Current Gastroenterology Reports

, Volume 10, Issue 5, pp 502–506

Diagnosis and management of anal cancer

Article

Abstract

During the past three decades, anal cancer has served as a paradigm for the successful application of chemoradiation to solid tumors. Since the early 1990s, the increasing incidence of anal cancer in homosexual men has highlighted the causative role of oncogenic human papillomavirus infection. This review focuses on significant trends and developments in the management of patients with squamous cell carcinoma of the anal canal, emphasizing three major aspects of diagnosis and treatment: routine screening and eradication of premalignant lesions in high-risk individuals; outcome of chemoradiation therapy in HIV-positive individuals in the era of highly active antiretroviral therapy; and potential improvements in chemoradiation protocols through improved radiation delivery technique and the combination of mitomycin with cisplatin in current prospective randomized trials.

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References and Recommended Reading

  1. 1.
    Jemal A, Siegel R, Ward E, et al.: Cancer statistics 2008. CA Cancer J Clin 2008, 58:71–96.PubMedCrossRefGoogle Scholar
  2. 2.
    Brewster DH, Bhatti LA: Increasing incidence of squamous cell carcinoma of the anus in Scotland, 1975–2002. Br J Cancer 2006, 95:87–90.PubMedCrossRefGoogle Scholar
  3. 3.
    Frisch M, Glimelius B, van den Brule AJC, et al.: Sexually transmitted infection as a cause of anal cancer. N Engl J Med 1997, 337:1350–1358.PubMedCrossRefGoogle Scholar
  4. 4.
    Gervaz P, Hirschel B, Morel P: Molecular biology of squamous cell carcinoma of the anus. Br J Surg 2006, 93:531–538.PubMedCrossRefGoogle Scholar
  5. 5.
    Aigner F, Boeckle E, Albright J, et al.: Malignancies of the colorectum and anus in solid organ recipients. Transpl Int 2007, 20:497–504.PubMedCrossRefGoogle Scholar
  6. 6.
    Konstantinopoulos PA, Schlecht HP, Bryan B, et al.: HIV-associated anal squamous cell cancer: an otherwise preventable disease. J Clin Oncol 2006, 24:4516–4517.PubMedCrossRefGoogle Scholar
  7. 7.
    Ryan DP, Compton C, Mayer RJ: Carcinoma of the anal canal. N Engl J Med 2000, 342:792–800.PubMedCrossRefGoogle Scholar
  8. 8.
    Abbasakoor F, Boulos PB: Anal intraepithelial neoplasia. Br J Surg 2005, 92:277–290.PubMedCrossRefGoogle Scholar
  9. 9.
    Piketty C, Darragh T, Heard I, et al.: High prevalence of anal squamous intraepithelial lesions in HIV-positive men despite the use of highly active antiretroviral therapy. Sex Transm Dis 2004, 31:96–99.PubMedCrossRefGoogle Scholar
  10. 10.
    Abramowitz L, Benabderrahmane D, Ravaud P, et al.: Anal squamous intraepithelial lesions and condyloma in HIV-infected heterosexual men, homosexual men and women: prevalence and associated factors. AIDS 2007, 21:1457–1465.PubMedCrossRefGoogle Scholar
  11. 11.
    Tramujas da Costa e Silva I, de Lima Ferreira LC, Santos Gimenez F, et al.: High-resolution anoscopy in the diagnosis of anal cancer precursor lesions in renal graft recipients. Ann Surg Oncol 2008, 15:1470–1475.PubMedCrossRefGoogle Scholar
  12. 12.
    Pineda CE, Berry JM, Jay N, et al.: High resolution anoscopy in the planned staged treatment of anal squamous intraepithelial lesions in HIV-negative patients. J Gastrointest Surg 2007, 11:1410–1415.PubMedCrossRefGoogle Scholar
  13. 13.
    Jay N, Berry JM, Hogeboom CJ, et al.: Colposcopic appearance of anal squamous intraepithelial lesions: relationship to histopathology. Dis Colon Rectum 1997, 40:919–928.PubMedCrossRefGoogle Scholar
  14. 14.
    Fox PA, Seet JE, Stebbing J, et al.: The value of anal cytology and human papillomavirus typing in the detection of anal intraepithelial neoplasia: a review of cases from an anoscopy clinic. Sex Transm Infect 2005, 81:142–146.PubMedCrossRefGoogle Scholar
  15. 15.
    Chiao EY, Giordano TP, Palefsky JM: Screening HIV-infected individuals for anal cancer precursor lesions: a systematic review. Clin Infect Dis 2006, 43:223–233.PubMedCrossRefGoogle Scholar
  16. 16.
    Scholefield JH, Castle MT, Watson NF: Malignant transformation of high-grade anal intraepithelial neoplasia. Br J Surg 2005, 92:1133–1136.PubMedCrossRefGoogle Scholar
  17. 17.
    Devaraj B, Cosman BC: Expectant management of anal squamous dysplasia in patients with HIV. Dis Colon Rectum 2006, 49:36–40.PubMedCrossRefGoogle Scholar
  18. 18.
    Goldstone SE, Kawalek AZ, Huyett JW: Infrared coagulator: a useful tool for treating anal squamous intraepithelial lesions. Dis Colon Rectum 2005, 48:1042–1054.PubMedCrossRefGoogle Scholar
  19. 19.
    Kreuter A, Potthoff A, Brockmeyer NH, et al.: Imiquimod leads to a decrease of human papillomavirus DNA and to a sustained clearance of anal intraepithelial neoplasia in HIV-infected men. J Invest Dermatol 2008, 128:2078–2083.PubMedCrossRefGoogle Scholar
  20. 20.
    Pineda CE, Berry JM, Jay N, et al.: High-resolution anoscopy targeted surgical destruction of anal high-grade squamous intraepithelial lesions: a ten-year experience. Dis Colon Rectum 2008, 51:829–835.PubMedCrossRefGoogle Scholar
  21. 21.
    Joura EA, Leodolter S, Hernandez-Avila M, et al.: Efficacy of a quadrivalent prophylactic human papillomavirus (types 6, 11, 16 and 18) L1 virus-like-particle vaccine against high-grade vulval and vaginal lesions: a combined analysis of three randomised clinical trials. Lancet 2007, 369:1693–1702.PubMedCrossRefGoogle Scholar
  22. 22.
    Palefsky JM, Berry JM, Jay N, et al.: A trial of SGN-00101 (HspE7) to treat high-grade anal intraepithelial neoplasia in HIV-positive individuals. AIDS 2006, 20:1151–1155.PubMedCrossRefGoogle Scholar
  23. 23.
    Nigro ND, Vaitkevicius VK, Buroker T, et al.: Combined therapy for cancer of the anal canal. Dis Colon Rectum 1981, 24:73–75.PubMedCrossRefGoogle Scholar
  24. 24.
    Bartelink H, Roelofsen F, Eschwege F, et al.: Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol 1997, 15:2040–2049.PubMedGoogle Scholar
  25. 25.
    Northover JMA, UKCCCR Anal Cancer Trial Working Party: Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. Lancet 1996, 348:1049–1054.CrossRefGoogle Scholar
  26. 26.
    Flam M, John M, Pajak TF, et al.: Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol 1996, 14:2527–2539.PubMedGoogle Scholar
  27. 27.
    Roohipour R, Patil S, Goodman KA, et al.: Squamous-cell carcinoma of the anal canal: predictors of treatment outcome. Dis Colon Rectum 2008, 51:147–153.PubMedCrossRefGoogle Scholar
  28. 28.
    Das P, Bhatia S, Eng C, et al.: Predictors and patterns of recurrence after definitive chemoradiation for anal cancer. Int J Radiat Oncol Biol Phys 2007, 68:794–800.PubMedGoogle Scholar
  29. 29.
    Gervaz P, Lavertu S, Kazemba B, et al.: Sphincter-preserving radiation therapy for rectal cancer: a simulation study using three-dimensional computerized technology. Colorectal Dis 2006, 8:570–574.PubMedCrossRefGoogle Scholar
  30. 30.
    Salama JK, Mell LK, Schomas DA, et al.: Concurrent chemotherapy and intensity-modulated radiation therapy for anal cancer patients: a multicenter experience. J Clin Oncol 2007, 25:4581–4586.PubMedCrossRefGoogle Scholar
  31. 31.
    Vuong T, Kopek N, Ducruet T, et al.: Conformal therapy improves the therapeutic index of patients with anal canal cancer treated with combined chemotherapy and external beam radiotherapy. Int J Radiat Oncol Biol Phys 2007, 67:1394–1400.PubMedGoogle Scholar
  32. 32.
    Hung A, Crane C, Delclos M, et al.: Cisplatin-based combined modality therapy for anal carcinoma: a wider therapeutic index. Cancer 2003, 97:1195–1202.PubMedCrossRefGoogle Scholar
  33. 33.
    Ajani JA, Winter KA, Gunderson LL, et al.: Fluorouracil, mitomycin and radiotherapy vs. fluorouracil, cisplatin and radiotherapy for carcinoma of the anal canal. JAMA 2008, 299:1914–1921.PubMedCrossRefGoogle Scholar
  34. 34.
    Crehange G, Bosset M, Lorchel F, et al.: Combining cisplatin and mitomycin with radiotherapy in anal carcinoma. Dis Colon Rectum 2007, 50:43–49.PubMedCrossRefGoogle Scholar
  35. 35.
    Schiller DE, Cummings BJ, Rai S, et al.: Outcomes of salvage surgery for squamous cell carcinoma of the anal canal. Ann Surg Oncol 2007, 14:2780–2789.PubMedCrossRefGoogle Scholar
  36. 36.
    Papaconstantinou HT, Bullard KM, Rothenberger DA, et al.: Salvage abdominoperineal resection after failed Nigro protocol: modest success, major morbidity. Colorectal Dis 2006, 8:124–129.PubMedCrossRefGoogle Scholar
  37. 37.
    Stewart D, Yan Y, Kodner IJ, et al.: Salvage surgery after failed chemoradiation for anal canal cancer: should the paradigm be changed for high-risk tumors? J Gastrointest Surg 2007, 11:1744–1751.PubMedCrossRefGoogle Scholar
  38. 38.
    Cleator S, Fife K, Nelson M, et al.: Treatment of HIV-associated invasive anal cancer with combined chemoradiation. Eur J Cancer 2000, 36:754–758.PubMedCrossRefGoogle Scholar
  39. 39.
    Kim JH, Sarani B, Orkin BA, et al.: HIV-positive patients with anal carcinoma have poorer treatment tolerance and outcome than HIV-negative patients. Dis Colon Rectum 2001, 44:1496–1502.PubMedCrossRefGoogle Scholar
  40. 40.
    Clifford GM, Polesel J, Rickenbach M, et al.: Cancer risk in the Swiss HIV cohort study: Association with immunodeficiency, smoking and highly active antiretroviral therapy. J Natl Cancer Inst 2005, 97:425–432.PubMedCrossRefGoogle Scholar
  41. 41.
    Gervaz P, Hahnloser D, Wolff BG, et al.: Molecular biology of squamous cell carcinoma of the anus: a comparison of HIV-positive and HIV-negative patients. J Gastrointest Surg 2004, 8:1024–1031.PubMedCrossRefGoogle Scholar
  42. 42.
    Oehler-Jänne C, Seifert B, Lütolf UM, Ciernik IF: Local tumor control and toxicity in HIV-associated anal carcinoma treated with radiotherapy in the era of antiretroviral therapy. Radiat Oncol 2006, 1:29.PubMedCrossRefGoogle Scholar
  43. 43.
    Wexler A, Berson AM, Goldstone SE, et al.: Invasive anal squamous-cell carcinoma in the HIV-positive patient: outcome in the era of highly active antiretroviral therapy. Dis Colon Rectum 2008, 51:73–81.PubMedCrossRefGoogle Scholar
  44. 44.
    Blazy A, Hennequin C, Gornet JM, et al.: Anal carcinomas in HIV-positive patients: high-dose chemoradiotherapy is feasible in the era of highly active antiretroviral therapy. Dis Colon Rectum 2005, 48:1176–1181.PubMedCrossRefGoogle Scholar
  45. 45.
    Chiao EY, Giordano TP, Richardson P, et al.: Human immunodeficiency virus-associated squamous cell cancer of the anus: epidemiology and outcomes in the highly active antiretroviral therapy era. J Clin Oncol 2008, 26:474–479.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Clinique de Chirurgie ViscéraleHôpital Cantonal Universitaire de GenèveGenèveSwitzerland

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