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World J Gastroenterol. Sep 28, 2014; 20(36): 13052-13059
Published online Sep 28, 2014. doi: 10.3748/wjg.v20.i36.13052
Anal squamous cell carcinoma: An evolution in disease and management
Marc C Osborne, Justin Maykel, Eric K Johnson, Scott R Steele
Marc C Osborne, University of Minnesota, Minneapolis, MN 55415, United States
Justin Maykel, University of Massachusetts Memorial Medical Center, Worcester, MA 01609, United States
Eric K Johnson, Scott R Steele, Department of Surgery, Madigan Army Medical Center, Tacoma, WA 98431, United States
Author contributions: Osborne MC, Maykel J, Johnson EK, and Steele SR all contributed equally to this work; Osborne MC and Steele SR designed the review; Osborne MC, Maykel J, Johnson EK, and Steele SR contributed to the construction and critical revision of the paper.
Correspondence to: Scott R Steele, MD, FACS, FASCRS, Chief, 9040a Fitzsimmons Dr Department of Surgery, Madigan Army Medical Center, Tacoma, WA 98431, United States. harkersteele@mac.com
Telephone: +1-253-9682200 Fax: +1-253-9685900
Received: March 3, 2014
Revised: April 14, 2014
Accepted: May 26, 2014
Published online: September 28, 2014
Processing time: 212 Days and 12.4 Hours
Abstract

Anal cancer represents less than 1% of all new cancers diagnosed annually in the United States. Yet, despite the relative paucity of cases, the incidence of anal cancer has seen a steady about 2% rise each year over the last decade. As such, all healthcare providers need to be cognizant of the evaluation and treatment of anal squamous cell carcinoma. While chemoradiation remains the mainstay of therapy for most patients with anal cancer, surgery may still be required in recurrent, recalcitrant and palliative disease. In this manuscript, we will explore the diagnosis and management of squamous cell carcinoma of the anus.

Keywords: Anal cancer; Squamous cell cancer; Nigro protocol; Anal intraepithelial neoplasia; Chemoradiation therapy; Anal neoplasm; Radiotherapy; Cancer screening; Drug therapy

Core tip: Despite advances in the diagnosis and management, we continue to see a steady rise in the incidence of anal squamous cell cancer. The management of anal cancer has evolved from mandatory surgery to sphincter preserving therapy and is now entering an era of screening and prevention. Chemoradiotherapy remains the primary therapy for anal cancer. Anal Pap smear and high-resolution anoscopy are emerging technologies for identification of precancerous lesions. A high index of suspicion and knowledge of the relevant anatomy and pathophysiology are essential to identify at risk group, avoid missed diagnosis, and provide proper counseling.