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Surg Oncol. 2013 Dec;22(4):230-7. doi: 10.1016/j.suronc.2013.08.002. Epub 2013 Aug 26.

A systematic review of anal squamous cell carcinoma in inflammatory bowel disease.

Author information

1
Division of Surgery and Cancer, Chelsea and Westminster Campus, Imperial College London, UK; Department of Colorectal Surgery, The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.

Abstract

AIM:

The aim of this systematic review was to determine the incidence, aetiology and clinical characteristics of anal squamous cell carcinomas (SCC) presenting in patients with inflammatory bowel disease.

METHOD:

A systematic review of the literature was undertaken using Medline, Embase, Cochrane and Web of Science.

RESULTS:

A total of 33 cases of anal SCC were described, 7 in ulcerative colitis (UC) and 26 in Crohn's disease (CD). The annual incidence of anal SCCs was 0.9/100,000 and 2.0/100,000 in patients with UC and CD respectively. The gender ratio in CD was 3M:17F with a median age of 42 years, the main presenting symptom was anal pain and 85% of CD cases had peri-anal disease. No studies described anal intra-epithelial neoplasia. The human papilloma virus was found to be positive in 2 out of 5 (40%) cases. The majority of patients (73%) with CD received radical surgery as their first line treatment. The cumulative overall and disease free survival in CD was 37 per cent at five years.

CONCLUSION:

The findings of this review when contrasted with the data from cancer registries suggests that there is a higher incidence of anal SCC, an earlier age of presentation and poorer outcomes in patients with Crohn's disease compared to the general population implying a more aggressive neoplastic process. This review supports the hypothesis that peri-anal disease plays a contributing role in anal SCCs and as such targeted surveillance in patients with longstanding peri-anal disease should be considered.

KEYWORDS:

Anal cancer; Anal squamous cell carcinoma; Crohn's disease; Inflammatory bowel disease; Ulcerative colitis

PMID:
24050823
DOI:
10.1016/j.suronc.2013.08.002
[Indexed for MEDLINE]

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