title: Small cell cancer of the anal canal--case report of a rare tumor.
abstract: BACKGROUND
  We report on a rare case of small cell cancer located at the anal canal.
  
  
  METHODS
  A 41-year old woman presented with locally advanced small cell anal cancer and simultaneous hepatic and pulmonal deposits. Due to metastatic disease, chemotherapy with etoposide and cisplatin was performed with mixed response after four cycles of chemotherapy. After application of two additional chemotherapy cycles, locally progressive disease occurred causing symptomatic bowel obstruction. Pelvic irradiation was started and, several days later, additional irradiation of cerebral metastases was initiated due to rapid progression of distant disease. Despite adequate local treatment the patient's condition further deteriorated and irradiation was stopped. The patient died 10 months after initial diagnosis due to rapid tumor progression.
  
  
  CONCLUSIONS
  In patients with metastatic small cell anal cancer chemotherapy remains the mainstay of therapy. Radiotherapy exerts additional activity and remains a prime choice to gain local control and ameliorate symptoms. Careful histopathological examination, together with immunohistochemistry, is needed to determine the therapeutic strategy to be followed.
authors.affiliation: Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany. andie.meyer@gmx.net
authors.forename: Andreas
authors.initials: A
authors.lastname: Meyer
authors.forename: Frank
authors.initials: F
authors.lastname: Bruns
authors.forename: Klaus
authors.initials: K
authors.lastname: Richter
authors.forename: Viktor
authors.initials: V
authors.lastname: Grünwald
authors.forename: Johann H
authors.initials: JH
authors.lastname: Karstens
mesh_terms: D000328:Adult; D001005:Anus Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000628:therapy*; D018288:Carcinoma, Small Cell / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans