-          carcinoma of the anus is a rare disease

-          has been linked to papillomavirus infection

-          histologically, it is most often

·         spinocelular carcinoma (70%).

·         The basaloid variant (cloacogenic tumor) is less common 

·         mucoepieloid

·         adenocarcinomas of anal region are rare. If they are diagnosed, their treatment follows the procedures for rectal cancer therapy.

risks

Women with 10 or more sexual partners have a higher risk of disease (OR 4.9)

partners and anal sex practitioners; and women with a history of herpesvirus or Chlamydia trachomatis infections. Papillomavirus DNA was detected in 88% of anal tumors, but viral DNA was not found in rectal adenocarcinomas.  The risk of becoming ill is up to 100 times higher in long-term immunosuppressed persons, e.g. after organ transplantation. Smoking increases the risk of anal cancer 2-5 times

diagnostics

- Medical history and physical examination, including per rectum!!

- Anoscopy and rectoscopy with biopsy

- Ultrasound of the rectum (with possible biopsy in case of unclear findings)

- CT scan of the abdomen and pelvis

- Transrectal sonography (TRUS) and MRI - to diagnose local spread

- X-ray/CT lung - to exclude dissemination

- Gynecological examination in women - infiltration of the rectovaginal septum and vaginal wall

- Basic haematological and biochemical examination

- Colonoscopy

- tumor markers level (CEA, Ca19-9, SCC)

classification

According to its relationship to the linea dentata, anatomical carcinoma of the anus is grouped into:

- carcinoma of the anal verge (aborally from the linea dentata), classified as skin tumors

- carcinoma of the anal canal (from the linea dentata orally)

The regional nodes are the perirectal, internal iliac and inguinal nodes.

patologic pTNM classification

T – tumour size, N – number of affected nodes and M metastases present

treatment

- surgical – excision with sufficient margin for small circumscribed lesions, abdominoperineal resection for advanced lesions, exenteration of the small pelvis

- radiotherapy, dose 45 Gy, possibly +- CHT

- concomitant chemoradiotherapy

- radiotherapy alone if CHT is contraindicated