Anal squamous cell carcinoma: An evolution in disease and management

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.