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Anal Carcinoma Surveillance Counterpoint: Canada

  • Natasha Press
  • John HayEmail author
Chapter
Part of the Current Clinical Oncology book series (CCO)

Abstract

Anal dysplasia and intraepithelial neoplasia are part of a continuum of anal cancer that is typically treated with curative intent. Surveillance after treatment in our practice includes high-resolution anoscopy. This is similar to colposcopy in cervical cancer screening and treatment programs. It allows for the visualization of the anal canal, with biopsy of suspicious looking lesions [1]. In Canada, high-resolution anoscopy is performed in a few outpatient settings, and constitutes part of a screening program for individuals who are at high risk for anal dysplasia due to human papillomavirus (e.g., men who have sex with men and HIV-positive individuals). These high-risk individuals are usually screened with an anal Pap smear, and referred for high-resolution anoscopy if the cytology result is abnormal. Following high-resolution anoscopy, biopsy may be indicated. If the biopsy shows high-grade dysplasia (anal intraepithelial neoplasia II/III, carcinoma in situ), lesions are treated with either 80 % trichloroacetic acid or infrared coagulation. Recent data on infrared coagulation show that it is a safe and effective office-based procedure, and that repeated treatments lead to resolution of the high-grade dysplasia [2].

Keywords

Squamous cell carcinoma High-resolution Anoscopy Radiation therapy Chemotherapy Survival duration 

References

  1. 1.
    Jay N, Berry JM, Hogeboom CJ, et al. Colposcopic appearance of anal squamous intraepithelial lesions: relationship to histopathology. Dis Colon Rectum. 1997;40:919–28.CrossRefPubMedGoogle Scholar
  2. 2.
    Goldstone SE, Hundert JS, Huyett JW. Infrared coagulator ablation of high-grade anal squamous intraepithelial lesions in HIV-negative males who have sex with males. Dis Colon Rectum. 2007;50:565–75.CrossRefPubMedGoogle Scholar
  3. 3.
    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;51:829–37.CrossRefPubMedGoogle Scholar
  4. 4.
    Foo M, Harrow S, Ma R, et al. Outcomes and treatment following recurrence of anal carcinoma after radical radiotherapy: the British Columbia experience. Radiother Oncol. 2010;96 Suppl 2:S44 (Abstr. 133).Google Scholar
  5. 5.
    Eeson G, Foo M, Harrow S, et al. Outcomes of salvage surgery for epidermoid carcinoma of the anus following failed combined modality treatment. Am J Surg. 2011;201:624–9.CrossRefGoogle Scholar
  6. 6.
    Newman G, Calverly DC, Acker BD, et al. The management of carcinoma of the anal canal by external beam radiotherapy, experience in Vancouver 1971–1988. Radiother Oncol. 1992;25:196–202.CrossRefPubMedGoogle Scholar
  7. 7.
    Cummings BJ, Keane TJ, O’Sullivan B, et al. Epidermoid anal cancer: treatment by radiation alone or radiation and 5-Fluorouracil with and without Mitomycin C. Int J Radiat Oncol Biol Phys. 1991;21:1115–25.CrossRefPubMedGoogle Scholar
  8. 8.
    Schwarz JK. Siegel BA. Dehdashti F. et al.Tumor response and survival predicted by post-therapy FDG-PET/CT in anal cancer. Int J Radiat Oncol Biol Phys. 2008;71(1):180–86.CrossRefPubMedGoogle Scholar
  9. 9.
    Day FL, Link E, Ngan S et al. FDG-PET metabolic response predicts outcomes in anal cancer managed with chemoradiotherapy. Br J Cancer. 2011;105:498–504.CrossRefPubMedGoogle Scholar
  10. 10.
    Ajani AJ, Winter KA, Gunderson L, et al. Fluorouracil, Mitomycin and radiotherapy vs Fluorouracil, Cisplatin and radiotherapy for carcinoma of the anal canal. A randomized controlled trial. JAMA. 2008;299:1914–21.CrossRefPubMedGoogle Scholar
  11. 11.
    Belkacemi Y, Berger C, Poortmans P, et al. Management of primary anal canal adenocarcinoma: a large retrospective study from the Rare Cancer Network. Int J Radiat Oncol Biol Phys. 2003;56: 1274–83.CrossRefPubMedGoogle Scholar

Copyright information

© Humana Press 2013

Authors and Affiliations

  1. 1.Division of Infectious DiseasesUniversity of British ColumbiaVancouverCanada
  2. 2.Radiation Oncologist, British Columbia Cancer Agency, Vancouver Cancer CentreUniversity of British ColumbiaVancouverCanada

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