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Anal cancer

Last updated: December 14, 2019

Summary

Anal cancer is a rare tumor. Risk factors include infection with human papillomavirus (HPV), immunodeficiency, and receptive anal intercourse. The most common clinical features are rectal bleeding (up to 45% of cases), pruritus ani, and tenderness or pain in the anal area. Anal cancer presents mainly as squamous cell carcinoma and in rare cases as adenocarcinoma or other non-epidermoid cancers. Depending on the exact localization and stage, it requires excision and/or radiochemotherapy. If the condition is treated in its early stages, the prognosis is favorable.

Epidemiology

References:[1][2]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References:[2]

Clinical features

  • Rectal bleeding (most important initial symptom)
  • A lump or tumor around the anus
  • Pruritus ani
  • Tenderness, pain in the anal area
  • Fecal incontinence
  • History of anorectal condyloma

References:[2]

Diagnostics

References:[2]

Pathology

References:[2][3]

Treatment

References:[2]

Complications

  • Metastasis
    • Local invasion of adjacent organs
    • Lymphatic spread (30% of patients): perirectal, paravertebral, inguinal, femoral
    • Hematogenous spread (< 10% of patients): liver, bone, lung

References:[4]

We list the most important complications. The selection is not exhaustive.

References

  1. Ryan DP, Willett CG, Goldberg RM, Savarese DMF. Clinical features, staging, and treatment of anal cancer. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-features-staging-and-treatment-of-anal-cancer?source=machineLearning&search=anal%20cancer&selectedTitle=1~98&anchor=H34§ionRank=2#H34.Last updated: October 25, 2016. Accessed: December 6, 2016.
  2. What is anal cancer?. http://www.cancer.org/cancer/analcancer/detailedguide/anal-cancer-what-is-anal-cancer. Updated: April 9, 2014. Accessed: December 5, 2016.
  3. Siegel RL, Miller KD, Ahmedin J. Cancer statistics, 2016. CA: A Cancer Journal for Clinicians. 2016; 66 : p.7-30. doi: 10.3322/caac.21332 . | Open in Read by QxMD
  4. Metastatic patterns of anal cancer. http://oncolex.org/Anal-cancer/Background/MetastaticPattern.aspx. Updated: August 22, 2014. Accessed: December 6, 2016.