Background 1. Incidence Anal canal cancer is a relatively rare tumor, representing approximately 1.
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- Cancerul de canal anal - aspecte legate de diagnostic și tratament
It is approximately 20 to 30 times rarer than colon cancer, but its annual incidence is increasing, reaching up to cases, with a female predominance 2. There is an important geographic variation regarding its incidence, as well as histopathological type.
The mainstay of the treatment is represented by chemo-radiotherapy, radical surgery being reserved to residual tumor or recurrences. Table 1; AJCC staging for anal cancer 2. Histopathology Depending on the lining epithelium, anal canal is divided into three regions: colorectal zone: located proximally and containg columnar epithelium; transitional zone: spread over a distance that varies between 0 and 12 mm that contains a pseudostratified type of epithelium resembling the urothelial one.
A transformation zone is unanimously accepted in uterine cancer. This region of metaplasia is extremely susceptible to HPV action 4 ; squamous zone: contains a non-keratinized epithelium, without hair follicles. Leiomyosarcomas, lymphomas and small cell carcinomas similar in terms of evolution and prognosis to lung small cell carcinomasundifferentiated carcinoma or anal Papilloma squamous metaplasia - only 17 cases described in literature up to 7 - have also been reported. Concerning anal margin neoplasia, these are represented by: Bowen disease in situ squamous-cell carcinoma ; invasive squamous-cell carcinoma; Paget disease; basal cell carcinoma: an extremely rare tumor, approximately 20 cases having papilloma squamous metaplasia reported in 20 years 28that is of good prognostic.
The treatment consists in ample local resection or rectal amputation in case of sphincter invasion. Papilloma squamous metaplasia staging Anal cancer staging is based on tumor dimension, papilloma squamous metaplasia node status and presence or absence of papilloma squamous metaplasia metastases. The risk of lymph node metastases is correlated with tumor size, invasion and grading.
Risk factors Benign perianal pathology - perianal fissures and fistulas determine a chronic local inflammation that can lead to genetic alterations and have been incriminated as being etiologic factors. However, recent studies did not show a significant correlation between this pathology and the development of anal carcinoma papilloma squamous metaplasia.
Sexual activity - according to a study lead by Daling, patients with anal cancer had genital papillomatosis, type II HSV and Chlamydia trachomatis infections in their medical history. In the case of male patients, homosexuality, bisexuality, history papilloma squamous metaplasia genital papilomatosis or gonorrhea have been associated to a higher risk of anal cancer 9.
Another study, published inadds to the risk papilloma squamous metaplasia, for females: history of gonorrhea, uterine cervix dysplasia, more than 10 sexual partners, anal sexual intercourse; for male patients: syphilis is another risk factor HPV infection - it is the widest spread sexually transmitted infection in Europe Anal HPV infection can be clinically inapparent or it may manifest as condyloma.
Of all HPV subtypes, subtype 16 is the most frequently incriminated as carcinogen. Viral transmission is not influenced by the use of condoms as it is localized at the base of papilloma squamous metaplasia penis and scrotum. Cigarette smoking - a study conducted in the papilloma squamous metaplasia s highlighted a relative risk of 1. Carcinogenesis associated to cigarette smoking can be linked to an anti-androgenic effect of tobacco. HIV infection - some studies showed an increase in anal canal cancer in seropositive patients.
The severity and length of HPV infection are inversely proportional correlated to CD4 lymphocyte number. Immunocompromised patients, either due to HIV infection or to post-transplantation status or chemotherapy, have an increased risk of HPV infection and progression to squamous cell carcinoma Anatomy Surgical anal canal spreads from ano-rectal ring 2 cm papilloma squamous metaplasia the dentate line to the external anal orifice.
Anal cancer must be distinguished from anal margin neoplasia that papilloma squamous metaplasia from the skin that presents perianal hair.
Some authors consider a 5 cm distance from the external anal orifice as the lateral limit The correct classification of perianal neoplasia into the two mentioned categories is extremely important as those of anal margin are of better prognosis. Altogether, an erroneous classification could overestimate the role of radio-chemotherapy Pectinate line represents an extremely important landmark for the vascularization and lymph node drainage.
Thus, above this line, venous drainage is to the portal circulation, by way of inferior mesenteric vein and below venous blood drains into systemic circulation through pudendal and hypogastric veins. Papilloma squamous metaplasia the pectinate line lymphatics drain into the inferior mesenteric, but also to hypogastric and obturatory lymph nodes, while below pectinate line-especially to inguinal lymph nodes, but also to femoral ones Papilloma squamous metaplasia to the resemblance to benign perianal pathology, the diagnosis is too often delayed.
Clinical examination consists in the inspection of perianal skin, anal margin, rectal examination and anoscopy and should indicate tumor localization above or below the pectinate line or its pertaining to anal margin.
Citologia cervicală asc-h - o provocare diagnostică
Bilateral inguinal region palpation is mandatory due to the lymphatic drainage to those lymphatic groups. Echo-endoscopy points our eventual loco-regional lymphadenopathies and gynecologic examination can indicate the coexistence of a uterine cervix lesion. The diagnostic of certainty is based on histopathologic examination. Bioptic samples can papilloma squamous metaplasia easily obtained with the patient in gynecological position; however, colonoscopy with exploration up to the cecum is obligatory to exclude eventual synchronous lesions.
As with other paraclinical investigations, a CT examination of the thorax, abdomen and pelvis or an MRI is recommended to point out possible secondary tumors. Untill the s, standard treatment consisted in abdominoperineal rectal amputation. For patients having small lesions, a large local excision has been proposed, accompanied however by disappointing results, excepting patients with a smaller than 2 que es el papiloma anal margin cancer Abdominoperineal rectal amputation is the standard salvage therapy for patients who develop local recurrences.
Tumor invasion into neighboring organs is not a papilloma squamous metaplasia of resection, provided a R0 resection is achieved.
Material and method: Sixty patients were included in our study. All of the patient underwent colposcopy-guided biopsy to asses the grade of CIN. For the immunohistochemistry exam we used p16INK4A and Ki antibody and their expression was semiquantitatively classified in 4 classes: 0, 1, 2 and 3. Results: 7 of our cases were benign Cancer burden in the year
This fact has lead to the use of rotated or advanced musculocutaneous papilloma squamous metaplasia to ameliorate the healing process. Provided the pelvic disease is controlled, papilloma squamous metaplasia liver or lung metastases have indications for surgical resection. Due to significant morbidity and the relatively low impact on papilloma squamous metaplasia, prophylactic inguinal lymphadenectomy is not recommended Papilloma squamous metaplasia lymphadenectomy is indicated for patients with voluminous lymphatic blocks or to those with an obvious lymphadenopathy after papilloma squamous metaplasia Some authors papilloma squamous metaplasia for synchronous lymphadenopathies inguinal lymphadenectomy with chemo- and radiotherapy following the healing of the wound.
Cancerul de canal anal - aspecte legate de diagnostic și tratament
For metachronous lymphadenopathies, the treatment consists of lymphadenectomy followed by radiotherapy. The complications of the intervention consist in: wound dehiscence, hematomas, seromas, lymphoceles and lymphedema. Cancer statistics, CA Cancer J Clin ; 2. CA Cancer J Clin ; International Agency for Research on Cancer.
Cancer incidence in five continents. Springer Philadelphia: Lippincott Raven; Malignant tumors of the anal canal: the spectrum of disease, treatment, and outcomes.
Atypical squamous cells cannot exclude high grade squamous intraepithelial lesion ASC-Ha recognized category in the Bethesda Nomenclature System for cervical cytology. Limited follow-up data are available on patients with this cervical cytology results. ASC-H is a large umbrella of citologic anomalies that can hide papilloma squamous metaplasia severe cervical lesion or an atrofic or an inflammatory modification with no special signification. Further investigation procedures are necesary to decide the diagnosis and the therapeutic management. A retrospective evaluation papilloma squamous metaplasia data from a total of Pap tests that were performed at our institution from 1.
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Declety G - Cancer de canal anal in Les cancers digestifs. Springer, Detection of human papillomavirus DNA in anal intraepithelial neoplasia and anal cancer. Cancer Res Am J Epidemiol. Tobacco smoking as a risk factor papilloma squamous metaplasia anal carcinoma: an antiestrogenic mechanism?
Mullerat J, Northover J. Human papilloma virus and anal neoplastic lesions in the immunocompromised Transplant patient. Semin Colon Rectal Surg ; Results of definitive irradiation in a series of epidermoid carcinomas of the anal canal. Management of inguinal papilloma squamous metaplasia node metastases in patients with carcinoma of the anal canal: experience in a series of patients treated in Lyon papilloma squamous metaplasia review of the literature.
Cancer ; Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. Lancet ; Anal carcinoma: histology, papilloma squamous metaplasia, epidemiology, treatment. Curr Opin Oncol ; Surgical management of epidermoid carcinoma of the anus. Am J Surg. Salvage abdomino-perineal resection after failed Nigro protocol: modest succes, major morbidity.
Colorectal Dis. Salvage abdominoperineal resection following combined chemotherapy and radiotherapy for epidermoid carcinoma of the anus. Ann Surg Oncol ; 1: