Cancer of the Anus Complicating Perianal Crohn's Disease

Abstract

Physicians should have a high level of suspicion of cancer in patients with longstanding perianal Crohn's disease who have a change in symptoms. In this series, patients who were diagnosed preoperatively and treated with multimodality therapy had better outcomes.

Fistula-associated anal adenocarcinoma in Crohnʼs disease

“…41 Our study has also demonstrated an increased risk for cancer-related death in CD patients with FAAA. Smoking status was documented in all 6 patients undergoing surgery at our institution and in all 21 patients reported by Devon et al 12 and Gaertner et al 26 Smoking status also correlated significantly with the presence of perirectal lymph node metastases, which was the strongest predictor of poor outcome both by univariate and multivariate analysis. Although cigarette smoking has been found to be associated with an increase in colorectal cancer incidence and mortality in the general population, [42][43] it cannot be concluded definitely whether cigarette smoking independently influences the oncological outcome in CD patients with FAAA because of the low number of cases in the present study.…”

“…Special attention should be paid to patients with a diverted colon with a rectal stump and chronic anal fistula (Case 1 of our series and 4 cases from Devon et al 12 ), since a significantly increased cancer risk has been described in patients with a rectal remnant. 2 Furthermore, a considerable delay in diagnosis can occur because of late clinical symptoms in diverted patients.…”

“…[4][5][6][7][8][9][10][11][12][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Clinical data from these articles were pooled with the 6 cases from our institution ( Table 3). The total Preoperative biopsies were positive in 20 cases and negative in 10.…”

“…4 Both fistula-associated anal adenocarcinoma (FAAA) and squamous cell carcinoma have been increasingly reported in the past 25 years. Most reports consist of single cases [7][8][9] or small series; 4,5,10,11 and both adenocarcinoma and squamous cell carcinoma are frequently reported together, 4,5,12 making the thorough description of each entity difficult. The purpose of this study was to report 6 patients with FAAA in the setting of CD and to perform a systematic review of reported cases with this rare pathology.…”

Imaging techniques and combined medical and surgical treatment of perianal Crohn’s disease

“…Malignant transformation in perianal Crohn's disease is rare (adenocarcinoma is more common than squamous cell carcinoma) [79,132], but diagnosis is often delayed because of the very low sensitivity of MRI, EUS, and CT in identifying neoplastic transformation in an environment of severe chronic inflammation [78,133,134].…”