Skip to main content

Part of the book series: Evidenzbasierte Chirurgie ((EC))

  • 1427 Accesses


Die Behandlung des Analkarzinoms wird in der Regel durch eine definitive Radiochemotherapie durchgeführt. Die früher übliche primäre Operation mittels abdominoperinealer Resektion (APR) und permanenter Kolostomie wird heute nicht mehr als primäre Standardtherapie empfohlen. Eine Ausnahme bilden gut differenzierte T1–2,N0-Analrandkarzinome, welche mittels lokaler Exzision mit ausreichendem Sicherheitsabstand behandelt werden. Bei ausbleibender vollständiger Remission nach Radiochemotherapie, fehlender Strahlenreserve nach vorangegangener Radiotherapie im Becken oder bei Rezidiven werden die Patienten einer Salvage-Operation, in der Regel mittels abdominoperinealer Resektion oder Beckenexenteration, zugeführt. Die Gesamtprognose des Analkarzinoms ist gut mit 5-Jahres-Überlebensraten zwischen 60 und 80 %. Hauptrisikofaktor für das Entstehen eines Analkarzinoms ist die Infektion mit humanen Papilloma-Viren (HPV).

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

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
USD 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others


  • Ajani JA, Winter KA, Gunderson LL, Pedersen J, Benson AB, Thomas CR, Mayer RJ, Haddock MG, Rich TA, Willett C (2008) Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA 299:1914–1921. doi: 10.1001/jama.299.16.1914

  • Alemany L, Saunier M, Alvarado-Cabrero I, Quirós B, Salmeron J, Shin H-R, Pirog EC, Guimerà N, Hernandez-Suarez G, Felix A, Clavero O, Lloveras B, Kasamatsu E, Goodman MT, Hernandez BY, Laco J, Tinoco L, Geraets DT, Lynch CF, Mandys V, Poljak M, Jach R, Verge J, Clavel C, Ndiaye C, Klaustermeier J, Cubilla A, Castellsagué X, Bravo IG, Pawlita M, Quint WG, Muñoz N, Bosch FX, de Sanjosé S, HPV VVAP Study Group (2015) Human papillomavirus DNA prevalence and type distribution in anal carcinomas worldwide. Int J Cancer 136:98–107. doi: 10.1002/ijc.28963

  • AWMF (2018) Anmeldung S3 Leitlinie Analkarzinom. Accessed 19 Jan 2018

  • AWMF (2013) S2k Leitlinie: Anale Dysplasien und Analkarzinom bei HIV-Infizierten: Prävention, Diagnostik und Therapie. Accessed 19 Jan 2018

  • Bartelink H, Roelofsen F, Eschwege F, Rougier P, Bosset JF, Gonzalez DG, Peiffert D, van Glabbeke M, Pierart M (1997) 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 15:2040–2049. doi: 10.1200/JCO.1997.15.5.2040

  • Cancer Research UK (2017) ISRCTN - ISRCTN88455282: PLATO - Personalising anal cancer radiotherapy dose. &filters=conditionCategory:Cancer&sort=&offset= 9&totalResults=1850&page=1&pageSize=10&searchType=basic-search. Accessed 27 Jan 2018

  • Colón-López V, Shiels MS, Machin M, Ortiz AP, Strickler H, Castle PE, Pfeiffer RM, Engels EA (2018) Anal Cancer Risk Among People With HIV Infection in the United States. J Clin Oncol 36:68–75. doi: 10.1200/JCO.2017.74.9291

  • Cooper R, Mason M, Finan P, Byrne P, Sebag-Montefiore D (2012) Defunctioning stomas prior to chemoradiation for anal cancer are usually permanent. Colorectal Dis 14:87–91. doi: 10.1111/j.1463–1318.2010.02529.x

  • Flam M, John M, Pajak TF, Petrelli N, Myerson R, Doggett S, Quivey J, Rotman M, Kerman H, Coia L, Murray K (1996) 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 14:2527–2539. doi: 10.1200/JCO.1996.14.9.2527

  • Frisch M, Glimelius B, van den Brule AJ, Wohlfahrt J, Meijer CJ, Walboomers JM, Goldman S, Svensson C, Adami HO, Melbye M (1997) Sexually transmitted infection as a cause of anal cancer. N Engl J Med 337:1350–1358. doi: 10.1056/NEJM199711063371904

  • Geh I, Gollins S, Renehan A, Scholefield J, Goh V, Prezzi D, Moran B, Bower M, Alfa-Wali M, Adams R (2017) Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) – Anal Cancer. Colorectal Dis 19:82–97. doi: 10.1111/codi.13709

  • Ghosn M, Kourie HR, Abdayem P, Antoun J, Nasr D (2015) Anal cancer treatment: Current status and future perspectives. World J Gastroenterol 21: 2294–2302. doi: 10.3748/wjg.v21.i8.2294

  • Glynne-Jones R, Nilsson PJ, Aschele C, Goh V, Peiffert D, Cervantes A, Arnold D (2014a) Anal cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 25 Suppl 3:iii10–20. doi: 10.1093/annonc/mdu159

  • Glynne-Jones R, Nilsson PJ, Aschele C, Goh V, Peiffert D, Cervantes A, Arnold D, ESMO, ESSO, ESTRO (2014b) Anal cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Radiother Oncol 111:330–339. doi: 10.1016/j.radonc. 2014.04.013

  • Glynne-Jones R, Nilsson PJ, Aschele C, Goh V, Peiffert D, Cervantes A, Arnold D, European Society for Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO), European Society of Radiotherapy and Oncology (ESTRO) (2014c) Anal cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Eur J Surg Oncol 40:1165–1176. doi: 10.1016/j.ejso.2014. 07.030

  • Glynne-Jones R, Sebag-Montefiore D, Meadows HM, Cunningham D, Begum R, Adab F, Benstead K, Harte RJ, Stewart J, Beare S, Hackshaw A, Kadalayil L, ACT II study group (2017) Best time to assess complete clinical response after chemoradiotherapy in squamous cell carcinoma of the anus (ACT II): a post-hoc analysis of randomised controlled phase 3 trial. Lancet Oncol 18:347–356. doi: 10.1016/S1470-2045(17)30071-2

  • Goldstone RN, Hasan SR, Drury S, Darragh TM, van Zante A, Goldstone SE (2017) A trial of radiofrequency ablation for anal intraepithelial neoplasia. Int J Colorectal Dis 32:357–365. doi: 10.1007/s00384-016-2679-2

  • Gunderson LL, Winter KA, Ajani JA, Pedersen JE, Moughan J, Benson AB, Thomas CR, Mayer RJ, Haddock MG, Rich TA, Willett CG (2012) Long-term update of US GI intergroup RTOG 98-11 phase III trial for anal carcinoma: survival, relapse, and colostomy failure with concurrent chemoradiation involving fluorouracil/mitomycin versus fluorouracil/cisplatin. J Clin Oncol 30:4344–4351. doi: 10.1200/JCO.2012.43.8085

  • Guyatt G, Gutterman D, Baumann MH, Addrizzo-Harris D, Hylek EM, Phillips B, Raskob G, Lewis SZ, Schünemann H (2006) Grading strength of recommendations and quality of evidence in clinical guidelines: report from an american college of chest physicians task force. Chest 129:174–181. doi: 10.1378/chest.129.1.174

  • Horch RE, Hohenberger W, Eweida A, Kneser U, Weber K, Arkudas A, Merkel S, Göhl J, Beier JP (2014) A hundred patients with vertical rectus abdominis myocutaneous (VRAM) flap for pelvic reconstruction after total pelvic exenteration. Int J Colorectal Dis 29:813–823. doi: 10.1007/s00384-014-1868-0

  • Islami F, Ferlay J, Lortet-Tieulent J, Bray F, Jemal A (2017) International trends in anal cancer incidence rates. Int J Epidemiol 46:924–938. doi: 10.1093/ije/dyw276

  • James RD, Glynne-Jones R, Meadows HM, Cunningham D, Myint AS, Saunders MP, Maughan T, McDonald A, Essapen S, Leslie M, Falk S, Wilson C, Gollins S, Begum R, Ledermann J, Kadalayil L, Sebag-Montefiore D (2013) Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2 × 2 factorial trial. Lancet Oncol 14:516–524. doi: 10.1016/S1470-2045(13)70086-X

  • Jones M, Hruby G, Solomon M, Rutherford N, Martin J (2015) The Role of FDG-PET in the Initial Staging and Response Assessment of Anal Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol 22:3574–3581. doi: 10.1245/s10434-015-4391-9

  • Kachnic LA, Winter K, Myerson RJ, Goodyear MD, Willins J, Esthappan J, Haddock MG, Rotman M, Parikh PJ, Safran H, Willett CG (2013) RTOG 0529: a phase 2 evaluation of dose-painted intensity modulated radiation therapy in combination with 5-fluorouracil and mitomycin-C for the reduction of acute morbidity in carcinoma of the anal canal. Int J Radiat Oncol Biol Phys 86:27–33. doi: 10.1016/j.ijrobp.2012.09.023

  • Kim E, Kim JS, Choi M, Thomas CR (2016) Conditional Survival in Anal Carcinoma Using the National Population-Based Survey of Epidemiology and End Results Database (1988-2012). Dis Colon Rectum 59:291–298. doi: 10.1097/DCR.0000000000000555

  • Kochhar R, Renehan AG, Mullan D, Chakrabarty B, Saunders MP, Carrington BM (2017) The assessment of local response using magnetic resonance imaging at 3- and 6-month post chemoradiotherapy in patients with anal cancer. Eur Radiol 27:607–617. doi: 10.1007/s00330-016-4337-z

  • Lefèvre JH, Corte H, Tiret E, Boccara D, Chaouat M, Touboul E, Svrcek M, Lefrancois M, Shields C, Parc Y (2012) Abdominoperineal resection for squamous cell anal carcinoma: survival and risk factors for recurrence. Ann Surg Oncol 19:4186–4192. doi: 10.1245/s10434-012-2485-1

  • Macaya A, Muñoz-Santos C, Balaguer A, Barberà MJ (2012) Interventions for anal canal intraepithelial neoplasia. Cochrane Database Syst Rev 12:CD009244. doi: 10.1002/14651858.CD009244.pub2

  • Machalek DA, Poynten M, Jin F, Fairley CK, Farnsworth A, Garland SM, Hillman RJ, Petoumenos K, Roberts J, Tabrizi SN, Templeton DJ, Grulich AE (2012) Anal human papillomavirus infection and associated neoplastic lesions in men who have sex with men: a systematic review and meta-analysis. Lancet Oncol 13:487–500. doi: 10.1016/S1470-2045(12)70080-3

  • Mahmud A, Poon R, Jonker D (2017) PET imaging in anal canal cancer: a systematic review and meta-analysis. Br J Radiol 90:20170370. doi: 10.1259/bjr.20170370

  • Moureau-Zabotto L, Vendrely V, Abramowitz L, Borg C, Francois E, Goere D, Huguet F, Peiffert D, Siproudhis L, Ducreux M, Bouché O (2017) Anal cancer: French Intergroup Clinical Practice Guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SNFCP). Digestive and Liver Disease 49:831–840. doi: 10.1016/j.dld.2017.05.011

  • National Comprehensive Cancer Network (2016) NCCN Clinical Practice Guidelines in Oncology - Anal Cancer. Accessed 20 Sep 2017

  • Nigro ND (1984) An evaluation of combined therapy for squamous cell cancer of the anal canal. Dis Colon Rectum 27:763–766

    Google Scholar 

  • Nigro ND, Vaitkevicius VK, Considine B (1993) Combined therapy for cancer of the anal canal: a preliminary report. 1974. Dis Colon Rectum 36:709–711

    Google Scholar 

  • Northover J, Glynne-Jones R, Sebag-Montefiore D, James R, Meadows H, Wan S, Jitlal M, Ledermann J (2010) Chemoradiation for the treatment of epidermoid anal cancer: 13-year follow-up of the first randomised UKCCCR Anal Cancer Trial (ACT I). Br J Cancer 102:1123–1128. doi: 10.1038/sj.bjc.6605605

  • Palefsky JM, Giuliano AR, Goldstone S, Moreira ED, Aranda C, Jessen H, Hillman R, Ferris D, Coutlee F, Stoler MH, Marshall JB, Radley D, Vuocolo S, Haupt RM, Guris D, Garner EIO (2011) HPV vaccine against anal HPV infection and anal intraepithelial neoplasia. N Engl J Med 365:1576–1585. doi: 10.1056/NEJMoa1010971

  • Peiffert D, Tournier-Rangeard L, Gérard J-P, Lemanski C, François E, Giovannini M, Cvitkovic F, Mirabel X, Bouché O, Luporsi E, Conroy T, Montoto-Grillot C, Mornex F, Lusinchi A, Hannoun-Lévi J-M, Seitz J-F, Adenis A, Hennequin C, Denis B, Ducreux M (2012) Induction chemotherapy and dose intensification of the radiation boost in locally advanced anal canal carcinoma: final analysis of the randomized UNICANCER ACCORD 03 trial. J Clin Oncol 30:1941–1948. doi: 10.1200/JCO.2011.35.4837

  • Renehan AG, Saunders MP, Schofield PF, O’Dwyer ST (2005) Patterns of local disease failure and outcome after salvage surgery in patients with anal cancer. Br J Surg 92:605–614. doi: 10.1002/bjs.4908

  • Shiels MS, Kreimer AR, Coghill AE, Darragh TM, Devesa SS (2015) Anal Cancer Incidence in the United States, 1977-2011: Distinct Patterns by Histology and Behavior. Cancer Epidemiol Biomarkers Prev 24:1548–1556. doi: 10.1158/1055-9965.EPI-15-0044

  • Smulian AG, Moore DM, Robertson JC, Kralovic SM (2014) Phase I study demonstrates safety and tolerability of radiofrequency ablation (RFA) of the anal mucosa. HIV Clin Trials 15:36–44. doi: 10.1310/hct1501-36

  • Spithoff, Cummings, Jonker, Biagi, Gastrointestinal Cancer Disease Site Group (2014) Management of Squamous Cell Cancer of the Anal Cancer. In: Cancer Care Ontario. Accessed 27 Jan 2018

  • Steele SR, Varma MG, Melton GB, Ross HM, Rafferty JF, Buie WD, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons (2012) Practice parameters for anal squamous neoplasms. Dis Colon Rectum 55:735–749. doi: 10.1097/DCR.0b013e318255815e

  • Sunesen KG, Buntzen S, Tei T, Lindegaard JC, Nørgaard M, Laurberg S (2009) Perineal healing and survival after anal cancer salvage surgery: 10-year experience with primary perineal reconstruction using the vertical rectus abdominis myocutaneous (VRAM) flap. Ann Surg Oncol 16:68–77. doi: 10.1245/s10434-008-0208-4

  • UK Co-ordinating Committee on Cancer Research (1996) Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet 348:1049–1054

    Google Scholar 

  • Wilkinson JR, Morris EJA, Downing A, Finan PJ, Aravani A, Thomas JD, Sebag-Montefiore D (2014) The rising incidence of anal cancer in England 1990-2010: a population-based study. Colorectal Dis 16:O234-239. doi: 10.1111/codi.12553

Download references

Author information

Authors and Affiliations


Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature

About this chapter

Cite this chapter

Bork, U., Weitz, J. (2018). Analkarzinom. In: Germer, CT., Keck, T., Grundmann, R.T. (eds) Evidenzbasierte Viszeralchirurgie maligner Erkrankungen. Evidenzbasierte Chirurgie. Springer, Berlin, Heidelberg.

Download citation

  • DOI:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-56532-2

  • Online ISBN: 978-3-662-56533-9

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics