Fistula-associated anal adenocarcinoma in Crohnʼs disease

Abstract

Adenocarcinoma arising from long-standing perianal CD fistulae is being increasingly reported. The outcome is poor following operative treatment, especially if perirectal lymph nodes are involved. Periodical cancer surveillance should be performed in all patients with long-standing perianal CD fistulae.

Gastrointestinal cancers in inflammatory bowel disease: An update with emphasis on imaging findings

“…Anal carcinoma in CD patients occurs at a mean age of 47-50 years, which is less than the mean age of 60-65 years observed in patients without CD (Wong and Harrison, 2001;Connell et al, 1994;Iesalnieks et al, 2010). Anal carcinoma occurs after a mean duration of perianal disease of 20 years (Ramage et al, 2005).…”

“…Anal carcinoma occurs after a mean duration of perianal disease of 20 years (Ramage et al, 2005). It has been suggested an increased incidence of anal cancer in patients with severe CD (Iesalnieks et al, 2010). Histologically, nearly 80% of anal carcinomas are squamous cell carcinomas whereas adenocarcinomas of mucinous or colloid subtype represent less than 20% of anal carcinomas (Vernava, 1999;Connell et al, 1994;Devon et al, 2009).…”

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

“…On the other hand, if fistulectomy is not performed, this increases the possibility of missing secondary tracts, which, as already mentioned, are considered a risk factor for recurrence and reoperation [31,32]. Moreover, particularly diseases of long duration present the risk of malignant transformation of the fistula [78,79]. For these reasons, the best surgical solution seems to be removal of fistula tracts and the surrounding inflamed Fig.…”

“…Often, diagnostic delay has already permitted the perineal neoplasia to infiltrate the surrounding tissues thereby requiring removal of large portions of tissue, sometimes extended to the vagina. In this situation, wound healing becomes very difficult, and the prognosis is generally dismal [1,78].…”

“…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].…”