2012;82(2):667–73.
  115. International Clinical Guideline Group. International guidelines on vaginal dilation after pelvic radiotherapy. Woodstock, UK: Owen Mumford; 2012. Tilgjengelig fra: 
  116. Muehlbauer PM, Thorpe D, Davis A, Drabot R, Rawlings BL, Kiker E. Putting evidence into practice: evidence-based interventions to prevent, manage, and treat chemotherapy- and radiotherapy-induced diarrhea. Clin J Oncol Nurs 2009;13(3):336–41.
  117. Glynne-Jones R, Sebag-Montefiore D, Meadows HM, Cunningham D, Begum R, Adab F, et al. Best time to assess complete clinical response after chemoradiotherapy in squamous cell carcinoma of the anus (ACT II): a post-hoc analysis of randomised controlled phase 3 trial. Lancet Oncol 2017;18(3):347–56.
  118. Clark MA, Hartley A, Geh JI. Cancer of the anal canal. Lancet Oncol 2004;5(3):149–57.
  119. Renehan AG, Saunders MP, Schofield PF, O’Dwyer ST. Patterns of local disease failure and outcome after salvage surgery in patients with anal cancer. Br J Surg 2005;92(5):605–14.
  120. Nilsson PJ, Svensson C, Goldman S, Glimelius B. Salvage abdominoperineal resection in anal epidermoid cancer. Br J Surg 2002;89(11):1425–9.
  121. Renehan AG, O’Dwyer ST. Management of local disease relapse. Colorectal Dis 2011;13 Suppl 1:44–52.
  122. Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen ML, Extermann M, et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 2014;32(24):2595–603.
  123. Dale JE, Sebjornsen S, Leh S, Rosler C, Aaserud S, Moller B, et al. Multimodal therapy is feasible in elderly anal cancer patients. Acta Oncol 2017;56(1):81–7.
  124. Bentzen AG, Balteskard L, Wanderås EH, Frykholm G, Wilsgaard T, Dahl O, et al. Impaired health-related quality of life after chemoradiotherapy for anal cancer: late effects in a national cohort of 128 survivors. Acta Oncol 2013;52(4):736–44.
  125. Bentzen AG, Guren MG, Vonen B, Wanderas EH, Frykholm G, Wilsgaard T, et al. Faecal incontinence after chemoradiotherapy in anal cancer survivors: long-term results of a national cohort. Radiother Oncol 2013;108(1):55–60.
  126. Alberta Provincial Gastrointestinal Tumour Team. Anal canal cancer. Alberta: Alberta health Services; 2013. Clinical practice guideline GI-001 version 4. Tilgjengelig fra: 
  127. Vanneste BG, Van De Voorde L, de Ridder RJ, Van Limbergen EJ, Lambin P, van Lin EN. Chronic radiation proctitis: tricks to prevent and treat. Int J Colorectal Dis 2015;30(10):1293–303.
  128. Incrocci L, Jensen PT. Pelvic radiotherapy and sexual function in men and women. J Sex Med 2013;10 Suppl 1:53–64.
  129. Miles T. International Guidelines on Vaginal Dilation after Pelvic Radiotherapy. Brook Hill, Woodstock, Oxon: Owen Mumford Ltd; 2012. Tilgjengelig fra: 
  130. Liem X, Saad F, Delouya G. A Practical Approach to the Management of Radiation-Induced Hemorrhagic Cystitis. Drugs 2015;75(13):1471–82.
  131. Tahir AR, Westhuyzen J, Dass J, Collins MK, Webb R, Hewitt S, et al. Hyperbaric oxygen therapy for chronic radiation-induced tissue injuries: Australasia’s largest study. Asia Pac J Clin Oncol 2015;11(1):68–77.
  132. Glover M, Smerdon GR, Andreyev HJ, Benton BE, Bothma P, Firth O, et al. Hyperbaric oxygen for patients with chronic bowel dysfunction after pelvic radiotherapy (HOT2): a randomised, double-blind, sham-controlled phase 3 trial. Lancet Oncol 2016;17(2):224–33.
  133. Sodergren SC, Vassiliou V, Dennis K, Tomaszewski KA, Gilbert A, Glynne-Jones R, et al. Systematic review of the quality of life issues associated with anal cancer and its treatment with radiochemotherapy. Support Care Cancer 2015;23(12):3613–23.
  134. Sodergren SC, Johnson CD, Gilbert A, Tomaszewski KA, Chu W, Chung HT, et al. Phase I-III development of the EORTC QLQ-ANL27, a health-related quality of life questionnaire for anal cancer. Radiother Oncol 2018;126(2):222–8.
  135. Higham CE, Faithfull S. Bone Health and Pelvic Radiotherapy. Clin Oncol (R Coll Radiol) 2015;27(11):668–78.
  136. Seneffekter etter kreftbehandling: faglige råd. Oslo: Helsedirektoratet; 2017. IS-2551. Tilgjengelig fra: etter kreftbehandling-IS-2551.pdf
  137. Akbari RP, Paty PB, Guillem JG, Weiser MR, Temple LK, Minsky BD, et al. Oncologic outcomes of salvage surgery for epidermoid carcinoma of the anus initially managed with combined modality therapy. Dis Colon Rectum 2004;47(7):1136–44.
  138. Faivre C, Rougier P, Ducreux M, Mitry E, Lusinchi A, Lasser P, et al. Carcinome epidermoide metastatique de l’anus: etude retrospective de l’efficacite de l’association de 5-fluoro-uracile en perfusion continue et de cisplatine [5-fluorouracile and cisplatinum combination chemotherapy for metastatic squamous-cell anal cancer]. Bull Cancer 1999;86(10):861–5.
  139. Rao S, Sclafani F, Eng C, Guren MG, Adams RA, Benson A, et al. InterAACT: A multicentre open label randomised phase II advanced anal cancer trial of cisplatin (CDDP) plus 5-fluorouracil (5-FU) vs carboplatin (C) plus weekly paclitaxel (P) in patients (pts) with inoperable locally recurrent (ILR) or metastatic treatment naïve disease – An International Rare Cancers Initiative (IRCI) trial. Foredrag på ESMO 2018 Congress 22. oktober 2018. Tilgjengelig fra: 
  140. Eng C, Chang GJ, You YN, Das P, Rodriguez-Bigas M, Xing Y, et al. The role of systemic chemotherapy and multidisciplinary management in improving the overall survival of patients with metastatic squamous cell carcinoma of the anal canal. Oncotarget 2014;5(22):11133–42.
  141. Kim R, Byer J, Fulp WJ, Mahipal A, Dinwoodie W, Shibata D. Carboplatin and paclitaxel treatment is effective in advanced anal cancer. Oncology 2014;87(2):125–32.
  142. Rogers JE, Eng C. Pharmacotherapy of Anal Cancer. Drugs 2017;77(14):1519–30.
  143. Sclafani F, Rao S. Systemic Therapies for Advanced Squamous Cell Anal Cancer. Curr Oncol Rep 2018;20(7):53.
  144. Cacheux W, Lievre A, De La Rochefordiere A, Dieumegard B, Cvitkovic F, Labib A, et al. Chemotherapy in the treatment of anal canal carcinoma. Dig Liver Dis 2012;44(10):803–11.
  145. Lim F, Glynne-Jones R. Chemotherapy/chemoradiation in anal cancer: a systematic review. Cancer Treat Rev 2011;37(7):520–32.
  146. Spithoff K, Cummings B, Jonker D, Biagi JJ. Chemoradiotherapy for squamous cell cancer of the anal canal: a systematic review. Clin Oncol (R Coll Radiol) 2014;26(8):473–87.
  147. Kim DW, Byer J, Kothari N, Mahipal A, Chang YD, Kim RD. EGFR Inhibitors in Patients with Advanced Squamous Cell Anal Carcinomas: A Single-Institution Experience. Oncology 2017;92(4):190–6.
  148. Lukan N, Ströbel P, Willer A, Kripp M, Dinter D, Mai S, et al. Cetuximab-based treatment of metastatic anal cancer: correlation of response with KRAS mutational status. Oncology 2009;77(5):293–9.
  149. Morris VK, Salem ME, Nimeiri H, Iqbal S, Singh P, Ciombor K, et al. Nivolumab for previously treated unresectable metastatic anal cancer (NCI9673): a multicentre, single-arm, phase 2 study. Lancet Oncol 2017;18(4):446–53.
  150. Aass N, Haugne DF, Rosland JH, HJordhøy M, Dønnem T, Knudsen AK. Nasjonalt handlingsprogram med retningslinjer for palliasjon i kreftomsorgen. 5. utg. Oslo: Helsedirektoratet; 2015. IS-2285. Tilgjengelig fra: 
  151. Bilimoria KY, Bentrem DJ, Rock CE, Stewart AK, Ko CY, Halverson A. Outcomes and prognostic factors for squamous-cell carcinoma of the anal canal: analysis of patients from the National Cancer Data Base. Dis Colon Rectum 2009;52(4):624–31.
  152. Arana R, Fléjou JF, Si-Mohamed A, Bauer P, Etienney I. Clinicopathological and virological characteristics of superficially invasive squamous-cell carcinoma of the anus. Colorectal Dis 2015;17(11):965–72.
  153. Scholefield JH, Castle MT, Watson NF. Malignant transformation of high-grade anal intraepithelial neoplasia. Br J Surg 2005;92(9):1133–6.
  154. Watson AJ, Smith BB, Whitehead MR, Sykes PH, Frizelle FA. Malignant progression of anal intra-epithelial neoplasia. ANZ J Surg 2006;76(8):715–7.
  155. Goldman S, Auer G, Erhardt K, Seligson U. Prognostic significance of clinical stage, histologic grade, and nuclear DNA content in squamous-cell carcinoma of the anus. Dis Colon Rectum 1987;30(6):444–8.
  156. Gilbert DC, Williams A, Allan K, Stokoe J, Jackson T, Linsdall S, et al. p16INK4A, p53, EGFR expression and KRAS mutation status in squamous cell cancers of the anus: correlation with outcomes following chemo-radiotherapy. Radiother Oncol 2013;109(1):146–51.
  157. Sun G, Dong X, Tang X, Qu H, Zhang H, Zhao E. The prognostic value of HPV combined p16 status in patients with anal squamous cell carcinoma: a meta-analysis. Oncotarget 2018;9(8):8081–8.
  158. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. American Joint Committee on Cancer. Ajcc cancer staging handbook: from the AJCC cancer staging manual. 7. utg. New York: Springer 2010.
  159. Nasjonal helse- og sykehusplan (2016−2019). Oslo: Helse- og omsorgsdepartemenetet; 2015. Meld. St. 11 (2015–2016). Tilgjengelig fra:​7b6ad7e0ef1a403d97958bcb34478609/no/pdfs/stm201520160011000dddpdfs.pdf 
  160. Lov om kommunale helse- og omsorgstjenester. LOV-2011-06-24-30.
  161. Nasjonal strategi for kreftområdet 2006–2009. Oslo: Helse- og omsorgsdepartementet; 2006. Tilgjengelig fra: 
  162. Sammen – mot kreft: nasjonal kreftstrategi 2013–2017. Oslo: Helse- og omsorgsdepartementet; 2013. Tilgjengelig fra:​07cd14ff763444a3997de1570b85fad1/kreftstrategien_2013.pdf 
  163. Leve med kreft: nasjonal kreftstrategi (2018–2022). Oslo: Helse- og omsorgsdepartementet; 2018. Tilgjengelig fra: