Fistula-Related Cancer in Crohn’s Disease: A Systematic Review

Abstract

Perianal fistulizing Crohn’s disease is a very disabling condition with poor quality of life. Patients with perianal fistulizing Crohn’s disease are also at risk of perianal fistula-related squamous cell carcinoma (SCC). Cancer arising at the site of a chronic perianal fistula is rare in patients with Crohn’s disease and there is a paucity of data regarding its incidence, diagnosis and management. A systematic review of the literature was undertaken using Medline, Embase, Pubmed, Cochrane and Web of Science. Several small series have described sporadic cases with perianal cancer in Crohn’s disease. The incidence rate of SCC related to perianal fistula was very low (<1%). Prognosis was poor. Colorectal disease, chronic perianal disease and HPV infection were possible risk factors. Fistula-related carcinoma in CD (Chron’s disease) can be very difficult to diagnose. Examination may be limited by pain, strictures and induration of the perianal tissues. HPV is an important risk factor with a particular carcinogenesis mechanism. MRI can help clinicians in diagnosis. Examination under anesthesia is highly recommended when findings, a change in symptoms, or simply long-standing disease in the perineum are present. Future studies are needed to understand the role of HPV vaccination in preventing fistula-related cancer.

Anal Adenocarcinoma Arising From a Fistula-in-Ano: A Case Report

“…While cases of FAAA have been noted to have increased over the past few decades [5,8], reports of these types of pathologies are exceedingly rare [7,[9][10][11][12]. It is thought that a combination of factors, including poor initial detection, low rates of early diagnosis, lack of effective monitoring tools, and unfavorable tumor staging at the time of surgery ultimately lead to adverse prognostic outlooks for patients diagnosed with FAAA [11,13].…”

Perioperative optimization of Crohn's disease

“…Because of the limited number of population‐based studies and relatively short follow‐up duration in Eastern countries, it is difficult to compare the incidence of colitis‐associated intestinal cancer between Western and Asian populations. Intestinal cancer in CD may develop in anorectal regions, especially in CD patients with chronic severe anorectal disease, rectal remnant, and strictures 31–34 . In addition, the incidence of anorectal cancer in CD may be higher in Asia than in Western countries 35 .…”

“…Intestinal cancer in CD may develop in anorectal regions, especially in CD patients with chronic severe anorectal disease, rectal remnant, and strictures. 31 , 32 , 33 , 34 In addition, the incidence of anorectal cancer in CD may be higher in Asia than in Western countries. 35 Therefore, patients with longstanding disease who have chronic non‐healing fistula, increase in bloody discharge, or increasing perianal pain should undergo examination under anesthesia with biopsy and curettage of the fistula track as well as close endoscopic and radiographic surveillance.…”

Interventional inflammatory bowel disease: endoscopic therapy of complications of Crohn’s disease

“…Occasionally adenocarcinoma can develop at the entero-enteric, ileocolonic-, colo-colonic, colorectal, or colon–anal anastomoses. Patients with CD-associated chronic perianal fistulas or anorectal strictures are at risk of neoplasia of glandular or squamous cell source [ 72 ]. The consensus document from the Global Interventional IBD Group recommended routine surveillance endoscopy in these patients [ 10 ].…”