Skip to main content

Advertisement

Log in

Current status—Perianal and anal canal neoplasms

  • Current Status
  • Published:
Diseases of the Colon & Rectum

Abstract

A large variety of neoplasms are found in the anal canal and perianal region. Most are distinctly uncommon and may, therefore, pose the question of suitable therapy. For some neoplasms, the treatment of choice is clear cut, while for others it is controversial. Certainly for squamous cell carcinoma of the anal canal, there has been a major rethinking of the treatment of choice. This review highlights the types of lesions found in the anal region and the current status regarding their appropriate treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Morson BC, Pang LS. Pathology of anal cancer. Proc R Soc Med 1968;61:623–4.

    PubMed  Google Scholar 

  2. Stearns MW, Jr, Quan SH. Epidermoid carcinoma of the anorectum. Surg Gynecol Obstet 1970;131:953–7.

    PubMed  Google Scholar 

  3. Daling JR, Weiss NS, Hislop TG, et al. Sexual practices, sexually transmitted diseases and the incidence of anal cancer. N Engl J Med 1987;317:973–7.

    PubMed  Google Scholar 

  4. Gal AA, Meyer PR, Taylor CR. Papillomavirus antigens in anorectal condyloma and carcinomas in homosexual men. JAMA 1987;257:337–10.

    PubMed  Google Scholar 

  5. Palmer JC, Shepard NA, Jass JR, et al. Human papillomavirus type 16 in anal squamous carcinomas. Lancet 1988;2:42.

    Google Scholar 

  6. Penn I. Cancers of the anogenital region in renal transplant recipients: analysis of 65 cases. Cancer 1986;58:611–6.

    PubMed  Google Scholar 

  7. Maleris M, Salmon RJ, Girodet J, et al. Recurrent deletions of chromosomes 11q and 3 p in anal canal carcinoma. Int J Cancer 1987;39:595–8.

    PubMed  Google Scholar 

  8. Goldberg SM, Gordon PH, Nivatvongs S. Essentials of anorectal surgery. Philadelphia: JB Lippincott, 1980:161.

    Google Scholar 

  9. Morson BC, Sobin LH. Histologic typing of intestinal tumors. Geneva: World Health Organization, 1976:62–5.

    Google Scholar 

  10. Morson BC. The pathology and results of treatment of squamous cell carcinoma of the anal canal and anal margin. Proc R Soc Med 1960;53:416–20.

    Google Scholar 

  11. Moller C, Saksela E. Cancer of the anus and anal canal. Acta Chir Scand 1970;136:340–8.

    PubMed  Google Scholar 

  12. Greenall MJ, Quan SH, Stearns MW, Urmacher C, Decosse J. Epidermoid cancer of the anal margin: pathologic features, treatment, and clinical results. Am J Surg 1985;149:95–101.

    PubMed  Google Scholar 

  13. McConnel EM. Squamous carcinoma of the anus: review of 96 cases. Br J Surg 1970;57:89–92.

    PubMed  Google Scholar 

  14. Beahrs OH, Wilson SM. Carcinoma of the anus. Ann Surg 1976;184:422–8.

    PubMed  Google Scholar 

  15. Aj-Jurf AS, Turnbull RB, Fazio VW. Local treatment of squamous cell carcinoma of the anus. Surg Gynecol Obstet 1979;148:576–8.

    PubMed  Google Scholar 

  16. Schraut WH, Wang CH, Dawson PJ, Block GE. Depth of invasion, location, and size of cancer of the anus dictate operative treatment. Cancer 1983;51:1291–6.

    PubMed  Google Scholar 

  17. Jensen SL, Hagen K, Harling H, Shokouh-Amiri MH, Nielsen OV. Long-term prognosis after radical treatment for squamous-cell carcinoma of the anal canal and anal margin. Dis Colon Rectum 1988;31:273–8.

    PubMed  Google Scholar 

  18. Pintor MP, Northover JM, Nicholls RJ. Squamous cell carcinoma of the anus at one hospital from 1948–1984. Br J Surg 1989;76:806–10.

    PubMed  Google Scholar 

  19. Nigro ND, Vaitkeviceus VK. Herskovic AM. Preservation of function in the treatment of cancer of the anus. In: Vita V, ed. Important advances in oncology. Philadelphia: JB Lippincott, 1989:161–77.

    Google Scholar 

  20. Nielsen OV, Jensen SL. Basal cell carcinoma of the anus: a clinical study of 34 cases. Br J Surg 1981;68:856–7.

    PubMed  Google Scholar 

  21. White WB, Schneiderman H, Sayre JT. Basal cell carcinoma of the anus: clinical and pathological distinction from cloacogenic carcinoma. J Clin Gastroenterol 1984;6:441–6.

    PubMed  Google Scholar 

  22. Beck DE, Fazio VW, Jagelman DG, Lavery IC. Perianal Bowen's disease. Dis Colon Rectum 1988;31:419–22.

    PubMed  Google Scholar 

  23. Ramos R, Salinas H, Tucker L. Conservative approach to the treatment of Bowen's disease of the anus. Dis Colon Rectum 1983;26:712–5.

    PubMed  Google Scholar 

  24. Marfing TE, Abel ME, Gallagher DM. Perianal Bowen's disease and associated malignancies: results of a survey. Dis Colon Rectum 1987;30:782–5.

    PubMed  Google Scholar 

  25. Beck DE, Fazio VW. Premalignant lesions of the anal margins. South Med J 1989;82:470–4.

    PubMed  Google Scholar 

  26. Graham JH, Helwig EB. Bowen's disease and its relationship to systemic cancer. Arch Dermatol 1961;83:738–58.

    PubMed  Google Scholar 

  27. Arbesman H, Ransohoff DF. Is Bowen's disease a predictor for the development of internal malignancy? A methodological critique of the literature. JAMA 1987;257:516–8.

    PubMed  Google Scholar 

  28. Morson BC, Dawson MP. Gastrointestinal pathology. London: Blackwell Scientific Publications, 1972:624–5.

    Google Scholar 

  29. Berardi RS, Lee S, Chen HP. Perianal extramammary Paget's disease. Surg Gynecol Obstet 1988;167:359–66.

    PubMed  Google Scholar 

  30. Jensen SL, Sjolin KE, Shokouh-Amiri MH, Hagen K, Harling H. Paget's disease of the anal margin. Br J Surg 1988;75:1089–92.

    PubMed  Google Scholar 

  31. Beck DE, Fazio VW. Perianal Paget's disease. Dis Colon Rectum 1987;30:263–6.

    PubMed  Google Scholar 

  32. Grodsky L. Uncommon nonkeratinizing cancers of the anal canal and perianal region. N Y State J Med 1965;65:894–901.

    PubMed  Google Scholar 

  33. Helwig EG, Graham JH. Anogenital (extramammary) Paget's disease: a clinicopathologic study. Cancer 1963;16:387–403.

    PubMed  Google Scholar 

  34. Armitage NC, Jass JR, Richman PI, Thomson JP, Phillips RK. Paget's disease of the anus: a clinicopathological study. Br J Surg 1989;76:60–3.

    PubMed  Google Scholar 

  35. Lee SH, McGregor DH, Kuziez MN. Malignant transformation of perianal condyloma acuminatum: a case report with review of the literature. Dis Colon Rectum 1981;24:462–7.

    PubMed  Google Scholar 

  36. Prioleau PG, Santa Cruz MJ, Meyer JS, Bauer WC. Verrucous carcinoma: a light and electron microscopic, autoradiographic, and immunofluorescence study. Cancer 1980;48:2849–57.

    Google Scholar 

  37. Gingrass PJ, Bubrick MP, Hitchcock CR, Strom RL. Anorectal verrucose squamous carcinoma: report of two cases. Dis Colon Rectum 1978;21:120–2.

    PubMed  Google Scholar 

  38. Elliot MS, Werner ID, Immelman EJ, Harrison AC. Giant condyloma (Bushke-Loewenstein tumor) of the anorectum. Dis Colon Rectum 1979;22:497–500.

    PubMed  Google Scholar 

  39. Shiels RA. A history of Kaposi's sarcoma. J R Soc Med 1986;79:532–4.

    PubMed  Google Scholar 

  40. Boman BM, Moertel CG, O'Connell MJ, et al. Carcinoma of the anal canal: a clinical and pathologic study of 188 cases. Cancer 1984;54:114–25.

    PubMed  Google Scholar 

  41. Greenall MJ, Quan SH, Urmacher C, DeCosse J. Treatment of epidermoid carcinoma of the anal canal. Surg Gynecol Obstet 1985;161:509–17.

    PubMed  Google Scholar 

  42. Wexner SD, Milsom JW, Dailey TH. The demographics of anal cancers are changing: identification of a high-risk population. Dis Colon Rectum 1987;30:942–6.

    PubMed  Google Scholar 

  43. Gordon PH. Squamous cell carcinoma of the anal canal. Surg Clin North Am 1988;68:1391–9.

    PubMed  Google Scholar 

  44. Klotz RG Jr, Pamukcoglu T, Souilliard DH. Transitional cloacogenic carcinoma of the anal canal. Cancer 1967;20:1727–45.

    PubMed  Google Scholar 

  45. Golden GT, Horsely JS III. Surgical management of epidermoid carcinoma of the anus. Am J Surg 1976;131:275–80.

    PubMed  Google Scholar 

  46. Singh R, Nime F, Mittelman A. Malignant epithelial tumors of the anal canal. Cancer 1981;48:411–4.

    PubMed  Google Scholar 

  47. Clark J, Petrelli N, Herrera L, Mittelman A. Epidermoid carcinoma of the anal canal. Cancer 1986;57:400–6.

    PubMed  Google Scholar 

  48. Sawyers JL. Current management of carcinoma of the anus and perianus. Am Surg 1977;43:424–9.

    PubMed  Google Scholar 

  49. Welch JP, Malt RA. Appraisal of the treatment of carcinoma of the anus and anal canal. Surg Gynecol Obstet 1977;145:837–41.

    PubMed  Google Scholar 

  50. O'Brien PH, Jenrette JM, Wallace KM, et al. Epidermoid carcinoma of the anus. Surg Gynecol Obstet 1982;155:745–51.

    PubMed  Google Scholar 

  51. Frost D, Richards P, Montague E. Giaceo G, Martin R. Epidermoid cancer of the anorectum. Cancer 1984;53:1285–93.

    PubMed  Google Scholar 

  52. Dougherty BG, Evans HL. Carcinoma of the anal canal: a study of 79 cases. Am J Clin Pathol 1985;83:159–64.

    PubMed  Google Scholar 

  53. Lopez MJ, Kraybill WG. Squamous cell cancer of the anus: the Ellis Fischel experience and current trends in management. Mo Med 1988;85:669–73.

    PubMed  Google Scholar 

  54. Cantril ST, Green JP, Schall GL, Schaupp WC. Primary radiation therapy in the treatment of anal carcinoma. Int J Radiat Oncol Biol Phys 1983;9:1271–8.

    PubMed  Google Scholar 

  55. Cummings BJ, Thomas GM, Keane TJ. Primary radiation therapy in the treatment of anal canal carcinoma. Dis Colon Rectum 1982;25:778–82.

    PubMed  Google Scholar 

  56. Papillon J, Montbarbon JF. Epidermoid carcinoma of the anal canal: a series of 276 cases. Dis Colon Rectum 1987;30:324–33.

    PubMed  Google Scholar 

  57. Hintz BL, Choryulu KK, Sudersanam A. Anal carcinoma: basic concepts and management. J Surg Oncol 1978;10:141–50.

    PubMed  Google Scholar 

  58. Salmon RJ, Fenton J, Asselain B, et al. Treatment of epidermoid anal canal cancer. Am J Surg 1984;147:43–8.

    PubMed  Google Scholar 

  59. Eschwege F, Lasser P, Chavy A, et al. Squamous cell carcinoma of the anal canal: treatment with external beam irradiation. Radiother Oncol 1985;3:145–50.

    PubMed  Google Scholar 

  60. Papillon J. Current therapeutic concepts in management of carcinoma of the anal canal. Recent Results Cancer Res 1988;110:146–9.

    PubMed  Google Scholar 

  61. Nigro ND, Vaitkevicius VK. Considine B. Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum 1974;17:354–6.

    PubMed  Google Scholar 

  62. Nigro ND. Multidisciplinary management of cancer of the anus. World J Surg 1987;11:446–51.

    PubMed  Google Scholar 

  63. Cummings BJ, Keane TJ, Thomas GM. The results and toxicity of the treatment of anal canal carcinoma by radiation therapy or radiation therapy and chemotherapy. Cancer 1984;54:2062–8.

    PubMed  Google Scholar 

  64. Flam MS, John MJ, Mowry PA, Lovalvo LJ, Ramalho LD, Wade J. Definitive combined modality therapy of carcinoma of the anus: a report of 30 cases including results of salvage therapy in patients with residual disease. Dis Colon Rectum 1987;30:495–502.

    PubMed  Google Scholar 

  65. Sischy B. The use of radiation therapy combined with chemotherapy in the management of squamous cell carcinoma of the anus and marginally resectable adenocarcinoma of the rectum. Int J Radiat Oncol Biol Phys 1985;11:1587–93.

    PubMed  Google Scholar 

  66. Cummings BJ. Current management of epidermoid carcinoma of the anal canal. Gastroenterol Clin North Am 1987;16:125–42.

    PubMed  Google Scholar 

  67. Meeker WR Jr, Sickle-Santanello BJ, Philpott G, et al. Combined chemotherapy, radiation and surgery for epithelial cancer of the anal canal. Cancer 1986;57:525–9.

    PubMed  Google Scholar 

  68. Habr-Gama A, da Silva e Sousa AH Jr, Nadalin W, Gansl R, da Silva JH, Pinotti HW. Epidermoid carcinoma of the anal canal: results of treatment by combined chemotherapy and radiotherapy. Dis Colon Rectum 1989;32:773–7.

    PubMed  Google Scholar 

  69. Stearns MW, Urmacher C, Sternberg SE, Woodruff J, Attiyeh FF. Cancer of the anal canal. Curr Probl Cancer 1980;4:1–44.

    Google Scholar 

  70. Nielsen OV, Koch F. Carcinoma of the anorectal region of extramucosal origin with special reference to the anal ducts. Acta Chir Scand 1973;139:299–305.

    PubMed  Google Scholar 

  71. Jensen SL, Shokouh-Amiri MH, Hagen K, Harling H, Nielsen OV. Adenocarcinoma of the anal ducts: a series of 21 cases. Dis Colon Rectum 1988;31:268–72.

    PubMed  Google Scholar 

  72. Nelson RL, Prasad ML, Abcarian H. Anal carcinoma presenting as a perianal abscess or fistula. Arch Surg 1985;120:632–5.

    PubMed  Google Scholar 

  73. Iversen K, Robins RE. Mucosal malignant melanoma. Am J Surg 1980;139:660–4.

    PubMed  Google Scholar 

  74. Wanebo HJ, Woodruff JM, Farr GH, et al. Anorectal melanoma. Cancer 1981;47:1891–1900.

    PubMed  Google Scholar 

  75. Cooper PH, Mills SE, Allen MS Jr. Malignant melanoma of the anus: report of 12 patients and analysis of 255 additional cases. Dis Colon Rectum 1982;25:693–703.

    PubMed  Google Scholar 

  76. Siegal B, Cohen D, Jacob ET. Surgical treatment of anorectal melanoma. Am J Surg 1983;146:336–8.

    PubMed  Google Scholar 

  77. Werdin C, Limas C, Knodell RG. Primary malignant melanoma of the rectum: evidence for origination from rectal mucosal melanocytes. Cancer 1988;61:1364–70.

    PubMed  Google Scholar 

  78. Chiu YS, Unni KK, Beart RW Jr. Malignant melanoma of the anorectum. Dis Colon Rectum 1980;23:122–4.

    PubMed  Google Scholar 

  79. Ward MW, Romano G, Nicholls RJ. The surgical treatment of anorectal malignant melanoma. Br J Surg 1986;73:68–9.

    PubMed  Google Scholar 

  80. Boliver JC, Harris JW, Branch W, Sherman RT. Melanoma of the anorectal region. Surg Gynecol Obstet 1982;154:337–41.

    PubMed  Google Scholar 

  81. Abbas JS, Karakousis CD, Holyoke ED. Anorectal melanoma: clinical features, recurrence, and patient survival. Int Surg 1980;65:423–6.

    PubMed  Google Scholar 

  82. Jorge E, Harvey HA, Simonds MA, et al. Symptomatic malignant melanoma of the gastrointestinal tract. Ann Surg 1984;199:326–31.

    Google Scholar 

  83. Pyper PC, Parks TG. Melanoma of the anal canal. Br J Surg 1984;71:671–2.

    PubMed  Google Scholar 

  84. Molnar L, Brezsnyak I, Daubner K, Horak E, Svastits E. Anorectal sarcomas. Acta Chir Hung 1985;26:85–91.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.

About this article

Cite this article

Smith, L., Gordon, P.H. Current status—Perianal and anal canal neoplasms. Dis Colon Rectum 33, 799–808 (1990). https://doi.org/10.1007/BF02052331

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02052331

Key words

Navigation