Anal Carcinoma Surveillance Counterpoint: USA
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Abstract:
Anal cancer accounts for 4 % of all lower gastrointestinal tract malignancies in the United States [1]. The incidence of anal cancer appears to be on the rise, with increases in incidence rates of 2.6 % per year reported between 1992 and 2000 [2]. Over 5,000 new cases of anal cancer are diagnosed in the U.S. annually [3]. The overall 5-year survival rate is 66.5 % [4]. This varies by stage at diagnosis (82 % for local disease; 59 % for regional disease and 19 % for distant disease) [3]. The vast majority (65–85 %) of anal malignancies are squamous cell carcinomas, which include various histological subtypes such as cloacogenic, basaloid, and transitional cell cancers [2]. Cancers of the anus have been categorized as those arising in the anal canal, or intraanal, and those arising at the anal margin, or perianal region [5].Keywords:
Anus
Anus neoplasms
Anal Carcinoma
Squamous anal cell carcinoma is a rare malignancy that represents the 1.5% to 2% of all the lower digestive tract cancers. However, an increased incidence of invasive anal carcinoma is observed in HIV-seropositive population since the widespread of highly active antiretroviral therapy. Human papillomavirus is strongly associated with the pathogenesis of anal cancer. Anal intercourse and a high number of sexual partners appear to be risk factors to develop anal cancer in both sexes. Anal pain, bleeding and a palpable lesion in the anal canal are the most common clinical features. Endo-anal ultrasound is the best diagnosis method to evaluate the tumor size, the tumor extension and the infiltration of the sphincter muscle complex. Chemoradiotherapy plus antiretroviral therapy are the recommended treatments for all stages of localized squamous cell carcinoma of the anal canal in HIV-seropositive patients because of its high rate of cure. Here we present an HIV patient who developed a carcinoma of the anal canal after a long time of HIV infection under highly active antiretroviral therapy with a good virological and immunological response.
Anal Carcinoma
Chemoradiotherapy
Proctoscopy
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Anus
Squamous cell cancer
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From January 1988 to December 1993, we identified six men with minimally invasive (stage I) squamous cell carcinoma of the anus and 10 men with anal carcinoma in situ (CIS). Of the six patients with invasive carcinoma, four were infected with human immunodeficiency virus (HIV), including one with AIDS. Of the 10 patients with CIS, eight were infected with HIV, including four with AIDS. Anal pain and bleeding were the most common symptoms of minimally invasive anal cancer and anal CIS. Anal irritation, burning, or pruritus occurred more frequently in patients with CIS, whereas anal ulcers, masses, or abscesses were more frequent in patients with minimally invasive cancer. Several patients with CIS had a discrete area of leukoplakia in the anal canal or a pigmented plaque of the anus and anal canal. These lesions were not observed in patients with minimally invasive anal cancer. The symptoms and signs of early-stage anal cancer in men at risk for developing HIV infection or men infected with HIV often resemble those of other common anorectal diseases in homosexual men. Anal cancer in HIV-infected men is not limited to those individuals with AIDS.
Anus
Anal Carcinoma
Carcinoma in situ
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Anal cancer accounts for 4 % of all lower gastrointestinal tract malignancies in the United States [1]. The incidence of anal cancer appears to be on the rise, with increases in incidence rates of 2.6 % per year reported between 1992 and 2000 [2]. Over 5,000 new cases of anal cancer are diagnosed in the U.S. annually [3]. The overall 5-year survival rate is 66.5 % [4]. This varies by stage at diagnosis (82 % for local disease; 59 % for regional disease and 19 % for distant disease) [3]. The vast majority (65–85 %) of anal malignancies are squamous cell carcinomas, which include various histological subtypes such as cloacogenic, basaloid, and transitional cell cancers [2]. Cancers of the anus have been categorized as those arising in the anal canal, or intraanal, and those arising at the anal margin, or perianal region [5].
Anus
Anus neoplasms
Anal Carcinoma
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Anal Carcinoma
Presentation (obstetrics)
Anus neoplasms
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Anus
Anus neoplasms
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Anal cancer represents a rare neoplasia, accounting for approximately 1.5% of all digestive cancers, but remains an important concern due to its association to sexually-transmitted infections and still dismal prognosis. This review focuses on the main diagnostic and treatment aspects concerning anal canal cancer. Anal cancer incidence has been increasing in the last years, probably due to the rise in the spread of sexually transmitted diseases, such as HPV and HIV infections. Although many risk factors have been associated to anal cancer (HPV, HIV infection, immunocompromised status, tobacco smoking), anal cancer biology is only partly understood. The most frequent histopathologic type of anal canal cancer is represented by squamous-cell carcinoma (80% of all anal canal cancers). Anal canal cancer should be distinguished from anal margin cancer, which is of better prognosis. Anal cancer diagnosis is usually delayed, due to its resemblance to benign perianal pathology that justifies the need for a better screening. Anal canal carcinoma therapeutic management has witnessed a major shift in time from a radical surgical (abdominoperineal resection) to multimodal approach. Nowadays, the standard treatment of anal carcinoma is represented by radiochemotherapy that is an effective therapy although can associate an important toxicity. Surgical treatment is reserved only to very small anal lesions and especially to residual disease or tumor recurrences after primary therapy, representing a salvage therapy (abdominoperineal rectal amputation) for these cases. Although approximately 10-30% of the patients present with inguinal lymph node metastases at initial diagnosis, prophylactic inguinal lymphadenopathy is not recommended, due to its associated complications and better response to radiotherapy. Inguinal lymphadenectomy is only indicated for voluminous lymphadenopathy blocks and inguinal lymph node metastases appeared after radiochemotherapy.
Abdominoperineal resection
Anal Carcinoma
Verrucous carcinoma
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Anal cancer represents a rare neoplasia, accounting for approximately 1.5% of all digestive cancers, but remains an important concern due to its association to sexually-transmitted infections and still dismal prognosis. This review focuses on the main diagnostic and treatment aspects concerning anal canal cancer. Anal cancer incidence has been increasing in the last years, probably due to the rise in the spread of sexually transmitted diseases, such as HPV and HIV infections. Although many risk factors have been associated to anal cancer (HPV, HIV infection, immunocompromised status, tobacco smoking), anal cancer biology is only partly understood. The most frequent histopathologic type of anal canal cancer is represented by squamous-cell carcinoma (80% of all anal canal cancers). Anal canal cancer should be distinguished from anal margin cancer, which is of better prognosis. Anal cancer diagnosis is usually delayed, due to its resemblance to benign perianal pathology that justifies the need for a better screening. Anal canal carcinoma therapeutic management has witnessed a major shift in time from a radical surgical (abdominoperineal resection) to multimodal approach. Nowadays, the standard treatment of anal carcinoma is represented by radiochemotherapy that is an effective therapy although can associate an important toxicity. Surgical treatment is reserved only to very small anal lesions and especially to residual disease or tumor recurrences after primary therapy, representing a salvage therapy (abdominoperineal rectal amputation) for these cases. Although approximately 10-30% of the patients present with inguinal lymph node metastases at initial diagnosis, prophylactic inguinal lymphadenopathy is not recommended, due to its associated complications and better response to radiotherapy. Inguinal lymphadenectomy is only indicated for voluminous lymphadenopathy blocks and inguinal lymph node metastases appeared after radiochemotherapy.
Abdominoperineal resection
Anal Carcinoma
Verrucous carcinoma
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Anal Carcinoma
Anus
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