Anal Adenocarcinoma: Outcomes in an Uncommon Malignancy

Abstract

Adenocarcinoma is an uncommon malignancy of the anal canal. Although it is recognized as an aggressive disease, optimal management and long-term outcomes are not well established. Patients diagnosed with anal adenocarcinoma were identified from a cancer database. Their charts were reviewed for patient and disease characteristics, management, and outcomes. Eighteen patient charts from 1997 to 2012 were reviewed. Nine patients presented with stage II disease, five with stage III, three with stage IV, and one was inadequately staged before chemoradiation. One patient refused treatment, one patient went straight to abdominoperineal resection, 13 patients underwent initial chemoradiation therapy, and three underwent palliative chemotherapy. Of the 13 patients who received neoadjuvant therapy, eight underwent subsequent radical resection; three progressed during neoadjuvant and became unresectable, one had complete pathologic response and was observed, and one did not complete neoadjuvant and was lost to follow-up. Two patients with stage II disease were disease free over eight years, and one was disease free after 26 months; four patients had persistent or recurrent local disease, and 10 developed metastatic disease. Seven patients died with disease at a median 16 months, and the other seven were alive with disease at a median follow-up of 10 months. Patients with anal adenocarcinoma present at advanced stages, and cure is rare. Although chemoradiation followed by abdominoperineal resection is the most common management strategy, the potential for curative resection and long-term disease free survival is minimal, regardless of stage at presentation.

Management and Outcomes in Anal Canal Adenocarcinomas—A Systematic Review

“…The studies by Bertelson et al [ 9 ], Franklin et al [ 10 ], Lewis et al [ 15 ], Wang et al [ 14 ], McKenna et al [ 12 ], Leong et al [ 13 ] and Gogna et al [ 20 ] did not provide values for the 5-year overall survival rates or any OS rate values for each treatment group. In the Franklin et al study of 307 patients, the 1-, 3-, 5- and 10-year survival rates were 76.8%, 46.2%, 30.2% and 16.2%, respectively.…”

“…Adenocarcinoma of the anus also exhibits more aggressive behaviour in comparison to that of the squamous cell type. This aggressive nature includes higher rates of local failure, distant metastasis and disease-associated mortality [ 9 , 24 , 25 , 26 , 27 ]. Low survival outcomes are also observed in the Franklin et al and Lewis et al studies [ 10 , 15 ].…”

An Exceptional Adenocarcinoma in a Girl

“…Current adenocarcinoma management is controversial, and experience with this disease remains largely anecdotal or based on very small series. The goal standard of anal adenocarcinoma treatment is surgery framed by radiochemotherapy or chemotherapy [ 4 , 5 , 10 , 13 , 14 ]. Surgical treatment depends on tumor size, stage, and physical performance.…”

Recent advances in the management of anal cancer

“…Owing to its rarity, the optimal treatment strategy for anal adenocarcinoma has not been established, there is very little evidence to guide treatment, and most are treated like low rectal cancers. Most patients undergo neoadjuvant chemoradiation followed by APR 53 , 54 .…”