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Anal dysplasia and anal cancer. English version

Anale Dysplasien und Analkarzinom

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Abstract

Anal intraepithelial neoplasia (AIN) and 89–100% of anal cancers are caused by persistent infections with high-risk (HR) human papillomaviruses (HPV). In HIV-positive patients, anal HPV infection and AIN are very common and these patients have a significantly increased risk for anal cancer. However, a continuous increase in the incidence of anal cancer has also been observed in the general population in recent decades. AIN can clinically present in diverse manners. In HIV-positive patients AIN can be hidden in condylomas. Approximately 3–14% of high-grade AIN progress to anal cancer within 5 years. Therefore, screening examinations should be offered to patients with an increased risk for anal cancer. The treatment options for AIN are similar to those for condylomas. HIV-positive patients with controlled immune status and HIV-negative patients with anal cancer respond comparably well to combined radiochemotherapy. A German-language S3 guideline for anal cancer will be available in 2020. In HIV-positive patients over 26 years of age, HPV vaccination showed no effect in a controlled phase‑3 study. To prevent AIN and anal cancer in the future, HPV vaccination rates need to be increased in HPV-naïve girls and boys.

Zusammenfassung

Anale intraepitheliale Neoplasien (AIN) und 89–100 % der Analkarzinome werden durch persistierende Infektionen mit Hochrisiko(HR)-humanen Papillomviren (HPV) verursacht. Bei HIV(„human immunodeficiency virus“)-positiven Patienten sind anale HPV-Infektionen und AIN sehr häufig, und diese Patienten haben ein stark erhöhtes Risiko für die Entwicklung eines Analkarzinoms. Auch in der Allgemeinbevölkerung wird jedoch in den letzten Jahrzehnten ein kontinuierlicher Anstieg der Analkarzinominzidenz beobachtet. AIN kann sich klinisch vielfältig präsentieren und bei HIV-positiven Patienten auch in Kondylomen verborgen sein. Etwa 3–14 % der hochgradigen AIN schreiten innerhalb von 5 Jahren zu Analkarzinomen fort. Deshalb sollten Screeninguntersuchungen für Patienten mit erhöhtem Analkarzinomrisiko angeboten werden. Die Therapieoptionen für AIN ähneln denen für Kondylome. HIV-positive Patienten mit kontrolliertem Immunstatus und HIV-negative Patienten mit Analkarzinom sprechen vergleichbar gut auf eine kombinierte Radiochemotherapie an. Eine deutschsprachige AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V.) S3-Leitlinie zum Analkarzinom wird 2020 vorliegen. Bei HIV-positiven Patienten über 26 Jahre zeigte die HPV-Impfung in einer kontrollierten Phase-3-Studie keinen Effekt. Um AIN und Analkarzinom zukünftig zu verhindern, müssen die HPV-Impfraten bei HPV-naiven Mädchen und Jungen erhöht werden.

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Authors and Affiliations

  1. Institute of Virology, National Reference Center for Papilloma- and Polyomaviruses, University of Cologne, Cologne, Germany

    Ulrike Wieland

  2. Institute of Pathology, Mühlheim an der Ruhr, Germany

    Frank Oellig

  3. Department of Dermatology, Venerology and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University of Witten/Herdecke, Josefstr. 3, 46045, Oberhausen, Germany

    Alexander Kreuter

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  1. Ulrike Wieland
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Correspondence to Alexander Kreuter.

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Conflict of interest

A. Kreuter received advisory fees from MSD Sharp & Dohne GmbH and was a member of the Advisory Board of MSD Sharp & Dohne GmbH. U. Wieland and F. Oellig declare that they have no competing interests.

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For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case. Additional written informed consent was obtained from all individual participants or their legal representatives for whom identifying information is included in this article.

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Wieland, U., Oellig, F. & Kreuter, A. Anal dysplasia and anal cancer. English version. Hautarzt 71 (Suppl 2), 74–81 (2020). https://doi.org/10.1007/s00105-020-04562-x

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