Very simply, the answer is yes.  I would treat this patient aggressively.  Nowadays we treat for cure many patients who have a formal M1 staging, and this patient fits into the same category.  There is no clear answer as to how far proximal the nodal treatment should go, probably into...

I agree with Joel's answer, the CI and PA nodes in anal cancer should be changed to N2. I typically treat up to the transverse duodenum in the case of CI involvement and up to the celiac axis for paraaortic involvement. We published in the Red J a small series showing that outcomes are similar to pe...