Module 1 

HPV Background (Epidemiology, Pathogenesis and Anatomy)

Objectives: 

• Apply knowledge of lower genital HPV infection, including natural history, to the anal canal
• Describe anal canal and perianal anatomy
• Define and identify histopathological and cytopathological features of anal squamous intraepithelial lesions and anal cancer

1.    Introduction to HPV: General Epidemiology - 30 mins

2.    Epidemiology of Anal Cancer and Squamous Intraepithelial Lesions (SIL) – 31 mins

3.    Anal Anatomy – 13 mins

4.    Pathology 1: Anal Squamous Intraepithelial Lesions and Cancer – 30 mins

5.    Pathology 2: Interpretation of Anal Cytology – 25 mins

Total time: approximately 2 hours

Module 2

Introduction to HRA and Related Procedures

Objectives:

• Understand and define terminology related to HRA
• Interpret the normal features encountered during HRA with respect to the transformation zone and anal/perianal anatomy
• Learn the steps of performing an HRA exam and related procedures

1.    HRA Terminology – 26 mins

2.    HRA: Features of the Normal Anal Transformation Zone – 21 mins

3.    HRA Procedures/Skills – 45 mins

4.    Putting it together: HRA Video – 25 mins 

Total time: approximately 2 hours

Module 3

HRA Pattern Recognition

Objectives:

• Identify and differentiate Low-grade (L)SIL and High-grade (H)SIL within the anal canal and perianus
• Recognize features of invasive disease

1.    HRA: Identification of LSIL – 20 mins

2.    HRA: Identification of HSIL – 26 mins 

3.    HRA: Identification of Perianal Lesions – 28 mins

4.    HRA: Identification of Cancer – 33 mins

5.    Tips to improving HRA skills – 31 mins 

Total time: approximately 2.3 hours

Module 4

Treatment of ASIL

Objectives:

• Summarize current treatment options for Anal SIL including topical, ablative and excisional methods
  
• Describe their mode of action, benefits and complications 
• Requirements for anesthesia associated with different treatment modalities

1.    Principles of Treatment – 24 mins

2.    Topical Therapies – 30 mins 

3.    Ablative Therapies: Technique – 49 mins

4.    Anesthesia for Procedures – 11 mins

Total time: approximately 2 hours

Module 5

Screening for HPV-associated Lesions

Objectives: 

• Summarize the key principles of screening
  
• Recognize how current screening criteria are used in anal cancer screening and anal cancer precursor screening 
• Identify high-risk groups appropriate for screening

1.    The WHO Screening Criteria – 35 mins

2.    Judging who to screen for prevention of anal cancer: where do we stand today - 39 mins

3.    Screening tests for anal cancer: Current approaches and future directions – 30 mins

4.     Screening for anal cancer: IANS Consensus Guidlines – 18 mins 

Total time: approximately 2 hours

Module 6

Management of Anal Cancer

Objectives:

• Describe the standard of care for treatment of invasive anal cancer
  
• Recognize the indications for and risks of conservative treatment for early anal cancer
• Understand the management for recurrent anal cancer
• Define the role of HRA following treatment of anal cancer

1.    Anal Cancer Treatment - 31 mins 

2.    HRA following Cancer – 14 mins 

Total time: approximately 45 mins

Module 7

Management and Counseling

Objectives: 

• Outline appropriate management for anal SIL including treatment in the operating room, and follow-up post-treatment
  
• Understanding the impact of anal neoplasia on patients

1.    Treatment Triage: Cases – 44 mins

2.    HRA in the Operating Room: Two Perspectives – 34 mins

3.    Messaging: Counseling the Patient with HPV-associated Disease – 28 mins

4.    The Patient’s Perspective – 32 mins

Total time: approximately 2.3 hours

Module 8

Practicalities for Establishing an HRA Practice

Objectives:

• Define components of an HRA practice 
  
• Recognize practice metrics, practice standards and international guidelines
• Describe the indications for HPV vaccination

1.    Essential Equipment for HRA – 21 mins

2.    Documentation for HRA – 22 mins

3.    Guidelines for Creating a New HRA Practice – 20 mins

4.    HRA Practice Metrics – 28 mins

5.    HPV Vaccination for prevention – 28 mins

Total time: approximately 2 hours

Module 9

Anal Neoplasia in Context

To receive full CMEs please choose a minimum of 3 topics (subjects noted as optional do not count towards CMEs)

Objectives: 

• Expand knowledge to that of other specialty areas that overlap with management of lower anogenital tract disorders
  

1.    Non-infectious Disease of the Anus and Perianus – 39 mins

2.    Vulvar Disease – 31 mins

3.    Sexually Transmitted Infections, Testing and Treatment – 24 mins

4.    Diseases of the Colon and Rectum – 29 mins

5.    Dermatologic conditions – 26 mins

6.    Coding and Billing (US based providers) - Optional – 34 mins

7.    HRA and Cervical Colposcopy: Differences - Optional – 23 mins

8.    Incorporating research into clinical practice - Optional – 11 mins