Fistula-Associated Anorectal Cancer in the Setting of Crohn’s Disease

Shwaartz, Chaya; Munger, Jordan; Deliz, Juan R.; Börnstein, J.; Gorfine, Stephan R; Chessin, David B.; Popowich, Daniel A.; Bauer, Joel J.

doi:10.1097/dcr.0000000000000700

Cited by 36 publications

(30 citation statements)

References 12 publications

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“…The characteristics of 52 studies reporting data from 208 patients with ARC are shown in Table 2 11,15,19,23,25,28,30,34,36–80 . Although many reports did not describe the details of each characteristic, the median survival prognosis was 2.1 ± 2.3 years in 74 patients, and advanced cancer greater than stage T3 occurred in 46/74 (62.1%) patients.…”

Section: Resultsmentioning

confidence: 99%

Intestinal cancer in patients with Crohn's disease: A systematic review and meta‐analysis

Uchino

Ikeuchi

Hata

et al. 2020

J of Gastro and Hepatol

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Background and Aim Although surveillance colonoscopy is recommended by several guidelines for Crohn's disease (CD), the evidence is insufficient to support the validity of this recommendation. Moreover, the efficacy of surveillance colonoscopy for anorectal cancer remains unclear. Therefore, we performed a systematic review of cancer in patients with CD before considering the proper surveillance methods. Methods We conducted a systematic review and meta‐analysis examining the incidence of intestinal cancer and a literature review to clarify the characteristic features of cancer in CD. We performed the systematic literature review of studies published up to May 2019. Results Overall, 7344 patients were included in eight studies. The standardized incidence ratios (95% confidence intervals) of colorectal cancer (CRC) and small bowel cancer (SBC) were 2.08 (1.43–3.02) and 22.01 (9.10–53.25), respectively. The prevalence of CRC and SBC was 57/7344 (0.77%) and 17/7344 (0.23%), respectively, during a median follow‐up of 12.55 years. Additionally, 54 studies reporting 208 anorectal cancer cases were identified. In patients with anorectal cancer, the prognosis for survival was 2.1 ± 2.3 years, and advanced cancer greater than stage T3 occurred in 46/74 patients (62.1%). Many more reports of anorectal cancer were published in Asia than in Western countries. Conclusion Although we were unable to state a recommendation for surveillance for SBC, we should perform cancer surveillance for CRC in patients with CD. However, the characteristics of cancer may differ according to geography or race. We must establish proper and effective surveillance methods that are independently suitable to detect these differences.

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Section: Resultsmentioning

confidence: 99%

Intestinal cancer in patients with Crohn's disease: A systematic review and meta‐analysis

Uchino

Ikeuchi

Hata

et al. 2020

J of Gastro and Hepatol

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“…Fistula-associated adenocarcinomas can develop in patients with chronic perianal CD 207208. The incidence is very rare, however, and was reported at 0.2/1,000 patient-years in CD patient in a meta-analysis of 20 clinical studies published from 1965 to 2008 209.…”

Section: Cancer Surveillancementioning

confidence: 99%

Management of Crohn's disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

et al. 2017

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Crohn's disease (CD) is a chronic relapsing and remitting inflammatory disease of the gastrointestinal tract. CD is rare in Taiwan and other Asian countries, but its prevalence and incidence have been steadily increasing. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of CD taking into account currently available evidence and the expert opinion of the committee. Thorough clinical, endoscopic, and histological assessments are required for accurate diagnosis of CD. Computed tomography and magnetic resonance imaging are complementary to endoscopic evaluation for disease staging and detecting complications. The goals of CD management are to induce and maintain remission, reduce the risk of complications, and improve quality of life. Corticosteroids are the mainstay for inducing re-mission. Immunomodulating and biologic therapies should be used to maintain remission. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to treatment and receive regular surveillance for cancer. These consensus statements are based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of patients with CD in Taiwan.

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“…The success rate of Nigro protocol was 75% in their series, similar to anal SCC without Crohn's disease [12]. The authors concluded that there might be a benefit to performing resection in these patients in order to avoid the harmful effect of radiation, which could be added later if necessary [12]. Our patient was managed in a similar manner.…”

Section: Discussionmentioning

confidence: 56%

“…Shwaartz et al reported their experience of treating nine patients with squamous cell carcinoma of perianal Crohn's fistula [12]. Two-thirds of the patients received neoadjuvant chemoradiation and did not require abdominoperineal resection (APR); however, one-third of the patients had recurrent/persistent disease ultimately requiring APR [12]. The success rate of Nigro protocol was 75% in their series, similar to anal SCC without Crohn's disease [12].…”

Section: Discussionmentioning

confidence: 99%

“…Two-thirds of the patients received neoadjuvant chemoradiation and did not require abdominoperineal resection (APR); however, one-third of the patients had recurrent/persistent disease ultimately requiring APR [12]. The success rate of Nigro protocol was 75% in their series, similar to anal SCC without Crohn's disease [12]. The authors concluded that there might be a benefit to performing resection in these patients in order to avoid the harmful effect of radiation, which could be added later if necessary [12].…”

Section: Discussionmentioning

confidence: 99%

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Squamous Cell Carcinoma Originating from a Crohn’s Enterocutaneous Fistula

Protyniak

Shutt

Farmer

2017

Case Reports in Surgery

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Purpose. Squamous cell carcinoma (SCC) developing within fistulae and chronic wounds in patients with Crohn's disease is a rare phenomenon with few reported studies in the literature. Clinical suspicion for SCC in Crohn's disease patients with chronic painful fistulae is low, leading to delayed diagnosis and treatment. We present a patient with long-standing Crohn's disease complicated by malignant degeneration of an enterocutaneous fistula tract. Methods. Workup with MRI, CT, and fistulogram revealed a 7 × 3 cm fistulous connection between a loop of small intestine and the patient's perineum. Biopsies of the fistula tract confirmed the diagnosis of SCC. Results. The patient underwent an abdominoperineal resection with positive margins and is currently awaiting radiation therapy. Conclusions. This is the second case reported within the English literature of SCC arising from an enterocutaneous fistula in the setting of Crohn's disease. Based on the findings in this case report and others presented in the literature, a high degree of suspicion of malignancy should be present in patients with chronic painful, poor-healing fistulae, especially in the absence of infection.

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Fistula-Associated Anorectal Cancer in the Setting of Crohn’s Disease

Abstract: Routine biopsies of long-standing fistula tracts in patients with Crohn's disease should be strongly considered and may yield an earlier diagnosis of cancer in the fistula tracts.

Cited by 36 publications

References 12 publications

Intestinal cancer in patients with Crohn's disease: A systematic review and meta‐analysis

Intestinal cancer in patients with Crohn's disease: A systematic review and meta‐analysis

Management of Crohn's disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

Squamous Cell Carcinoma Originating from a Crohn’s Enterocutaneous Fistula

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