Interventions for anal canal intraepithelial neoplasia

Macaya, Antonio; Balaguer, Albert; Barberà, Maria José

doi:10.1002/14651858.cd009244

Cited by 10 publications

(14 citation statements)

References 8 publications

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“…The management of AIN is complicated by a lack of large-scale studies comparing treatment options 28. Treatment modalities used include topical 5% imiquimod cream, 5% 5-fluorouracil cream, photodynamic therapy, local excision or ablative interventions 27.…”

Section: Discussionmentioning

confidence: 99%

Unilateral leg weakness and pain secondary to metastatic anal squamous cell carcinoma

2019

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A 58-year-old man presented to colorectal clinic with intermittent rectal bleeding, weight loss, also pain and weakness affecting his lower back and right leg. On inspection, there were perianal warts (condyloma acuminata), with an additional palpable anal lesion on digital rectal examination, confirmed by colonoscopy. Subsequent imaging revealed a large right psoas abscess, and an associated paravertebral soft tissue component invading the right lumbosacral plexus and nerve roots at L4, L5 and S1. Biopsy of the paravertebral mass revealed metastatic squamous cell carcinoma. Given his symptomatology, and also as biopsy of the perianal warts revealed high-grade squamous intraepithelial lesion/grade III anal intraepithelial neoplasia on histology with infection by human papillomavirus type 6, the primary was presumed to be anal. This was a case of sciatic pain which proved to be diagnostically challenging on initial presentation to primary care. This mode of presentation and pattern of metastasis are uncommon in anal cancer.

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Section: Discussionmentioning

confidence: 99%

Unilateral leg weakness and pain secondary to metastatic anal squamous cell carcinoma

2019

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“…A recent Cochrane review of the management of AIN found that there was a lack of quality data on the natural progression of AIN. The limited number of randomized trials on the management of AIN mean clear conclusions and recommendations for management were difficult to make [50]. …”

Section: • • Anal Intraepithelial Neoplasiamentioning

confidence: 99%

Cancers of the Anal Canal: Diagnosis, Treatment and Future Strategies

et al. 2014

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Anal cancer is an uncommon cancer; however, it is rising in incidence. There is confusion regarding nomenclature and the distinction between anal canal cancer and anal margin cancer. This article discusses the modern definition, etiology and staging of anal canal and anal margin cancers. Modern chemotherapy and radiotherapy regimens are discussed, in addition to modern imaging and radiotherapy techniques. Future preventative strategies and potential novel treatments are discussed.

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“…This is particularly so for GBMSM living with HIV for whom estimates of incidence exceeding a 30-fold increase compared with the general population have been reported 4. Screening programmes for the detection of cytological abnormalities related to human papillomavirus (HPV), analogous to cervical cancer screening programmes, have been suggested for individuals within these higher risk populations to facilitate prevention, early detection and treatment of anal cancer 5 6. However, lack of knowledge surrounding progression and regression rates of the presumed anal cancer precursor high-grade squamous intraepithelial lesions (HSIL), and the lack of proven HSIL treatments5 have prevented their widespread implementation.…”

Section: Introductionmentioning

confidence: 99%

“…Screening programmes for the detection of cytological abnormalities related to human papillomavirus (HPV), analogous to cervical cancer screening programmes, have been suggested for individuals within these higher risk populations to facilitate prevention, early detection and treatment of anal cancer 5 6. However, lack of knowledge surrounding progression and regression rates of the presumed anal cancer precursor high-grade squamous intraepithelial lesions (HSIL), and the lack of proven HSIL treatments5 have prevented their widespread implementation. At present, screening for anal cancer in the form of a Pap test is not currently recommended or routinely carried out among GBMSM in Australia, regardless of their HIV status.…”

Section: Introductionmentioning

confidence: 99%

Psychological and utility-based quality of life impact of screening test results for anal precancerous lesions in gay and bisexual men: baseline findings from the Study of the Prevention of Anal Cancer

et al. 2019

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ObjectiveGay, bisexual and other men who have sex with men (GBMSM), particularly HIV-positive GBMSM, are at increased anal cancer risk compared with the general population. This study examined the psychological and quality of life (QoL) impact of receiving abnormal anal cancer screening results during the baseline visit of the Study of the Prevention of Anal Cancer (SPANC).MethodsSPANC was a prospective cohort study of the natural history of anal human papillomavirus (HPV) and associated abnormalities in GBM aged 35 years and over. Participants completed questionnaires including aspects of health-related QoL (HR-QoL) and psychosocial functioning at baseline. Participants underwent procedures including an anal swab for cytology, and high-resolution anoscopy with biopsy of any possibly HPV-related abnormality. Questionnaires were readministered 2 weeks and 3 months after participants were given cytology and histology results. Perceived test result served as the study factor.ResultsParticipants with perceived abnormal results (n=232) reported poorer HR-QoL (mean difference=1.8; p=0.004) and lower utility-based QoL (mean difference=0.02; p=0.018) 2 weeks after screening than individuals with perceived normal results (n=268). These differences did not persist at 3-month follow-up. A greater proportion of participants who perceived their results as abnormal reported feeling worse than usual about their anal health and anal cancer fear (p’s<0.001), experienced more intrusive thoughts about their results (p’s≤0.006) and felt more likely to develop cancer than other gay men their age (p’s≤0.025) at both time points than those with perceived normal results.ConclusionsProviding abnormal results may cause psychological distress and impact HR-QoL, with sustained intrusive thoughts, increased cancer worry and perceived cancer risk. The potential for psychological harm needs to be considered when implementing anal cancer screening programmes.

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Interventions for anal canal intraepithelial neoplasia

Cited by 10 publications

References 8 publications

Unilateral leg weakness and pain secondary to metastatic anal squamous cell carcinoma

Unilateral leg weakness and pain secondary to metastatic anal squamous cell carcinoma

Cancers of the Anal Canal: Diagnosis, Treatment and Future Strategies

Psychological and utility-based quality of life impact of screening test results for anal precancerous lesions in gay and bisexual men: baseline findings from the Study of the Prevention of Anal Cancer

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