Squamous cell carcinoma of the anal canal: a review of the aetiology, presentation, staging, prognosis and methods available for treatment

Abstract

Anal cancer is an uncommon malignancy, with the majority of cases comprised of squamous cell carcinomas. The increasing incidence of this disease reflects a rise in the transmission of the human papillomavirus, the causative organism of most tumours. Abdominoperineal resection (APR), once the primary mode of treatment, has been supplanted by sphincter-saving combination chemoradiation as the first-line therapy. However, surgeons continue to play a role in the multidisciplinary management of patients with anal cancer for diagnosis and post-treatment surveillance. Sentinel node biopsy may identify patients with clinically and radiographically negative inguinal lymph nodes who will benefit from groin irradiation. In very select cases, the controversial means of local excision has been employed as primary treatment, often in conjunction with radiation and chemotherapy. The management of persistent or recurrent anal cancers following primary chemoradiation remains a concern, for which only salvage APR currently offers the possibility of a cure. The introduction of human papillomavirus vaccines presents the exciting potential for the eradication of the disease.

The inside story. Physicians’ views on digital ano-rectal examination for anal cancer screening of HIV positive men who have sex with men

“…5 Some experts recommend that anal cancer screening be routinely undertaken in certain populations. [6][7][8][9] Though there is currently little empirical evidence to support DARE beyond 'expert opinion', early detection of anal cancer should be evaluated more thoroughly. If evidence for early anal cancer detection using DARE is supported and included in routine HIV care guidelines, substantial professional education and training will be required for anal cancer screening using DARE to be adopted.…”

Why a special issue on anal cancer and what is in it?

“…15 An extensive review of anal cancer treatment is provided by Szmulowicz and Wu. 16 They highlight its relatively late presentation, often despite persistent symptoms, and encourage a high index of suspicion among clinicians. 16 They describe the different approaches to treatment including, in highly selected cases, local excision with and without radiation or chemotherapy.…”

“…16 They highlight its relatively late presentation, often despite persistent symptoms, and encourage a high index of suspicion among clinicians. 16 They describe the different approaches to treatment including, in highly selected cases, local excision with and without radiation or chemotherapy. 16 They highlight the absence of reports on the effect of treatment on sexual function, which is also relevant to the more destructive treatments for AIN.…”

“…16 They describe the different approaches to treatment including, in highly selected cases, local excision with and without radiation or chemotherapy. 16 They highlight the absence of reports on the effect of treatment on sexual function, which is also relevant to the more destructive treatments for AIN. 16 The complex issue of the cost-effectiveness of screening for anal cancer is dealt with in a systematic review by Howard.…”

“…16 They highlight the absence of reports on the effect of treatment on sexual function, which is also relevant to the more destructive treatments for AIN. 16 The complex issue of the cost-effectiveness of screening for anal cancer is dealt with in a systematic review by Howard. 17 She describes how cost-effectiveness estimates are calculated.…”