Updated: 10/28/2019

Anal Cancer

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Snapshot
  • A 42-year-old woman presents to her primary care physician for rectal bleeding. She cannot identify a clear cause to her symptoms. She has noticed it being associated with constant pain. She has a medical history of HIV and condyloma acuminatum. Physical examination is notable for a mass arising from the anus.
Introduction
  • Overview
    • the anal mucosa is comprised of 3 histological types
      • glandular (proximal anus)
        • can give rise to adenocarcinoma
      • transitional
        • can lead to squamous cell carcinoma (SCC)
      • squamous (distal anus)
        • can lead to SCC
    • SCC is the most common anal cancer
  • Epidemiology
    • risk factors
      • female gender
      • HPV
      • HIV
      • increased lifetime number of sexual partners
      • cigarette smoking
      • receptive anal intercourse
  • Associated conditions
    • HIV
    • condyloma acuminatum
Presentation
  • Symptoms
    • rectal bleeding
      • most common initial symptom
    • anorectal pain
    • pruritus ani
  • Physical exam
    • anorectal mass 
Studies
  • Sigmoidoscopy or anoscopy
    • indication
      • used to obtain a biopsy of the area for a histological diagnosis
Differential
  • Hemorrhoids
    • differentiating factors
      • painless rectal bleeding
  • Anal fissure
    • differentiating factors
      • pain that is exacerbated by defecation
      • longitudinal tear in the anoderm
Treatment
  • Treatment is dependent on the stage of the malignancy
  • Medical
    • chemotherapy
      • indication
        • metastatic anal cancer
      • comments
        • can be combined with radation
  • Surgical
    • local excision
      • indication
        • well-differentiated lesion without lymph node involvement
Complications
  • Metastasis

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