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Updated: Dec 27 2021

Anal Cancer

  • 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
    • 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
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