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Anorectal cancer
Last reviewed: 23.04.2024
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Most often, anorectal cancer is represented by adenocarcinoma. Squamous cell (nonkeratinizing epithelial or basal cell) carcinoma of the anorectal zone accounts for 3-5% of cancerous lesions of the distal colon.
Less common are basal cell carcinoma, Bowen's disease (intradermal carcinoma), extramammary Paget's disease, cloacogenic carcinoma, and malignant melanoma. Other tumors include lymphoma and various forms of sarcoma. Metastasis occurs via the lymphatic pathways of the rectum and to the inguinal lymph nodes.
[ What causes anorectal cancer?
Risk factors include human papillomavirus (HPV) infection, chronic fistulas, anal skin irradiation, leukoplakia, lymphogranuloma venereum, and genital warts. Homosexual men who engage in anal intercourse are at increased risk. Patients with HPV infection may have dysplasia in mildly abnormal or apparently normal anal epithelium ("anal intraepithelial neoplasia," histologic type I, II, or III). These changes are more common in HIV-infected patients, especially homosexual men. At higher grades, progression to invasive carcinoma occurs. It is unknown whether early recognition and eradication of infection improve long-term outcome; therefore, screening recommendations are uncertain.
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Treatment of anorectal cancer
Wide local excision is often satisfactory for perianal carcinoma. Combined radiation and chemotherapy result in a high cure rate for squamous cell anal and cloacogenic tumors. If radiation and chemotherapy do not result in complete tumor regression and there is no metastasis outside the irradiated area, abdominoperineal resection is indicated.
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