Analysis of outcomes achieved with squamous cell carcinomas of the anus in a single university hospital over the last two decades: Clinical response rate, relapse and survival of 190 patients
Gianpiero GravanteJames A. StephensonMohamed ElshaerA. E. OsmanS. VasanthanJoseph MullineuxMohamed Akil Dilawar GaniDavid SharpeJustin M YeungMichael NorwoodA. S. MillerKirsten BoyleDavid Hemingway
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Abstract:
We reviewed our series of anal squamous cell carcinomas (ASCC) treated over the last two decades.ASCC patients undergoing treatment at the Leicester Royal Infirmary between 1998 and 2016 were selected. Age, gender, pathological tumor characteristics, treatment adopted, the overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) at 5-year follow-up were recorded and calculated.A total of 190 ASCC were reviewed, of these 64.2% (n = 122) received primary radical chemoradiotherapy. Complete response rate was 92.6% (n = 113) and four patients with residual disease underwent a salvage APER. Twenty-eight patients experienced recurrent disease (23.0%) either systemic (n = 8), local (n = 14), or both (n = 6); six had a salvage APER. Complete follow-up data are available for 63.1% patients (77/122). Overall, the locoregional failure rate of primary chemoradiotherapy (residual + recurrent disease) was present in 29 patients (29/122; 23.8%). OS was 41.6% CSS was 69.2% and DFS 60.0% at 5 years follow-up.In our series of ASCC primary chemoradiotherapy had achieved significant initial complete response rates, however, long term-follow ups still present systemic and local recurrences. APR is able to treat 30% of the pelvic recurrences (6/20), the others are either associated with systemic disease or locally inoperable masses.Keywords:
Chemoradiotherapy
Anus
Squamous cell cancer
Systemic therapy
The treatment of choice for anal cancer is chemoradiotherapy.Skin reaction and bowel symptoms such as tenesmus, diarrhoea and bleeding are common side effects.We report a patient who developed stridor as a result of chemoradiotherapy for anal cancer and discuss the pathogenesis and potential consequences.
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Anal cancer represents less than 1% of all new cancers diagnosed annually in the United States.Yet, despite the relative paucity of cases, the incidence of anal cancer has seen a steady about 2% rise each year over the last decade.As such, all healthcare providers need to be cognizant of the evaluation and treatment of anal squamous cell carcinoma.While chemoradiation remains the mainstay of therapy for most patients with anal cancer, surgery may still be required in recurrent, recalcitrant and palliative disease.In this manuscript, we will explore the diagnosis and management of squamous cell carcinoma of the anus.
Anus
Anal Carcinoma
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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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Chemoradiotherapy
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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].
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Anus neoplasms
Anal Carcinoma
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Carcinoma of the anal canal is a rare malignancy, although its incidence is steadily increasing. Anal cancer is a rare disease that accounts for <1% of all new cancer diagnoses and <3% of gastrointestinal tumors. The most common histological subtype is squamous cell carcinoma of the anus (SCCA) with an annual incidence of 0.5–2.0 in 100,000 [1]. The development of anal cancer is a multifocal process largely associated with human papillomavirus (HPV) infection. Treatment of anal cancer differs by disease stage and patient's physical condition. In this chapter, we review different treatment options according to the stage of the disease.
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Individuals with human immunodeficiency virus (HIV) infection are at increased risk for human papillomavirus-related squamous cell cancer of the anus. Screening HIV-infected patients for squamous cell cancer of the anus and human papillomavirus-related anal dysplasia may prevent excess morbidity and mortality. We have conducted a systematic review of the indirect evidence in the literature regarding the utility of anal Papanicolau (Pap) smear screening of HIV-infected individuals in the highly active antiretroviral therapy era. Although there are no published studies evaluating the efficacy of anal Pap smear screening for preventing squamous cell cancer of the anus or anal intraepithelial neoplasia, we reviewed data regarding the burden of disease, anal Pap smear sensitivity and specificity, the prevalence of anal dysplasia, and 1 cost effectiveness study. The available evidence demonstrates that HIV-infected individuals have an increased risk for squamous cell cancer of the anus and anal intraepithelial neoplasia. This review identifies important areas for further study before routine anal Pap smear screening can be recommended.
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Papillomaviridae
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Squamous cell cancer
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Squamous cell carcinoma of the anal canal is a rare disease and is no more than 1.7-2% of the annual cancer incidence. Chemoradiation therapy - the standard modern treatment of squamous cell anal cancer. Short-term recurrence-free period of the new approaches to the treatment of anal cancer, in particular to the new regimes chemoradiotherapy.
Chemoradiotherapy
Squamous cell cancer
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