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Clinical features, staging, and treatment of anal cancer

Authors
David P Ryan, MD
Christopher G Willett, MD
Section Editor
Richard M Goldberg, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

Anal cancer comprises 2.5 percent of all digestive system malignancies in the United States; 8080 new cases are diagnosed annually [1]. The incidence of anal cancer in the general population has increased over the last 30 years. A higher incidence has been associated with female gender, infection with human papillomavirus (HPV), lifetime number of sexual partners, genital warts, cigarette smoking, receptive anal intercourse, and infection with human immunodeficiency virus (HIV) [2]. From an etiologic standpoint, anal cancer is more similar to genital malignancies than it is to other gastrointestinal tract cancers. Substantial progress has been made in understanding the pathophysiology and the management of anal cancer [3]. As a result of carefully conducted epidemiologic and clinical studies, it is now known that anal cancer is closely associated with HPV infection and that cure is possible in the majority of patients with preservation of the anal sphincter. (See "Virology of human papillomavirus infections and the link to cancer".)

This topic review will cover clinical features, staging, and treatment of anal cancer, both squamous cell and the less common adenocarcinomas. Primary rectal squamous cell carcinomas (SCC), which are very rare, can be difficult to distinguish from anal cancers, and they should be treated according to the same approach as anal cancer. The classification and epidemiology of anal cancer, the diagnosis and management of anal intraepithelial neoplasia, as well as an overview of the link between HPV infection and cancer are presented separately. (See "Classification and epidemiology of anal cancer" and "Anal squamous intraepithelial lesions: Diagnosis, screening, prevention, and treatment" and "Virology of human papillomavirus infections and the link to cancer".)

ANAL CANAL VERSUS PERIANAL SKIN CANCERS

The anus consists of a glandular mucosa-lined anal canal, and the epidermis-lined perianal "margin" (figure 1). The anus encompasses mucosa of three different histologic types: glandular, transitional, and squamous (proximal to distal, respectively). Distally, the squamous mucosa (which is devoid of the epidermal appendages, hair follicles, apocrine glands, and sweat glands) merges with the hair-bearing perianal skin (true epidermis). This mucocutaneous junction has been referred to as the anal "verge" or margin. (See "Classification and epidemiology of anal cancer".)

Four distinct categories of tumors arise in the anal region:

Tumors that develop from any of the three types of mucosa are termed anal canal cancers. Tumors arising in the transitional or squamous mucosa are squamous cell cancers (SCCs) and appear to behave similarly, despite their sometimes variable morphologic appearance. By convention, most series that report outcomes of "anal cancer" refer exclusively to these tumors. The term "anal cancer" by common definition refers to SCCs arising within the mucosa of the anus, and the two terms will be used interchangeably throughout this review.

                                            

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Literature review current through: Nov 2016. | This topic last updated: Tue Oct 25 00:00:00 GMT+00:00 2016.
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