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English KJ. Anal carcinoma - exploring the epidemiology, risk factors, pathophysiology, diagnosis, and treatment. World J Exp Med 2024; 14:98525. [PMID: 39312693 PMCID: PMC11372733 DOI: 10.5493/wjem.v14.i3.98525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/15/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024] Open
Abstract
Anal carcinoma is a relatively rare tumor that accounts for approximately 2% of gastrointestinal malignancies and less than 7% of anorectal cancers. Most anal tumors originate between the anorectal junction and the anal verge. Risk factors for the disease include human papillomavirus infection, human immunodeficiency virus, tobacco use, immunosuppression, female sex, and older age. The pathogenesis of anal carcinoma is believed to be linked to human papillomavirus-related inflammation, leading to dysplasia and progression to cancer. Squamous cell carcinoma is the most common type of anal tumor, with an annual incidence of approximately 1 to 2 per 100000 persons. Treatment regarding anal cancer has emerged over time. However, chemoradiation therapy remains the mainstay approach for early localized disease. Patients with metastatic disease are treated with systemic therapy, and salvage surgery is reserved for disease recurrence following chemoradiation. This article aims to provide background information on the epidemiology, risk factors, pathology, diagnosis, and current trends in the management of anal cancer. Future directions are briefly discussed.
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Affiliation(s)
- Kevan J English
- Department of Medicine, Division of Gastroenterology & Hepatology, Saint George’s University School of Medicine, Saint George 33334, Saint George, Grenada
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English K, Erpelding M, Kaldas S, Semoin S. A case of a rare type of cancer: Anal squamous cell carcinoma in a patient without significant risk factors. Qatar Med J 2024; 2024:7. [PMID: 38362253 PMCID: PMC10867331 DOI: 10.5339/qmj.2024.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/11/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Anal carcinoma is a relatively uncommon tumor that accounts for less than 2% of large bowel malignancies and approximately 1-6% of anorectal tumors. Most anal cancers originate in the mucosa between the anorectal junction and the anal verge. Risk factors for anal carcinoma include human papillomavirus (HPV), immunosuppression, older age, female gender, and smoking. Approximately 85% of anal cancers are squamous cell carcinoma, and the pathophysiology is believed to be linked to HPV-related inflammation, leading to dysplasia and progression to cancer. CASE PRESENTATION We present the case of a 65-year-old woman who sought medical attention at the emergency department (ED) due to rectal pain and concurrent rectal lesions persisting for the past three months. Before admission, she reported abdominal discomfort and constipation for 2-3 months, during which she took laxatives for relief. Laboratory findings in the ED were significant for anemia and leukocytosis, with all other values within normal limits. Blood tests, including antibodies for HPV and human immunodeficiency virus, were negative. A computed tomography scan of the abdomen and pelvis was largely unremarkable. On physical examination, perianal lesions with heaped-up edges were observed. A punch biopsy was subsequently performed, revealing squamous cell carcinoma (SCC). About three weeks following discharge, after one week of admission to the general medicine ward, the patient started chemoradiation therapy and reported some improvement in her symptoms. Seven weeks later, she was in remission. DISCUSSION Squamous cell carcinoma (SCC) of the anus, a rare disease entity, is often a slow and progressive malignancy. The length of time for patients to become symptomatic, in combination with its mimicking clinical presentation to common gastrointestinal tract diseases and its rarity, makes diagnosis challenging. Additionally, a patient lacking traditional risk factors for anal cancer, such as HPV and smoking, may further complicate diagnosis, treatment, and quality of life. CONCLUSION This case report emphasizes the pathogenesis and the similarities in clinical presentation of anal cancer to mild diseases, which may lead to a delay in diagnosis. Patients with anal carcinoma often delay seeking medical care, which is anecdotal in relation to the considerable overlap in symptoms of benign diseases such as hemorrhoids. Therefore, patients with "hemorrhoid" complaints, rectal bleeding, or rectal mass should warrant further physical examination and prompt referral to a gastroenterologist or a colorectal surgeon for additional evaluation.
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Affiliation(s)
- Kevan English
- Department of Surgery, St. George's University School of Medicine, Saint George, Grenada ORCID iD: 0009-0006-8893-5696
| | - Mercedes Erpelding
- Department of Surgery, Ross University School of Medicine, Bridgetown, Barbados
| | - Sandra Kaldas
- Department of Surgery, Ross University School of Medicine, Bridgetown, Barbados
| | - Sabrine Semoin
- Department of Surgery, Jackson North Medical Center, Miami, Florida, USA
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Sirikurnpiboon S. The risk factors for failure and recurrence of LIFT procedure for fistula in ano. Turk J Surg 2023; 39:27-33. [PMID: 37275932 PMCID: PMC10234717 DOI: 10.47717/turkjsurg.2023.5807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 01/23/2023] [Indexed: 06/07/2023]
Abstract
Objectives Fistula in ano (FIA) is a common anorectal problem. There are several techniques that have been used for treatment; however, all of them carry risks of recurrence and incontinence. Ligation intersphincteric fistula tract (LIFT) is a type of treatment with a promising result of preserving the anal sphincter function. This study aimed to evaluate the outcome and risk factor of LIFT failure and to demonstrate the pattern of recurrence. The research funding was supported by Rajavithi Hospital. Material and Methods From January 2015 to January 2020, there were 250 cases of fistula in ano operations. A total of 148 patients underwent LIFT operation. The patients' average age was 39.72 ± 10.55 years and the average follow-up period was 111.86 ± 79.73 days. The average time to diagnose the recurrence was 99.12 ± 30.08 days. In addition, average time to perform a surgery after the diganosis was 64.67 ± 25.76 days. The study's analyses used data on age, sex, type of fistula, operative intervention, healing time, reinterventions, and recurrence. Results There were 22.97% of recurrence among 148 LIFT patients. Half of the patients who underwent the operation had a preoperative imaging study with MRI or endoanal ultrasonography in the first time due to the complexity of the disease. Factors associated with operation failure were collection, fistula tract size more than 5 millimeters, and the failure of ligating the tract in one attempt. Conclusion LIFT procedure is one of the several sphincter saving procedures to treat FIA. Recurrence is related with the complexity of the disease. Most of the recurrence is diseases that are easier to treat, such as performing a re-operation or fistulotomy.
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Affiliation(s)
- Siripong Sirikurnpiboon
- Clinic of Colorectal Surgery, Rajavithi Hospital, Rangsit University College of Medicine, Bangkok, Thailand
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Influence of radiation treatment technique (IMRT vs. 3D-RT) on acute toxicity and prognostic factors for survival for anal cancer. Sci Rep 2022; 12:19914. [PMID: 36402828 PMCID: PMC9675840 DOI: 10.1038/s41598-022-24362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022] Open
Abstract
We compared our institutional experience with intensity-modulated radiotherapy (IMRT) and 3D-conformal radiotherapy (3D-RT) for definitive treatment of primary anal cancer. We performed a single-institution retrospective review of all patients with anal squamous cell carcinoma treated with definitive (chemo) radiotherapy with curative intent from 2004 through 2018. We assessed several prognostic factors in respect to relevant survival endpoints. In addition, acute toxicities were determined and compared between IMRT and 3D-RT patients. This study included 94 patients (58 IMRT, 36 3D-RT). Mean follow up for all patients, for IMRT and 3D-RT patients was 61 months (range 6-176), 46 months (range 6-118), and 85 months (range 6-176), respectively. 5-year overall survival (OS) was 86%, disease-free survival (DFS) was 72%, and colostomy-free survival (CFS) was 75% in the IMRT cohort. In the 3D-RT cohort, OS was 87%, DFS was 71%, and CFS was 81% (all p > 0.05). Male gender and Karnofsky Index (KI) were revealed as independent prognostic factors for 5-year OS (p = 0.017; p = 0.023). UICC stage was an independent prognostic factor for DFS and CFS (p = 0.023; p = 0.042). In addition, the pre-treatment leukocyte count was an independent prognostic factor for CFS (p = 0.042). Acute grade ≥ 3 toxicity was not significantly different between IMRT and 3D-RT patients, but the IMRT cohort had favorable outcomes. This study confirmed IMRT as the primary definitive treatment of anal cancer. With similar survival rates, IMRT had the potential to reduce acute toxicity by sparing organs at risk. Promising prognostic factors such as BMI, KI, and leucocyte and hemoglobin levels should be further investigated.
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Rathi R, Sanshita, Kumar A, Vishvakarma V, Huanbutta K, Singh I, Sangnim T. Advancements in Rectal Drug Delivery Systems: Clinical Trials, and Patents Perspective. Pharmaceutics 2022; 14:2210. [PMID: 36297645 PMCID: PMC9609333 DOI: 10.3390/pharmaceutics14102210] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 07/30/2023] Open
Abstract
The rectal route is an effective route for the local and systemic delivery of active pharmaceutical ingredients. The environment of the rectum is relatively constant with low enzymatic activity and is favorable for drugs having poor oral absorption, extensive first-pass metabolism, gastric irritation, stability issues in the gastric environment, localized activity, and for drugs that cannot be administered by other routes. The present review addresses the rectal physiology, rectal diseases, and pharmaceutical factors influencing rectal delivery of drugs and discusses different rectal drug delivery systems including suppositories, suspensions, microspheres, nanoparticles, liposomes, tablets, and hydrogels. Clinical trials on various rectal drug delivery systems are presented in tabular form. Applications of different novel drug delivery carriers viz. nanoparticles, liposomes, solid lipid nanoparticles, microspheres, transferosomes, nano-niosomes, and nanomicelles have been discussed and demonstrated for their potential use in rectal administration. Various opportunities and challenges for rectal delivery including recent advancements and patented formulations for rectal drug delivery have also been included.
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Affiliation(s)
- Ritu Rathi
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India
| | - Sanshita
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India
| | - Alpesh Kumar
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India
| | | | | | - Inderbir Singh
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India
| | - Tanikan Sangnim
- Faculty of Pharmaceutical Sciences, Burapha University, Chonburi 20131, Thailand
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Radhakrishnan SJ, Goksu SY, Radhakrishnan SM, Beg MS, Sanford NN, Kazmi SM. Trends in utilization of first-line palliative treatments for anal squamous cell carcinoma. Cancer Med 2022; 12:3460-3467. [PMID: 36082966 PMCID: PMC9939099 DOI: 10.1002/cam4.5126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 07/10/2022] [Accepted: 07/21/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Anal squamous cell carcinoma patients often present with significant symptoms, including pain, bleeding, and obstructive symptoms. This requires palliation-directed therapy as a first-line treatment to alleviate symptoms. The proportion of patients receiving first-line palliative treatments is unknown. We aimed to study the factors associated with the use of first-line palliative treatments in stage II-IV anal squamous cell carcinoma patients. METHODS We used the National Cancer Database to identify adult patients diagnosed with stage II-IV anal squamous cell carcinoma between 2004 and 2016. We performed univariable and multivariable logistic regression analysis to determine the clinical and sociodemographic variables associated with the utilization of palliative treatment in the first-line setting, including palliative radiotherapy, chemotherapy, surgery, and pain management. RESULTS Among 16,944 patients diagnosed with stage II-IV anal squamous cell carcinoma, only a small proportion of 492 (2.9%) required first-line palliative treatments to control symptoms. The majority of these patients received palliative radiotherapy (32%), followed by palliative surgery (25%), palliative chemotherapy (19%), combination therapies (14%), and pain management (10%). On multivariable analysis, higher stage disease, lower income, Medicare and Medicaid insurance, and life expectancy <6 months were associated with higher odds of use of first-line palliative therapy. CONCLUSIONS First-line use of palliative treatments to control symptoms is needed in a small proportion of anal squamous cell cancer patients. It was utilized in all stages, but it was most frequently observed in patients with stage IV disease and patients with <6 months life expectancy. First-line palliative therapy was also more frequent in lower-income patients and patients with Medicare and Medicaid insurance which highlights the disparities in anal cancer management.
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Affiliation(s)
| | - Suleyman Y. Goksu
- Department of Internal MedicineUT Southwestern Medical CenterDallasTexasUSA,Department of Internal Medicine, Division of GeriatricsLoyola University Medical CenterHinesIllinoisUSA,Division of Hematology and OncologyUT Southwestern Medical CenterDallasTexasUSA
| | | | - Muhammad S. Beg
- Department of Internal MedicineUT Southwestern Medical CenterDallasTexasUSA,Division of Hematology and OncologyUT Southwestern Medical CenterDallasTexasUSA,Science 37DurhamNorth CarolinaUSA
| | - Nina N. Sanford
- Department of Radiation OncologyUT Southwestern Medical CenterDallasTexasUSA
| | - Syed M. Kazmi
- Department of Internal MedicineUT Southwestern Medical CenterDallasTexasUSA,Division of Hematology and OncologyUT Southwestern Medical CenterDallasTexasUSA
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Theophanous S, Lønne PI, Choudhury A, Berbee M, Dekker A, Dennis K, Dewdney A, Gambacorta MA, Gilbert A, Guren MG, Holloway L, Jadon R, Kochhar R, Mohamed AA, Muirhead R, Parés O, Raszewski L, Roy R, Scarsbrook A, Sebag-Montefiore D, Spezi E, Spindler KLG, van Triest B, Vassiliou V, Malinen E, Wee L, Appelt AL. Development and validation of prognostic models for anal cancer outcomes using distributed learning: protocol for the international multi-centre atomCAT2 study. Diagn Progn Res 2022; 6:14. [PMID: 35922837 PMCID: PMC9351222 DOI: 10.1186/s41512-022-00128-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anal cancer is a rare cancer with rising incidence. Despite the relatively good outcomes conferred by state-of-the-art chemoradiotherapy, further improving disease control and reducing toxicity has proven challenging. Developing and validating prognostic models using routinely collected data may provide new insights for treatment development and selection. However, due to the rarity of the cancer, it can be difficult to obtain sufficient data, especially from single centres, to develop and validate robust models. Moreover, multi-centre model development is hampered by ethical barriers and data protection regulations that often limit accessibility to patient data. Distributed (or federated) learning allows models to be developed using data from multiple centres without any individual-level patient data leaving the originating centre, therefore preserving patient data privacy. This work builds on the proof-of-concept three-centre atomCAT1 study and describes the protocol for the multi-centre atomCAT2 study, which aims to develop and validate robust prognostic models for three clinically important outcomes in anal cancer following chemoradiotherapy. METHODS This is a retrospective multi-centre cohort study, investigating overall survival, locoregional control and freedom from distant metastasis after primary chemoradiotherapy for anal squamous cell carcinoma. Patient data will be extracted and organised at each participating radiotherapy centre (n = 18). Candidate prognostic factors have been identified through literature review and expert opinion. Summary statistics will be calculated and exchanged between centres prior to modelling. The primary analysis will involve developing and validating Cox proportional hazards models across centres for each outcome through distributed learning. Outcomes at specific timepoints of interest and factor effect estimates will be reported, allowing for outcome prediction for future patients. DISCUSSION The atomCAT2 study will analyse one of the largest available cross-institutional cohorts of patients with anal cancer treated with chemoradiotherapy. The analysis aims to provide information on current international clinical practice outcomes and may aid the personalisation and design of future anal cancer clinical trials through contributing to a better understanding of patient risk stratification.
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Affiliation(s)
- Stelios Theophanous
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
| | - Per-Ivar Lønne
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Ananya Choudhury
- MAASTRO (Dept of Radiotherapy), GROW School of Oncology and Developmental Biology, Maastricht University and Maastricht University Medical Centre+, P. Debyelaan 25, 6229, Maastricht, Netherlands
| | - Maaike Berbee
- MAASTRO (Dept of Radiotherapy), GROW School of Oncology and Developmental Biology, Maastricht University and Maastricht University Medical Centre+, P. Debyelaan 25, 6229, Maastricht, Netherlands
| | - Andre Dekker
- MAASTRO (Dept of Radiotherapy), GROW School of Oncology and Developmental Biology, Maastricht University and Maastricht University Medical Centre+, P. Debyelaan 25, 6229, Maastricht, Netherlands
| | | | | | | | - Alexandra Gilbert
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Marianne Grønlie Guren
- Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lois Holloway
- Ingham Research Institute and Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | | | | | | | | | | | - Rajarshi Roy
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Andrew Scarsbrook
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | | | - Baukelien van Triest
- The Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, The Netherlands
| | | | - Eirik Malinen
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Leonard Wee
- MAASTRO (Dept of Radiotherapy), GROW School of Oncology and Developmental Biology, Maastricht University and Maastricht University Medical Centre+, P. Debyelaan 25, 6229, Maastricht, Netherlands
| | - Ane L Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Tekbaş A, Mothes H, Settmacher U, Schuele S. Non-mucinous adenocarcinomas and squamous cell carcinomas of the anal region masquerading as abscess or fistula: a retrospective analysis and systematic review of literature. J Cancer Res Clin Oncol 2022; 148:1509-1522. [PMID: 34338860 PMCID: PMC9114013 DOI: 10.1007/s00432-021-03747-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/26/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Abscess or fistula of the anal region is an uncommon presentation of malignancy. Under the assumption of a benign condition, diagnostics is often delayed, resulting in advanced tumour stages at first diagnosis. Due to the case rarity, treatment guidelines for cancers of anorectal region masquerading as abscess or fistula are missing. METHODS We analysed all patients presenting with an abscess or fistula of the anal region in our department between January 2004 and August 2020. The malignancies were included to our study to acquire data on clinical presentation, treatment and outcome. Furthermore, a systematic review to present adenocarcinomas and squamous cell carcinomas associated to an abscess or fistula was performed. RESULTS 0.5% of the patients treated for an abscess or fistula of the anal region met the selection criteria. Mean time from the onset of symptoms to diagnosis of malignancy was 100 days. Histology revealed adenocarcinoma and squamous cell carcinoma each in two patients. All patients had locally advanced tumours without distant metastases, in two cases with regional lymph-node metastases. Neoadjuvant chemoradiation was applied in two patients. All patients underwent abdomino-perineal resection of the rectum. The overall outcome reveals a recurrence-free survival of 4.5 and 3 years for two patients. Further two patients died within 5 months after the primary resection. CONCLUSION Advanced carcinomas of the anorectal region may masquerade as abscess or fistula, cause diagnostic problems and delay oncologic treatment. However, even in these very advanced situations, surgical therapy with curative intent should be attempted.
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Affiliation(s)
- Aysun Tekbaş
- Department of General, Visceral and Vascular Surgery, University Hospital of Jena, Jena, Germany.
- Research Programme "Clinician Scientist Programme", Interdisciplinary Center for Clinical Research, University of Jena, Jena, Germany.
| | - Henning Mothes
- Department of General, Visceral and Vascular Surgery, Sophien-und Hufeland-Klinikum gGmbH, Weimar, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, University Hospital of Jena, Jena, Germany
| | - Silke Schuele
- Department of General, Visceral and Vascular Surgery, University Hospital of Jena, Jena, Germany
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Koppula BR, Fine GC, Salem AE, Covington MF, Wiggins RH, Hoffman JM, Morton KA. PET-CT in Clinical Adult Oncology: III. Gastrointestinal Malignancies. Cancers (Basel) 2022; 14:cancers14112668. [PMID: 35681647 PMCID: PMC9179927 DOI: 10.3390/cancers14112668] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Positron emission tomography (PET), typically combined with computed tomography (CT), has become a critical advanced imaging technique in oncology. With PET-CT, a radioactive molecule (radiotracer) is injected in the bloodstream and localizes to sites of tumor because of specific cellular features of the tumor that accumulate the targeting radiotracer. The CT scan, performed at the same time, provides information to facilitate the characterization of radioactivity from deep or dense structures, and to provide detailed anatomic information. PET-CT has a variety of applications in oncology, including staging, therapeutic response assessment, restaging and surveillance. This series of six review articles provides an overview of the value, applications, and imaging interpretive strategies of PET-CT in the more common adult malignancies. The third report in this series provides a review of PET-CT imaging in gastrointestinal malignancies. Abstract PET-CT is an advanced imaging modality with many oncologic applications, including staging, assessment of response to therapy, restaging and longitudinal surveillance for recurrence. The goal of this series of six review articles is to provide practical information to providers and imaging professionals regarding the best use of PET-CT for specific oncologic indications, and the potential pitfalls and nuances that characterize these applications. In the third of these review articles, key tumor-specific clinical information and representative PET-CT images are provided to outline the role that PET-CT plays in the management of patients with gastrointestinal malignancies. The focus is on the use of 18F fluorodeoxyglucose (FDG), rather than on research radiopharmaceuticals under development. Many different types of gastrointestinal tumors exist, both pediatric and adult. A discussion of the role of FDG PET-CT for all of these is beyond the scope of this review. Rather, this article focuses on the most common adult gastrointestinal malignancies that may be encountered in clinical practice. The information provided here will provide information outlining the appropriate role of PET-CT in the clinical management of patients with gastrointestinal malignancies for healthcare professionals caring for adult cancer patients. It also addresses the nuances and provides interpretive guidance related to PET-CT for imaging providers, including radiologists, nuclear medicine physicians and their trainees.
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Affiliation(s)
- Bhasker R. Koppula
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (B.R.K.); (G.C.F.); (A.E.S.); (M.F.C.); (R.H.W.); (J.M.H.)
| | - Gabriel C. Fine
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (B.R.K.); (G.C.F.); (A.E.S.); (M.F.C.); (R.H.W.); (J.M.H.)
| | - Ahmed Ebada Salem
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (B.R.K.); (G.C.F.); (A.E.S.); (M.F.C.); (R.H.W.); (J.M.H.)
- Department of Radio Diagnosis and Intervention, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt
| | - Matthew F. Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (B.R.K.); (G.C.F.); (A.E.S.); (M.F.C.); (R.H.W.); (J.M.H.)
| | - Richard H. Wiggins
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (B.R.K.); (G.C.F.); (A.E.S.); (M.F.C.); (R.H.W.); (J.M.H.)
| | - John M. Hoffman
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (B.R.K.); (G.C.F.); (A.E.S.); (M.F.C.); (R.H.W.); (J.M.H.)
| | - Kathryn A. Morton
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (B.R.K.); (G.C.F.); (A.E.S.); (M.F.C.); (R.H.W.); (J.M.H.)
- Summit Physician Specialists, Intermountain Healthcare Hospitals, Murray, UT 84123, USA
- Correspondence: ; Tel.: +1-801-581-7553
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Selimagic A, Dozic A, Husic-Selimovic A, Tucakovic N, Cehajic A, Subo A, Spahic A, Vanis N. The Role of Inflammation in Anal Cancer. Diseases 2022; 10:27. [PMID: 35645248 PMCID: PMC9149845 DOI: 10.3390/diseases10020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this article was to present a summary of the current resources available in the literature regarding the role of inflammation in anal cancer development. Anal cancer is relatively uncommon, accounting for about 2.7% of all reported gastrointestinal cancers in the United States. However, the importance of understanding the pathogenesis and risk factors for anal cancer has been recognized over the last several decades due to a noticed increase in incidence worldwide. Infections, autoimmune diseases, and inflammatory diseases of unknown etiology cause chronic inflammation that promotes tumorigenesis. The association between chronic inflammation and cancer development is widely accepted. It is based on different pathophysiological mechanisms that lead to cellular transformation and changes in immunological response, allowing tumor cells to avoid apoptosis and immune surveillance. However, there are still many molecular and cellular mechanisms that remain largely unexplored. Further studies on this topic could be of tremendous significance in elucidating anal cancer pathogenesis and developing immunotherapeutic approaches for its treatment.
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Affiliation(s)
- Amir Selimagic
- Department of Gastroenterohepatology, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.H.-S.); (N.T.); (A.C.)
| | - Ada Dozic
- Department of Internal Medicine, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.D.); (A.S.); (A.S.); (N.V.)
| | - Azra Husic-Selimovic
- Department of Gastroenterohepatology, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.H.-S.); (N.T.); (A.C.)
| | - Nijaz Tucakovic
- Department of Gastroenterohepatology, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.H.-S.); (N.T.); (A.C.)
| | - Amir Cehajic
- Department of Gastroenterohepatology, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.H.-S.); (N.T.); (A.C.)
| | - Anela Subo
- Department of Internal Medicine, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.D.); (A.S.); (A.S.); (N.V.)
| | - Azra Spahic
- Department of Internal Medicine, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.D.); (A.S.); (A.S.); (N.V.)
| | - Nedim Vanis
- Department of Internal Medicine, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.D.); (A.S.); (A.S.); (N.V.)
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Hilmi M, Neuzillet C, Lefèvre JH, Svrcek M, Vacher S, Benhaim L, Dartigues P, Samalin E, Lazartigues J, Emile JF, Rigault E, Rioux-Leclercq N, de La Fouchardière C, Tougeron D, Cacheux W, Mariani P, Courtois L, Delaye M, Dangles-Marie V, Lièvre A, Bieche I. Prognostic Value of Fusobacterium nucleatum after Abdominoperineal Resection for Anal Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:1606. [PMID: 35406380 PMCID: PMC8997094 DOI: 10.3390/cancers14071606] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 01/25/2023] Open
Abstract
Main prognostic factors of anal squamous cell carcinoma (ASCC) are tumor size, differentiation, lymph node involvement, and male gender. However, they are insufficient to predict relapses after exclusive radiotherapy (RT) or chemoradiotherapy (CRT). Fusobacterium nucleatum has been associated with poor prognosis in several digestive cancers. In this study, we assessed the association between intratumoral F. nucleatum load and clinico-pathological features, relapse, and survival in patients with ASCC who underwent abdominoperineal resection (APR) after RT/CRT. We retrospectively analyzed surgical samples from a cohort of 166 patients with ASCC who underwent APR. F. nucleatum 16S rRNA gene sequences were quantified using real-time quantitative PCR. We associated F. nucleatum load with classical clinicopathological features, overall survival (OS), disease-free survival (DFS), and metastasis-free survival (MFS) using Cox regression univariate and multivariate analyses. Tumors harboring high loads of F. nucleatum (highest tercile) showed longer OS and DFS (median: not reached vs. 50.1 months, p = 0.01, and median: not reached vs. 18.3 months, p = 0.007, respectively). High F. nucleatum load was a predictor of longer OS (HR = 0.55, p = 0.04) and DFS (HR = 0.50, p = 0.02) in multivariate analysis. High F. nucleatum load is an independent favorable prognostic factor in patients with ASCC who underwent APR.
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Affiliation(s)
- Marc Hilmi
- Medical Oncology Department, Institut Curie, 92210 Saint-Cloud, France; (M.H.); (M.D.)
| | - Cindy Neuzillet
- Medical Oncology Department, Institut Curie, 92210 Saint-Cloud, France; (M.H.); (M.D.)
| | - Jérémie H. Lefèvre
- Digestive Surgery Department, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, 75012 Paris, France;
| | - Magali Svrcek
- Pathology Department, Hôpital Saint-Antoine, AP-HP, 75012 Paris, France;
| | - Sophie Vacher
- Genetics Department, Institut Curie, 75005 Paris, France; (S.V.); (L.C.); (I.B.)
| | - Leonor Benhaim
- Digestive Surgery Department, Gustave Roussy Institute, 94800 Villejuif, France;
| | - Peggy Dartigues
- Pathology Department, Gustave Roussy Institute, 94800 Villejuif, France;
| | - Emmanuelle Samalin
- Medical Oncology Department, Institut du Cancer de Montpellier (ICM), University of Montpellier, 34000 Montpellier, France;
| | - Julien Lazartigues
- Gastroenterology Department, Hôpital Ambroise Paré, AP-HP, 92100 Boulogne-Billancourt, France;
| | - Jean-François Emile
- Pathology Department, Hôpital Ambroise Paré, AP-HP, Université de Versailles SQY, 92100 Boulogne-Billancourt, France;
| | - Eugénie Rigault
- Gastroenterology Department, Rennes University Hospital, 35200 Rennes, France; (E.R.); (A.L.)
- Medical Oncology Department, Gustave Roussy Institute, 94800 Villejuif, France
| | | | | | - David Tougeron
- Department of Gastroenterology and Hepatology, Poitiers University Hospital, 86073 Poitiers, France;
| | - Wulfran Cacheux
- Medical Oncology Department, Hôpital Privé Pays de Savoie, 74000 Annemasse, France;
| | - Pascale Mariani
- Surgical Oncology Department, Institut Curie, 75005 Paris, France;
| | - Laura Courtois
- Genetics Department, Institut Curie, 75005 Paris, France; (S.V.); (L.C.); (I.B.)
| | - Matthieu Delaye
- Medical Oncology Department, Institut Curie, 92210 Saint-Cloud, France; (M.H.); (M.D.)
| | - Virginie Dangles-Marie
- Faculty of Pharmacy, Université de Paris, 75019 Paris, France;
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, PSL Research University, 75006 Paris, France
| | - Astrid Lièvre
- Gastroenterology Department, Rennes University Hospital, 35200 Rennes, France; (E.R.); (A.L.)
- Inserm U1242, COSS (Chemistry Oncogenesis Stress Signaling), Rennes 1 University, 35000 Rennes, France
| | - Ivan Bieche
- Genetics Department, Institut Curie, 75005 Paris, France; (S.V.); (L.C.); (I.B.)
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12
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Sauter C, Peeken JC, Borm K, Diehl C, Münch S, Combs SE, Dapper H. Quality of life in patients treated with radiochemotherapy for primary diagnosis of anal cancer. Sci Rep 2022; 12:4416. [PMID: 35292732 PMCID: PMC8924204 DOI: 10.1038/s41598-022-08525-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/04/2022] [Indexed: 11/12/2022] Open
Abstract
Anal cancer and the related treatment are generally known to affect patients’ quality of life. The aim of this study was to assess self-reported quality of life (QoL) of anal cancer patients after combined radiation and chemotherapy, and to identify patient-, disease-, and therapy-related factors associated with QoL. A total of 94 patients treated with definitive chemoradiation for anal cancer at our institution in the period from 2004 to 2018 were identified from our database. QoL was assessed in the remaining 52 patients using the EORTC QLQ-C30 questionnaire (cancer-specific QoL) and the newly developed anal cancer module QLQ-ANL27 (site-specific QoL). Differences in QoL between anal cancer patients and a German age and sex adjusted reference population were examined. The median follow-up was 71 months (range, 7–176). In the cancer-specific QoL module, the anal cancer cohort presented with significantly lower scores in role (− 12.2 points), emotional (− 6.6 points), and social functioning (− 6.8 points), but higher scores in diarrhea (+ 36.3 points) and constipation (+ 13.3 points) than the German reference population. There were no significant differences in disease- or therapy-related factors, but age greater than 70 years and a follow-up time greater than 71 months had a negative impact on global QoL. As for the site-specific QoL, patients with a tumor relapse showed significantly higher symptom scores than patients with a complete clinical remission in all scales except of micturition frequency. Compared to 3D conformal radiotherapy, IMRT treatment seemed to improve non-stoma bowel function (+ 23.3 points), female sexual functioning (+ 24.2 points), and came along with less scores in the symptom scales pain (− 35.9 points), toilet proximity (− 28.6 points), and cleanliness (− 26.2 points). Most of the functional scores of anal cancer patients were lower compared to the general German population, but did not seem to affect the general QoL. Fatigue, physical, and role functioning had the strongest impact on global QoL causing psychological symptoms as important as physical.
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Affiliation(s)
- Christina Sauter
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Jan C Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.,Institute for Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstr. 1, Neuherberg, Germany
| | - Kai Borm
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Diehl
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stefan Münch
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.,Institute for Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstr. 1, Neuherberg, Germany
| | - Hendrik Dapper
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
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13
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Katano A, Yamashita H. Definitive Radiotherapy for Patients With Anal Squamous Cell Carcinoma: A Retrospective Cohort Study. Cureus 2021; 13:e18732. [PMID: 34790484 PMCID: PMC8586789 DOI: 10.7759/cureus.18732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Anal squamous cell carcinoma accounts for less than 2-3% of all digestive system carcinomas. The present study aimed to determine the clinical characteristics, treatment patterns, and treatment outcomes of patients at our institution. Methodology We reviewed the clinical data of all consecutive patients with anal squamous cell carcinoma who were treated with definitive radiotherapy in our department between July 2009 and July 2020. Radiotherapy was delivered in 1.8-2 Gy daily fractions to a whole pelvic dose ranging from 45 to 50 Gy, followed by boost radiotherapy of 10-15 Gy, resulting in a total dose of approximately 60 Gy. Concurrent chemotherapy with radiotherapy included 5-fluorouracil/mitomycin C or 5-fluorouracil/cisplatin. Results A total of 14 patients with a median age of 61.5 years (range: 45-85 years) were analyzed. There were nine women and five men. The clinical T stage was T1 in two patients, T2 in six patients, T3 in two patients, and T4 in four patients. The clinical N stage was N0 in four patients and N1 in 10 patients. Patients with clinical stage III disease comprised 79% of the entire study population. For the entire cohort, the five-year overall survival rate was 83.3% and the five-year progression-free survival rate was 48.5%. One patient experienced grade 3 fecal incontinence, and the others experienced no radiation-induced severe delayed adverse events. Conclusions The results of our study demonstrated that definitive radiotherapy with or without chemotherapy for patients with anal squamous cell carcinoma is an effective and feasible treatment.
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Affiliation(s)
- Atsuto Katano
- Radiology, The University of Tokyo Hospital, Tokyo, JPN
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14
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Bushara O, Krogh K, Weinberg SE, Finkelman BS, Sun L, Liao J, Yang GY. Human Immunodeficiency Virus Infection Promotes Human Papillomavirus-Mediated Anal Squamous Carcinogenesis: An Immunologic and Pathobiologic Review. Pathobiology 2021; 89:1-12. [PMID: 34535611 DOI: 10.1159/000518758] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Anal squamous cell carcinoma (SCC) is a rare gastrointestinal malignancy with rising incidence, both in the United States and internationally. The primary risk factor for anal SCC is human papillomavirus (HPV) infection. However, there is a growing burden of disease in patients with human immunodeficiency virus (HIV) and HPV coinfection, with the incidence of anal SCC significantly increasing in this population. This is particularly true in HIV-infected men. The epidemiologic correlation between HIV-HPV coinfection and anal SCC is established; however, the immunologic mechanisms underlying this relationship are not well understood. SUMMARY HIV-related immunosuppression due to low circulating CD4+ T cells is one component of increased risk, but other mechanisms, such as the effect of HIV on CD8+ T lymphocyte tumor infiltration and the PD-1/PD-L1 axis in antitumor and antiviral response, is emerging as significant contributors. The goal of this article is to review existing research on HIV-HPV coinfected anal SCC and precancerous lesions, propose explanations for the detrimental synergy of HIV and HPV on the pathogenesis and immunologic response to HPV-associated cancers, and discuss implications for future treatments and immunotherapies in HIV-positive patients with HPV-mediated anal SCC. Key Messages: The incidence of anal squamous cell carcinoma is increased in human immunodeficiency virus (HIV)-infected patients, even in patients on highly active antiretroviral therapy. Locoregional HIV infection may enhance human papillomavirus oncogenicity. Chronic inflammation due to HIV infection may contribute to CD8+ T lymphocyte exhaustion by upregulating PD-1 expression, thereby blunting cytotoxic antitumor response.
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Affiliation(s)
- Omar Bushara
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katrina Krogh
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Samuel Edward Weinberg
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brian Steven Finkelman
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Leyu Sun
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jie Liao
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Guang-Yu Yang
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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15
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Inthasorn P, Wetpithayakom N, Laiwejpithaya S, Lohsiriwat V, Jaishuen A, Viriyapak B. Prevalence of Abnormal Anal Cytology in Women with Abnormal Cervical Cytology. Asian Pac J Cancer Prev 2021; 22:2165-2169. [PMID: 34319039 PMCID: PMC8607085 DOI: 10.31557/apjcp.2021.22.7.2165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/07/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence of abnormal anal cytology in women presenting with abnormal cervical cytology (intraepithelial lesion or cervical cancer) at the largest tertiary university hospital in Thailand. METHODS A cross-sectional prospective study design was used. Anal cytology was performed on 145 women with abnormal cervical cytology between June 2014-Octoble 2014. If abnormal anal cytology was detected, anoscopy was performed with biopsy in any suspicious area of precancerous change. RESULTS Prevalence of abnormal anal cytology was 5.5% (8 patients). Of 8 patients, six patients presented with low-grade squamous intraepithelial lesion, one patient with high-grade squamous intraepithelial lesion, and one with atypical squamous cell cannot exclude high-grade squamous intraepithelial lesion. Abnormal anoscopic impression was found in 3 cases, as follow: The first case showed faint acetowhite lesion and anoscopic impression was low grade squamous intraepithelial lesion; the second case was reported as human papillomavirus (HPV) change by anoscopic impression; and the third case showed dense acetowhite lesion with multiple punctation and pathologic examination showed anal intraepithelial neoplasm III (AIN3). The last patient underwent wide local excision of AIN3 with split-thickness skin graft reconstruction. Final pathology confirmed AIN3 with free resection margin. CONCLUSION Prevalence of abnormal anal cytology was 5.5% in patients with abnormal cervical cytology. The prevalence might be support anal cytology screening in this group of patients.
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Affiliation(s)
- Perapong Inthasorn
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand.
| | | | - Somsak Laiwejpithaya
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand.
| | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand.
| | - Atthapon Jaishuen
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand.
| | - Boonlert Viriyapak
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand.
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16
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Talwar G, Daniel R, McKechnie T, Levine O, Eskicioglu C. Radiotherapy alone versus chemoradiotherapy for stage I anal squamous cell carcinoma: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36:1111-1122. [PMID: 33486535 DOI: 10.1007/s00384-021-03846-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Patients with stage I anal squamous cell carcinoma (SCC) have been underrepresented in landmark trials showing superiority of chemoradiotherapy over radiotherapy for definitive treatment. This review aims to elucidate whether definitive treatment with radiotherapy versus chemoradiotherapy is associated with differences in survival and treatment-related toxicity outcomes in patients with stage I anal SCC. METHODS Medline, EMBASE, and CENTRAL were searched as of November 2020 to identify studies comparing outcomes of radiotherapy versus chemoradiotherapy for non-operative treatment of patients with stage I anal SCC. The primary outcomes were 5-year overall survival and 5-year disease-free survival. The secondary outcome was treatment-related toxicities. A pairwise meta-analysis was performed using an inverse-variance random-effects model. RESULTS From 2174 citations, 5 retrospective studies with 415 patients treated with radiotherapy and 3784 patients treated with chemoradiotherapy were included. Patients treated with chemoradiotherapy had an increased 5-year overall survival (RR 1.18, 95% CI 1.10-1.26, p < 0.00001, I2 = 0%) but no significant difference in 5-year disease-free survival (RR 1.01, 95% CI 0.92-1.11, p = 0.87, I2 = 0%). Treatment-related toxicities could not be meta-analyzed due to heterogeneity. Limited data from individual studies suggested an increased frequency of select toxicities with chemoradiotherapy. CONCLUSION Radiotherapy may be an appropriate alternative to chemoradiotherapy for patients with stage I anal SCC who may be unable to tolerate chemotherapy-related toxicity; however, chemoradiotherapy remains the gold standard. Larger prospective studies comparing strategies for this select patient population are needed to clarify whether treatment can be de-escalated.
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Affiliation(s)
- Gaurav Talwar
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ryan Daniel
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tyler McKechnie
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Oren Levine
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Oncology, Division of Medical Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. .,Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada. .,Department of Surgery, Division of General Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, Ontario, Canada.
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17
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Shenoy MA, Winnicka L, Mirsadraei L, Marks D. Anal Cancer with Mediastinal Lymph Node Metastasis. Gastrointest Tumors 2021; 8:134-137. [PMID: 34307312 PMCID: PMC8280435 DOI: 10.1159/000514112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/29/2020] [Indexed: 11/19/2022] Open
Abstract
Squamous cell carcinoma of the anal canal remains rare, with metastatic disease even less commonly reported. We present a case of a patient with both a prior history of squamous cell carcinoma of the anal canal as well as breast cancer, who was without evidence of disease for 1 year. She was subsequently found to have FDG-avid mediastinal lymphadenopathy, initially assumed to be related to her more recent breast cancer. However, a biopsy confirmed recurrent anal cancer, with HPV infection. This represents a novel site of spread for anal cancer, one not yet reported in the literature.
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Affiliation(s)
- Mangalore Amith Shenoy
- Department of Pulmonary and Critical Care, NYU Winthrop Hospital, Mineola, New York, USA
| | - Lydia Winnicka
- Department of Pulmonary and Critical Care, NYU Winthrop Hospital, Mineola, New York, USA
| | - Leili Mirsadraei
- Department of Pathology, NYU Winthrop Hospital, Mineola, New York, USA
| | - Douglas Marks
- Department of Hematology and Oncology, NYU Winthrop Hospital, Mineola, New York, USA
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18
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Ortiz AP, García-Camacho SI, Ramos-Cartagena JM, Colón-López V, Estremera-Rodríguez LM, Berríos-Toledo KM, Romaguera J. Knowledge, Attitudes, and Experiences of Anal Cancer and Anal Cancer Screening Among a Clinical Sample of Hispanic Women. J Low Genit Tract Dis 2021; 25:98-105. [PMID: 33660677 PMCID: PMC8171435 DOI: 10.1097/lgt.0000000000000598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Anal cancer screening has been recommended for women with lower genital tract neoplasia, lupus, Crohn disease, HIV, and/or organ transplantation recipients. This study described and compared knowledge, attitudes, and experiences related to anal cancer and anal cancer screening between women at high risk for anal cancer and their counterparts. METHODS This is a cross-sectional study within colposcopy and gynecology oncology clinics in Puerto Rico; 278 women 21 years or older and with prior diagnosis of gynecological neoplasia completed an interviewer-administered questionnaire. Women were categorized according to their medical history as being high risk or non-high risk for anal cancer. The high-risk group included women with a history of lower genital tract neoplasia, lupus, Crohn disease, HIV, and/or organ transplantation. RESULTS Overall, 40.7% of the study population were at high risk for developing anal cancer. History of anal cancer screening was low among high-risk and non-high-risk women (11.5% vs 5.6%, p > .05). Less than 1% of all women reported to have had a high-resolution anoscopy. Most women (87.6%) had little knowledge about anal Pap test but were willing to have one if their doctors recommended it (96.5%). No major differences in knowledge, attitudes, or screening history were observed between high-risk and non-high-risk women. CONCLUSIONS Although experts do not recommend routine anal cancer screening for the general population, they do recommend it for women within certain high-risk groups. Study findings highlight the importance of increasing education and awareness of anal cancer among high-risk patients and physicians, to promote better preventive methods, achieve early detection, and improve disease outcomes.
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Affiliation(s)
| | | | - Jeslie M Ramos-Cartagena
- University of Puerto Rico/MD Anderson Cancer Center Partnership for Excellence in Cancer Research Program, San Juan, Puerto Rico
| | | | - Lianeris M Estremera-Rodríguez
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
| | - Kyara M Berríos-Toledo
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
| | - Josefina Romaguera
- Department of Obstetrics and Gynecology, School of Medicine, University of Puerto Rico
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19
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A Case Report of Anorectal Squamous Cell Carcinoma Associated with Overlap Myositis Syndrome-a Possible Paraneoplastic Myositis Syndrome. Clin Colorectal Cancer 2021; 20:148-152. [PMID: 33736942 DOI: 10.1016/j.clcc.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/27/2021] [Accepted: 02/14/2021] [Indexed: 11/23/2022]
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20
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Effectiveness of the Quadrivalent HPV Vaccine in Preventing Anal ≥ HSILs in a Spanish Population of HIV+ MSM Aged > 26 Years. Viruses 2021; 13:v13020144. [PMID: 33498165 PMCID: PMC7908967 DOI: 10.3390/v13020144] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 12/22/2022] Open
Abstract
Anal squamous cell carcinoma is the most frequent virus-related non-AIDS-defining neoplasia among HIV-infected individuals, especially MSM. The objectives of this study were to analyze the effectiveness of the quadrivalent HPV (qHPV) vaccine to prevent anal ≥ high-grade squamous intraepithelial lesions (≥HSILs), external ano-genital lesions (EAGLs), and infection by qHPV vaccine genotypes in HIV+ MSM, and to study the immunogenicity of the vaccine and risk factors for ≥ HSILs. This study is nested within a randomized, double-blind, placebo-controlled trial of the qHPV vaccine, which enrolled participants between May 2012 and May 2014, with a 48-month follow-up. A vaccine or placebo was administered at 0, 2, and 6 months, and vaccine antibody titers were evaluated at 7, 12, 24, 36, and 48 months. Data were gathered at 12, 24, 36, and 48 months on sexual habits, CD4/CD8 cell/counts, HIV viral load, and the results of cytology (Thin Prep® Pap Test), HPV PCR genotyping (Linear Array HPV Genotyping Test), and high-resolution anoscopy (Zeiss 150 fc© colposcope). The study included 129 patients (mean age of 38.8 years, 40 [31%] with a history of AIDS, 119 [92.2%] receiving ART, and 4 [3.3%] with virological failure), 66 (51.2%) in vaccine arm and 63 (48.4%) in placebo arm. The vaccine and placebo groups did not differ in ≥ HSILs (14.1 vs. 13.1%, respectively, p = 0.98) or EAGL (11.1 vs. 6.8%, p = 0.4) rates during follow-up; however, a protective effect against HPV 6 was observed during the first year of follow-up in the vaccine versus placebo group (7.5% vs. 23.4%; p = 0.047). A between-arm difference (p = 0.0001) in antibodies against qHPV vaccine genotypes was observed at 7 months (76.9% in vaccine arm vs. 30.2% in placebo arm), 12 months (68.1% vs. 26.5%), 24 months (75% vs. 32.5%), 36 months (90% vs. 24.4%), and 48 months (87.2% vs. 30%). Finally, the factor associated with the risk of anal ≥ HSIL onset during the four-year follow-up was the receipt of the last dose of the vaccine less than 6 months earlier in comparison to those vaccinated for a longer period (82.4% vs. 17.6% (OR 0.869 [95% CI, 0.825-0.917]). Vaccine and placebo arms did not significantly differ in ≥ HSIL or EAGL rates or in protection against infection by HPV genotype vaccine except for HPV6 at 12 months after the first dose. A long-lasting immune response was observed in almost all the vaccinated men. The main protective factor against ≥ HSIL was to have completed the vaccination regimen more than 6 months earlier.
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21
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Sandach P, Kasper-Virchow S, Rischpler C, Herrmann K. Molecular Imaging and Therapy of Colorectal and Anal Cancer. Semin Nucl Med 2020; 50:465-470. [PMID: 32768009 DOI: 10.1053/j.semnuclmed.2020.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Colorectal cancer is the cancer with the third highest incidence both in males and females in the USA and is also frequently occurring in other industrialized nations. Anal cancer on the other hand is much rarer, but has a rising incidence, especially in high income nations and with a connection to HIV infections, homosexual men and a younger age of the first sexual encounter. Both have high mortality rates in common and are complex to handle in terms of prevention, staging, treatment and diagnostic of recurrence. This article aims to give an overview about the established diagnostic methods of nuclear medicine, especially sole PET and (contrast enhanced) hybrid imaging with 18F-FDG as tracer for primary staging, restaging, therapy monitoring and radiotherapy planning in current guidelines, with a special focus on the American guidelines of the National Comprehensive Cancer Network for colorectal and anal cancer. There will also be an outlook on potential future adjustments in those leading to a more significant representation of nuclear medicine by giving a synopsis of the available studies and data published in international medical press. New tracers that are still in research stage, progress in the imaging techniques, for example a further establishment of PET/MR hybrid imaging, the use of artificial intelligence and parametric imaging, as well as possible future theranostic applications like c-MET binding peptides will also be shortly discussed.
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Affiliation(s)
- Patrick Sandach
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen, Germany.
| | - Stefan Kasper-Virchow
- Westdeutsches Magen-und Darmzentrum Essen, Universitätsklinikum Essen, Essen, Germany.
| | | | - Ken Herrmann
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen, Germany.
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Mazloom A, Ghalehsari N, Gazivoda V, Nimkar N, Paul S, Gregos P, Rateshwar J, Khan U. Role of Immune Checkpoint Inhibitors in Gastrointestinal Malignancies. J Clin Med 2020; 9:E2533. [PMID: 32781500 PMCID: PMC7463795 DOI: 10.3390/jcm9082533] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 12/24/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of several solid and hematological malignancies. ICIs are not only able to produce long and durable responses, but also very well tolerated by patients. There are several approved indications of use of ICIs in treatment of metastatic gastrointestinal malignancies including gastric, esophageal, colorectal and hepatocellular carcinoma. In addition, ICIs can be used in microsatellite instability-high (MSI-H) and high tumor mutational burden (TMB) tumors in chemotherapy-resistant setting. Despite having good efficacy and superior safety profile, ICIs are clinically active in small subset of patients, therefore, there is a huge unmet need to enhance their efficacy and discover new predictive biomarkers. There are several ongoing clinical trials that are exploring the role of ICIs in various gastrointestinal cancers either as single agent or in combination with chemotherapy, radiation therapy, targeted agents or other immunotherapeutic agents. In this review, we discuss the published and ongoing trials for ICIs in gastrointestinal malignancies, including esophageal, gastric cancer, pancreatic, hepatocellular, biliary tract, colorectal and anal cancers. Specifically, we focus on the use of ICIs in each line of therapy and discuss the future directions of these agents in each type of gastrointestinal cancer.
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Affiliation(s)
- Anita Mazloom
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital—Weill Cornell Medicine, Brooklyn, NY 11215, USA; (A.M.); (N.G.); (N.N.); (S.P.); (P.G.); (J.R.)
| | - Nima Ghalehsari
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital—Weill Cornell Medicine, Brooklyn, NY 11215, USA; (A.M.); (N.G.); (N.N.); (S.P.); (P.G.); (J.R.)
| | - Victor Gazivoda
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA;
| | - Neil Nimkar
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital—Weill Cornell Medicine, Brooklyn, NY 11215, USA; (A.M.); (N.G.); (N.N.); (S.P.); (P.G.); (J.R.)
| | - Sonal Paul
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital—Weill Cornell Medicine, Brooklyn, NY 11215, USA; (A.M.); (N.G.); (N.N.); (S.P.); (P.G.); (J.R.)
| | - Peter Gregos
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital—Weill Cornell Medicine, Brooklyn, NY 11215, USA; (A.M.); (N.G.); (N.N.); (S.P.); (P.G.); (J.R.)
| | - Janice Rateshwar
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital—Weill Cornell Medicine, Brooklyn, NY 11215, USA; (A.M.); (N.G.); (N.N.); (S.P.); (P.G.); (J.R.)
| | - Uqba Khan
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital—Weill Cornell Medicine, Brooklyn, NY 11215, USA; (A.M.); (N.G.); (N.N.); (S.P.); (P.G.); (J.R.)
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Cheng L, Wang Y, Du J. Human Papillomavirus Vaccines: An Updated Review. Vaccines (Basel) 2020; 8:vaccines8030391. [PMID: 32708759 PMCID: PMC7565290 DOI: 10.3390/vaccines8030391] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022] Open
Abstract
Human papillomavirus (HPV) vaccines, which were introduced in many countries in the past decade, have shown promising results in decreasing HPV infection and related diseases, such as warts and precancerous lesions. In this review, we present the updated information about current HPV vaccines, focusing on vaccine coverage and efficacy. In addition, pan-gender vaccination and current clinical trials are also discussed. Currently, more efforts should be put into increasing the vaccine’s coverage, especially in low- and middle-income countries. Provision of education on HPV and vaccination is one of the most important methods to achieve this. Vaccines that target HPV types not included in current vaccines are the next stage in vaccine development. In the future, all HPV-related cancers, such as head and neck cancer, and anal cancer, should be tracked and evaluated, especially in countries that have introduced pan-gender vaccination programs. Therapeutic vaccines, in combination with other cancer treatments, should continue to be investigated.
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24
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Nichols DS, Satteson E, Harbor P, DeFranzo A, David L, Thompson JT. Factors associated with the use of vertical rectus abdominus myocutaneous flap reconstruction following abdominoperineal resection for anorectal cancer. J Surg Oncol 2020; 122:923-927. [PMID: 32596855 DOI: 10.1002/jso.26086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/13/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Following abdominoperineal resection (APR), primary closure of the perineal defect is often possible. Some patients, however, require flap reconstruction. Identifying these patients preoperatively is critical to facilitate comprehensive patient counseling and optimize surgical efficacy. METHODS A retrospective review of patients undergoing APR over a 10-year period was performed to identify predictive factors for patients requiring reconstruction with a vertical rectus abdominis myocutaneous (VRAM) flap as opposed to primary closure. Student's t and Fisher's exact tests were utilized for statistical analysis. RESULTS A total of 158 patients underwent APR, 29 of whom (18%) required a VRAM flap. A higher average skin resection area was seen among those requiring flap reconstruction (P < .0001). Flap reconstruction was also associated with current smoking status (P = .0197), anal tumor location (P < .0001), and neoadjuvant radiation (P = .0457). Although not statistically significant, average tumor diameter was larger in the VRAM flap group compared with the primary closure group. CONCLUSIONS While the appropriate method of closure for those undergoing APR should be considered on an individual case basis, patients who smoke, have a tumor located at the anus, or require large skin resection are more likely to need flap reconstruction.
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Affiliation(s)
- David S Nichols
- University of Florida College of Medicine, Gainesville, Florida
| | - Ellen Satteson
- University of Florida College of Medicine, Gainesville, Florida.,Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida, Gainesville, Florida
| | - Patrick Harbor
- Department of Plastic Surgery, Georgetown University Hospital, Washington, District of Columbia
| | - Anthony DeFranzo
- Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lisa David
- Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - James T Thompson
- Section of Plastic and Reconstructive Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
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25
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Lin ACH, Hakim A, Kellish AS, Singh P, Wozniak M, Kwiatt M, Gaughan J, Hong YK. Inguinal Lymph Node Dissection Does Not Improve Overall Survival in Anal Cancer Nodal Disease. J Surg Res 2020; 255:13-22. [PMID: 32540576 DOI: 10.1016/j.jss.2020.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/10/2020] [Accepted: 05/05/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Anal SCC is a rare disease mainly treated with chemoradiation. Abdominoperineal resection (APR), once the mainstay of treatment for anal cancer, now serves a role as salvage therapy for persistent or recurrent disease after chemoradiation. In addition, clinically positive nodes are currently treated by extending the radiation field to the groin. The role of inguinal lymph node dissection in recurrent or persistent anal SCC is unclear. The aim of the study is to determine the role of inguinal lymph node dissection in the management of inguinal lymph node metastasis for anal squamous cell carcinoma (SCC). METHODS Retrospective analysis of patients with anal SCC in the National Cancer Database with positive inguinal nodes undergoing salvage APR between 2004 and 2014 was performed. A comparison of overall survival between patients who underwent APR with lymph node dissection versus APR only was analyzed using Kaplan-Meier plot. RESULTS A total of 3424 patients underwent salvage APR, with 274 (8%) having clinically positive nodes. Within the subgroup that had clinically positive nodes, 195 (71%) underwent APR, whereas 79 (29%) underwent both APR and node dissection. Kaplan-Meier analysis demonstrates no difference in overall survival in the two groups (P = 0.99). Five-year survival for both groups was similar (36% versus 42%; P = 0.987). No significant difference was found when adjusted for age, gender, and Tumor Node Metastasis staging. CONCLUSIONS Inguinal lymph node dissection does not appear to improve overall survival in patients with advanced-stage anal cancer requiring salvage APR. Proper patient selection for node dissection is essential to spare patients from additional morbid procedures.
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Affiliation(s)
- Andrew C H Lin
- Department of Surgery, Cooper University Hospital, Camden, New Jersey
| | - Abraham Hakim
- School of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Alec S Kellish
- School of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Puja Singh
- School of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Marisa Wozniak
- School of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Michael Kwiatt
- Department of Surgery, Cooper University Hospital, Camden, New Jersey
| | - John Gaughan
- Department of Surgery, Cooper University Hospital, Camden, New Jersey
| | - Young Ki Hong
- Department of Surgery, Cooper University Hospital, Camden, New Jersey.
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26
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Long-term results achieved by guideline-based stage-dependent management of anal cancer in a non-HIV population. Int J Colorectal Dis 2019; 34:1895-1905. [PMID: 31641849 DOI: 10.1007/s00384-019-03396-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Therapy of anal cancer follows national and international guidelines that are mainly derived from randomized trials. This study aimed to analyze long-term results of stage-dependent treatment of anal cancer in a non-selected patient cohort. PATIENTS AND METHOD All consecutive patients treated for anal cancer between 2000 and 2015 were retrieved from a prospective database. Risk-dependent screening for human immunodeficiency virus showed no infection. Main outcome measure was overall survival with respect to tumor site and treatment. Secondary endpoints were cause-specific survival, stoma free survival, and the rate of salvage operations. RESULTS In total, 106 patients were treated for anal cancer. Of those, 69 (65.1%) suffered from anal canal cancer and 37 (34.9%) from anal margin cancer. Three patients with synchronous distant metastases were excluded from analysis. The majority of patients (n = 79, 76.7%) were treated by chemoradiotherapy in curative intention. Twenty-two patients underwent local surgery. Five-year overall survival was 73.1% and cause-specific survival at 5 years was 87.4%. Overall, 14 patients (13.6%) needed salvage surgery. Their 5-year cause-specific survival was 57.7%. A permanent ostomy was avoided in 77.7%. CONCLUSIONS Treatment of anal cancer results in low rates of salvage surgery and permanent ostomies, when therapy was determined by a multidisciplinary team following national and international guidelines.
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27
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Kool R, João Mansure J, Kassouf W. Molecular subtyping, tumor infiltration, and trimodal therapy for muscle-invasive bladder cancer: more questions than answers. Transl Androl Urol 2019; 8:S325-S328. [PMID: 31392159 DOI: 10.21037/tau.2019.05.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ronald Kool
- Experimental Surgery, McGill University Health Centre, Montreal, Canada
| | - José João Mansure
- Experimental Surgery, McGill University Health Centre, Montreal, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Centre, McGill University, Montreal, Canada
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28
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Youssef I, Osborn V, Lee A, Katsoulakis E, Kavi A, Choi K, Safdieh J, Schreiber D. Survival benefits and predictors of use of chemoradiation compared with radiation alone for early stage (T1-T2N0) anal squamous cell carcinoma. J Gastrointest Oncol 2019; 10:616-622. [PMID: 31392041 DOI: 10.21037/jgo.2019.02.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Standard of care treatment for anal squamous cell carcinoma (SCC) is concurrent chemoradiation (CRT). However, the necessity of CRT over radiation alone for T1-2N0 disease is less certain. Methods The National Cancer Database (NCDB) was queried to identify patients who received CRT, defined as initiation of chemo and RT within 14 days of each other, or RT alone (without any chemo during initial treatment phase) for cT1-2N0M0 SCC of the anus. The cohort was limited to patients less than 70 years old with Charlson-Deyo Comorbidity Index of 0, receiving a radiation dose range of 4,500-5,940 cGy. Univariable and multivariable logistic regression were performed to assess for predictors of CRT usage. Five-year overall survival (OS) was analyzed using the Kaplan-Meier method with the log rank test both for the full cohort and then on the subsets of T1 and T2 patients. Results We identified 4,564 patients, of whom 4,371 (95.8%) received CRT and 193 (4.2%) received RT alone. Median follow up was 49.8 months. About 33.5% of patients had cT1N0 disease, while 66.5% of patients had cT2N0 disease. On multivariable logistic regression, patients were more likely to receive CRT if they had T2 disease [OR 2.318 (1.732-3.102), P<0.0001]. Five-year OS was 86.6% for CRT and 79.1% for RT (P=0.001). For T1 patients, 5-year OS was 90.3% with CRT and 84.7% with RT (P=0.114). For T2 patients, 5-year OS was 84.7% with CRT and 72.8% with RT (P<0.0001). Multivariable Cox regression analysis confirmed association between OS and CRT use [HR 0.588 (95% CI: 0.430-0.804), P=0.001]. Conclusions The vast majority of patients under age 70 without significant comorbidities are treated with CRT over radiation alone for early stage anal SCC, with better survival associated with CRT.
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Affiliation(s)
- Irini Youssef
- SUNY Downstate Medical Center, Brooklyn, NY, USA.,Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Virginia Osborn
- Mount Sinai Elmhurst Faculty Practice Group, Queens, NY, USA
| | - Anna Lee
- SUNY Downstate Medical Center, Brooklyn, NY, USA.,Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Evangelia Katsoulakis
- Department of Veterans Affairs, James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Ami Kavi
- SUNY Downstate Medical Center, Brooklyn, NY, USA.,Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Kwang Choi
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | - David Schreiber
- Summit Medical Group MD Anderson Cancer Center, Florham Park, NJ, USA
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Dapper H, Schiller K, Münch S, Peeken JC, Borm K, Weber W, Combs SE. Have we achieved adequate recommendations for target volume definitions in anal cancer? A PET imaging based patterns of failure analysis in the context of established contouring guidelines. BMC Cancer 2019; 19:742. [PMID: 31357959 PMCID: PMC6664500 DOI: 10.1186/s12885-019-5970-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background There are different contouring guidelines for the clinical target volume (CTV) in anal cancer (AC) which vary concerning recommendations for radiation margins in different anatomical regions, especially on inguinal site. PET imaging has become more important in primary staging of AC as a very sensitive method to detect lymph node (LN) metastases. Using PET imaging, we evaluated patterns of LN spread, and examined the differences of the respective contouring guidelines on the basis of our results. Methods We carried out a retrospective study of thirty-seven AC patients treated with chemoradiation (CRT) who underwent FDG-PET imaging for primary staging in our department between 2011 and 2018. Patients showing PET positive LN were included in this analysis. Using a color code, LN metastases of all patients were delineated on a template with “standard anatomy” and were divided indicating whether their location was in- or out-field of the standard CTV as recommended by the Radiation Therapy Oncology Group (RTOG), the Australasian Gastrointestinal Trials Group (AGITG) or the British National Guidance (BNG). Furthermore, a detailed analysis of the location of LN of the inguinal region was performed. Results Twenty-two out of thirty-seven AC patients with pre-treatment PET imaging had PET positive LN metastases, accumulating to a total of 154 LN. The most commonly affected anatomical region was inguinal (49 LN, 32%). All para-rectal, external/internal iliac, and pre-sacral LN were covered by the recommended CTVs of the three different guidelines. Of forty-nine involved inguinal LN, fourteen (29%), seven (14%) and five (10%) were situated outside of the recommended CTVs by RTOG, AGITG and BNG. Inguinal LN could be located up to 5.7 cm inferiorly to the femoral saphenous junction and 2.8 cm medial or laterally to the big femoral vessels. Conclusion Pelvis-related, various recommendations are largely consistent, and all LN are covered by the recommended CTVs. LN “misses” appear generally cranially (common iliac or para-aortic) or caudally (inguinal) to the recommended CTVs. The established guidelines differ significantly, particular regarding the inguinal region. Based on our results, we presented our suggestions for CTV definition of the inguinal region. LN involvement of a larger number of patients should be investigated to enable final recommendations.
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Affiliation(s)
- Hendrik Dapper
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Kilian Schiller
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stefan Münch
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Jan C Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany.,Institute for innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstr. 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Kai Borm
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Wolfgang Weber
- Department of Nuclear Medicine, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany.,Institute for innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstr. 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
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Fulop ZZ, Gurzu S, Bara T, Dragus E, Bara T, Voidazan S, Banias L, Jung I. Lymph node ratio, an independent prognostic factor for patients with stage II-III rectal carcinoma. Pathol Res Pract 2019; 215:152384. [PMID: 30910253 DOI: 10.1016/j.prp.2019.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Identification of the proper surgical method and the most reliable prognostic parameters of rectal carcinomas is a challenging issue. The aim of this paper was to determine the possible prognostic role of the number of harvested lymph nodes versus lymph node ratio (LNR) in patients with rectal carcinomas, and the proper value of LNR that can be used as prognostic parameter. MATERIALS AND METHODS A retrospective study was performed in 186 consecutive patients with rectal carcinomas that underwent surgical resection. The LNR was calculated for cases from stage II-III, and was correlated with classic prognostic parameters and overall survival (OS). RESULTS A statistically significant difference was found between LNR of 0.15 and OS (p = 0.03), respectively LNR > 0.15 and TNM stage (p < 0.0001), but also tumor infiltration level (p < 0.05). The number of harvested lymph nodes was not correlated with the tumor stage (r = 0.148, p = 0.06) and this parameter did not influence the OS, when the number of 12 or 14 lymph nodes was used as the ideal value (p = 0.6 and p = 0.66, respectively). CONCLUSION In patients with rectal carcinomas that underwent preoperative chemoradiotherapy, a LNR of 0.15 is a parameter with independent prognostic value, comparing with the number of harvested lymph nodes. The specific LNR should be calculated in larger cohorts.
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Affiliation(s)
- Zsolt Zoltan Fulop
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania; Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Simona Gurzu
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania; Department of Pathology, CCAMF - Research Center, Targu Mures, Romania.
| | - Tivadar Bara
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Emoke Dragus
- Department of Urology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Tivadar Bara
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Septimiu Voidazan
- Department of Epidemiology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Laura Banias
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Ioan Jung
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
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Díaz Del Arco C, García D, Sanabria C, Rodríguez Escudero E, Domínguez I, Sanz Ortega G, Fernández Aceñero MJ. Anal cytology in women: Experience from a single tertiary center. Pathol Res Pract 2019; 215:905-909. [PMID: 30718099 DOI: 10.1016/j.prp.2019.01.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/06/2019] [Accepted: 01/25/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Anal cytology (AC) can be used as a screening tool for detection of anal HPV associated lesions, mainly in men who have sex with men and in immunosuppressed patients. Our aim is to review our experience with AC in women. MATERIAL & METHODS We have retrospectively reviewed all AC diagnosed between 2010-2017 in a single tertiary hospital (n = 644) and selected those performed in women (n = 158). RESULTS 24.53% of AC were performed in women. 14.7% of all women were HIV positive and 56.7% referred anal intercourse. Squamous lesions were found in 27.2% of women, most of them ASCUS and LSIL (14% and 11.5%). HPV DNA was detected in 38.6% of patients, and 63.9% of them showed positivity for multiple high-risk types. Anal biopsy showed high grade lesions in 20% of biopsied patients. We observed a significant relationship between HPV status and receptive anal sex, and the association between HPV status and anal histological diagnosis tended to significance. Sensitivity, specificity, negative predictive value and positive predictive value for anal cytology were 57%; 83%; 28% and 94%, respectively. 70.9% of women had synchronous cervical cytology, and squamous cervical lesions were detected in 46.4% of the cases, most of them LSIL or ASCUS (21.4% and 15.2%). We did not confirm a significant association between cytological diagnosis of cervical and anal samples. CONCLUSIONS AC is less widely used in women than in homosexual men. However, women show important rates of anal lesions, regardless of their HIV status. More studies should be performed to assess the potential impact of screening protocols in this population.
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Affiliation(s)
- C Díaz Del Arco
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain; Complutense University of Madrid, Spain.
| | - D García
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain.
| | - C Sanabria
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain.
| | | | - I Domínguez
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain; Department of General and Gastrointestinal Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - G Sanz Ortega
- Department of General and Gastrointestinal Surgery, Hospital Clínico San Carlos, Madrid, Spain.
| | - M J Fernández Aceñero
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain; Complutense University of Madrid, Spain.
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Abstract
Anal fistula, or fistula-in-ano, is a condition involving the anal region that is common yet debilitating. Surgery is the mainstay of treatment for an anal fistula and the chances of recurrence are quite high even after corrective surgical procedures. The risk factors for recurrence can be broadly classified into four categories: 1) risk factors related to the fundamental anatomy of the fistula and presence of comorbidities, 2) lack of proper preoperative assessment of the fistula, which includes failure to recognize the internal opening and overall structure of the fistula and not supplementing the proctologic examination with sufficient imaging, 3) intraoperative loopholes that include improper procedure selection, inexperience of the surgeon, and failure to get rid of the entire tract along with its ramifications, and 4) lack of proper postoperative care in the early and late periods following the surgery. The aim of this paper, therefore, is to highlight the factors that could increase the risk of recurrence in different types of anal fistulae. Once surgeons know these risk factors, they can anticipate any complication and detect recurrence early.
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33
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Oda R, Agsalda-Garcia M, Loi N, Kamada N, Milne C, Killeen J, Choi SY, Lim E, Acosta-Maeda T, Misra A, Shiramizu B. Raman-Enhanced Spectroscopy Distinguishes Anal Squamous Intraepithelial Lesions in Human Immunodeficiency Virus-Serodiscordant Couples. AIDS Res Hum Retroviruses 2019; 35:287-294. [PMID: 30612435 DOI: 10.1089/aid.2018.0198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
HIV-positive individuals are at increased risk for precancerous anal squamous intraepithelial lesions (SILs). Anal cytology and digital rectal examination are performed as screening tools, but extensive training and appropriate instruments are required to follow up on an abnormal anal cytology. Thus, novel approaches to SIL evaluation could improve better health care follow-up by efficient and timely diagnosis to offer treatment options. Recently, Raman-enhanced spectroscopy (RESpect) has emerged as a potential new tool for early identification of SIL. RESpect is a noninvasive, label-free, laser-based technique that identifies molecular composition of tissues and cells. HIV-serodiscordant couples had anal biopsies obtained during high-resolution anoscopy. RESpect was performed on the specimens. Principal component analysis of the data identified differences between normal and abnormal tissue as well as HIV-positive and HIV-negative individuals of each couple even with similar pathologies. RESpect has the potential to change the paradigm of anal pathology diagnosis and could provide insight into different pathways leading to SIL in HIV-serodiscordant couples.
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Affiliation(s)
- Robert Oda
- 1 Department of Molecular Biosciences and Bioengineering, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Melissa Agsalda-Garcia
- 2 Department of Tropical Medicine, Medical Microbiology and Pharmacology, Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Nicholas Loi
- 2 Department of Tropical Medicine, Medical Microbiology and Pharmacology, Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Natalie Kamada
- 2 Department of Tropical Medicine, Medical Microbiology and Pharmacology, Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Cris Milne
- 2 Department of Tropical Medicine, Medical Microbiology and Pharmacology, Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Jeffrey Killeen
- 3 Department of Pathology, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - So Yung Choi
- 4 Biostatistics Core, Department of Complementary and Integrative Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Eunjung Lim
- 4 Biostatistics Core, Department of Complementary and Integrative Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Tayro Acosta-Maeda
- 5 Hawaii Institute of Geophysics and Planetology, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Anupam Misra
- 5 Hawaii Institute of Geophysics and Planetology, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Bruce Shiramizu
- 2 Department of Tropical Medicine, Medical Microbiology and Pharmacology, Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
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Pichon M, Joly M, Lebreton F, Benchaïb M, Mekki Y, Devouassoux-Shisheboran M. Evaluation of p16/Ki-67 Dual Staining Compared with HPV Genotyping in Anal Cytology with Diagnosis of ASC-US for Detection of High-Grade Anal Intraepithelial Lesions. J Cytol 2019; 36:152-156. [PMID: 31359914 PMCID: PMC6592121 DOI: 10.4103/joc.joc_131_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Human Papillomavirus (HPV) infection is the main risk factor for anogenital cancer. The objective of this study was to compare p16/Ki-67 dual staining to HPV genotyping in anal cytology samples with an atypical squamous cell of undetermined significance (ASC-US) for the identification of high-grade squamous intraepithelial lesion (HSIL). Methods Anal cytology samples with an ASC-US result (n = 111) were collected from patients of a university hospital (Lyon, France) from 2014 to 2015. Cases with remaining squamous cells (n = 82) were stained using p16/Ki-67 dual staining (CINtec-Plus kit) and analyzed for HPV screening (CLART2-PCR kit) using a composite endpoint of biopsy and cytology results on follow-up specimens. Results Detection of HSIL on follow-up specimens (5/22 biopsies; 1/29 cytology samples) was obtained in two out of six cases with p16/Ki-17 versus. five out of six with HPV genotyping alone. Sensitivity and specificity to detect HSIL for p16/Ki-67 was 33% (95% confidence interval [CI] [4; 77]) and 49% (95%CI [34; 64]) versus. 83% (95%CI [36; 99.6]) and 13% (95%CI [5; 27]) for HPV genotyping. Conclusion Herein, HPV genotyping was more sensitive but less specific than p16/Ki-67 staining for the detection of subsequent HSIL in ASC-US anal cytology. A larger study is required to evaluate the combination of these biomarkers for triage.
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Affiliation(s)
- Maxime Pichon
- Hospices Civils de Lyon, Virology Department, Institut des Agents Infectieux, Centre de Biologie et de Pathologie Nord, Hôpital de la Croix Rousse, Lyon, France
| | - Marie Joly
- Hospices Civils de Lyon, Pathology Department, Centre de Biologie et de Pathologie Sud, Pierre Bénite, France
| | - Frédérique Lebreton
- Hospices Civils de Lyon, Pathology Department, Centre de Biologie et de Pathologie Sud, Pierre Bénite, France
| | - Medhi Benchaïb
- Hospices Civils de Lyon, Reproduction Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Yahia Mekki
- Hospices Civils de Lyon, Virology Department, Institut des Agents Infectieux, Centre de Biologie et de Pathologie Nord, Hôpital de la Croix Rousse, Lyon, France
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Yamaura M, Yamada T, Watanabe R, Kawai H, Hirose S, Tajima H, Sato M, Uchida Y, Suganuma D, Yamamoto Y, Moriwaki T, Hyodo I. Anal canal adenocarcinoma with neuroendocrine features accompanying secondary extramammary Paget disease, successfully treated with modified FOLFOX6: a case report. BMC Cancer 2018; 18:1142. [PMID: 30458812 PMCID: PMC6245632 DOI: 10.1186/s12885-018-5084-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 11/12/2018] [Indexed: 02/07/2023] Open
Abstract
Background Anal canal cancer occasionally accompanies extramammary Paget disease. Although most of them are squamous cell carcinoma, anal canal adenocarcinoma with neuroendocrine features accompanying secondary extramammary Paget disease has never been reported. Case presentation Here, we report a 76-year-old man presented with pruritus in the perianal area. Investigation revealed a fist-sized perianal erythema, diffuse liver tumors, and right inguinal lymph node swelling. Pathological examination of biopsies from the erythema suggested secondary extramammary Paget disease with positive cytokeratin-7 and -20 expressions and negative GCDFP-15 expression. The anal canal tumor was confirmed by digital examination and endoscopy. Biopsies from the anal canal tumor, swollen lymph node, and Paget lesion all showed poorly differentiated adenocarcinoma with neuroendocrine features expressing synaptophysin and chromogranin A. Serum CEA and NSE levels were high, 809.4 ng/ml and 85.8 ng/ml, respectively. After chemotherapy with modified FOLFOX6 for 2 months, the Paget lesion disappeared, and the primary anal canal tumor and liver metastases shrunk remarkably. Serum CEA and NSE levels decreased promptly to within normal ranges. Conclusions This is a clinically significant case, as it reveals novel pathological features about anal canal cancer with secondary Paget disease and successfully treated with modified FOLFOX6. Careful pathological investigation and appropriate treatment choice are needed for this rare cancer.
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Affiliation(s)
- Masamichi Yamaura
- Department of Gastroenterology, University of Tsukuba Hospital, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takeshi Yamada
- Department of Gastroenterology, University of Tsukuba Hospital, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Rei Watanabe
- Division of Dermatology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Hitomi Kawai
- Division of Pathology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Suguru Hirose
- Department of Gastroenterology, University of Tsukuba Hospital, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroki Tajima
- Department of Gastroenterology, University of Tsukuba Hospital, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masashi Sato
- Department of Gastroenterology, University of Tsukuba Hospital, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yuichi Uchida
- Department of Gastroenterology, University of Tsukuba Hospital, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Daisuke Suganuma
- Department of Gastroenterology, University of Tsukuba Hospital, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yoshiyuki Yamamoto
- Department of Gastroenterology, University of Tsukuba Hospital, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Toshikazu Moriwaki
- Department of Gastroenterology, University of Tsukuba Hospital, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Ichinosuke Hyodo
- Department of Gastroenterology, University of Tsukuba Hospital, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Chinyowa S, Palefsky JM, Chirenje ZM, Makunike-Mutasa R, Munjoma M, Muguti GI. Anal human papillomavirus infection in HIV-positive men and women at two opportunistic infections clinics in Harare, Zimbabwe. BMC Public Health 2018; 18:1260. [PMID: 30428859 PMCID: PMC6237038 DOI: 10.1186/s12889-018-6170-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 10/31/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND HIV-infected individuals are at increased risk of anal cancer; in the majority of cases this is linked to human papillomavirus (HPV) infection. Anal cancer screening is not routinely offered in Zimbabwe. METHODS A cross-sectional study was performed on 152 patients (88 females; 64 males) attending Opportunistic Infection Clinics at 2 tertiary hospitals between November 2014 and June 2015. Demographic data, immunological parameters and behavioural characteristics were collected. An anal swab was collected from each patient for HPV genotype testing. HPV testing was performed using MY09/MY11 PCR, followed by typing using the dot blot method. RESULTS The mean age was 39.6 years (range, 18-69 years). Median CD4 count was 375 cells/μL. 96% were on antiretroviral therapy. Only one patient identified as a man who has sex with men. Of 122 samples tested for HPV, 54 were positive (44%). HPV was three times more common in females (60%) than males (20%). Being HPV-positive was associated with history of perianal warts, history of cervical intraepithelial neoplasia and having more than ten lifetime sexual partners. The most commonly detected high-risk HPV genotypes were HPV-58 (13%), HPV-31 (11%) and HPV-16 (9%). Nine patients harboured multiple high-risk HPV types. The two most commonly detected low-risk genotypes were HPV-11 (17%) and HPV-53 (11%). CONCLUSION Overall anal HPV prevalence was 44% in this mostly heterosexual HIV-positive population. Oncogenic HPV types accounted for almost half of infections, supporting the need for surveillance of anal cancer in this population.
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Affiliation(s)
- Simbarashe Chinyowa
- Department of Surgery, University of Zimbabwe College of Health Sciences, P.O. Box A178 Avondale, Harare, Zimbabwe
| | - Joel M. Palefsky
- Department of Medicine, University of California, San Francisco, USA
| | - Zvavahera M. Chirenje
- Department of Gynaecology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Rudo Makunike-Mutasa
- Department of Histopathology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Marshall Munjoma
- Department of Gynaecology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Godfrey I. Muguti
- Department of Surgery, University of Zimbabwe College of Health Sciences, P.O. Box A178 Avondale, Harare, Zimbabwe
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Krzowska-Firych J, Lucas G, Lucas C, Lucas N, Pietrzyk Ł. An overview of Human Papillomavirus (HPV) as an etiological factor of the anal cancer. J Infect Public Health 2018; 12:1-6. [PMID: 29980478 DOI: 10.1016/j.jiph.2018.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 05/24/2018] [Accepted: 06/25/2018] [Indexed: 01/07/2023] Open
Abstract
Human papillomavirus (HPV) is a DNA tumour virus that is the primary cause of sexually transmitted infections (STIs). The direct connection between HPV and cervical cancer was discovered in 1980, however, many physicians and the general public are still oblivious to the association of HPV and anal cancer; most individuals find out about this relationship after a confirmed diagnosis, and therefore, it is important to raise awareness about HPV as an etiological agent in anal cancer. There is a quadrivalent vaccine available, which prevents an individual from being infected with HPV, thus anal cancer is mainly a preventable cancer when caused by HPV, and ultimately, preventing cancer is better than curing cancer, especially when there is no definite cure.This article aims to review the microbiology, pathophysiology, epidemiology, clinical presentation, diagnostic evaluation, prophylaxis and treatment options for HPV as an etiology agent in anal cancers in light of recent literature.
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Affiliation(s)
- Joanna Krzowska-Firych
- Department of Infectious Diseases, Medical University of Lublin, Poland; Clinical Research Association for Infectious Disease at the Department of Infectious Diseases, Medical University of Lublin, Poland
| | - Georgia Lucas
- Clinical Research Association for Infectious Disease at the Department of Infectious Diseases, Medical University of Lublin, Poland
| | - Christiana Lucas
- Clinical Research Association for Infectious Disease at the Department of Infectious Diseases, Medical University of Lublin, Poland
| | - Nicholas Lucas
- Clinical Research Association for Infectious Disease at the Department of Infectious Diseases, Medical University of Lublin, Poland
| | - Łukasz Pietrzyk
- Department of General, Oncological and Minimally Invasive Surgery, 1st Military Clinical Hospital with the Outpatient Clinic in Lublin, Poland; Department of Didactics and Medical Simulation, Chair of Anatomy, Medical University of Lublin, Poland.
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Dapper H, Habl G, Hirche C, Münch S, Oechsner M, Mayinger M, Sauter C, Combs SE, Habermehl D. Dosimetric quantification of the incidental irradiation of the 'true' (deep) ano-inguinal lymphatic drainage of anal cancer patients not described in conventional contouring guidelines. Acta Oncol 2018; 57:825-830. [PMID: 29297232 DOI: 10.1080/0284186x.2017.1415459] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The ano-inguinal lymphatic drainage (AILD) is located in the subcutaneous adipose tissue of the proximal medial thigh. Findings from fluorescence methods give us new information about anatomical conditions of the AILD. Current contouring guidelines do not advise the inclusion of the 'true' AILD into the clinical target volume (CTV). Aim of this work was the retrospective analysis of the incidental dose to the AILD in an anal cancer (AC) patient cohort who underwent definitive chemoradiation (CRT) therapy with Volumetric Arc Therapy - Intensity Modulated Radiation Therapy (VMAT-IMRT). METHODS VMAT-IMRT plans of 15 AC patients were analyzed. Based on findings from new fluorescence methods we created a new volume, the expected AILD. The examined dosimetric parameters were the minimal, maximal and mean dose and V10-V50 that were delivered to the AILD, respectively. RESULTS The median volume of AILD was 1047 cm³. Mean Dmin, Dmax and Dmean were 7.5 Gy, 58.9 Gy and 40.8 Gy for AILD. The clinical relevant dose of 30.0 Gray covered in mean 76% of the volume of the AILD, respectively. CONCLUSIONS Only 76% of the AILD-volume received at least an expected required treatment dose of 30 Gy incidentally. Concerning the low number of loco-regional relapses in AC patients after definitive CRT one has to balance increased side effects against a rigid oncological-anatomical interpretation of the local lymphatic drainage by including the AILD into the standard CTV.
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Affiliation(s)
- Hendrik Dapper
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU München, Munich, Germany
| | - Gregor Habl
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU München, Munich, Germany
| | - Christoph Hirche
- Department for Hand-, Plastic and Rekonstructive Surgery, Burn Centre BG-Trauma Centre Ludwigshafen/RhineBG – Klinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Stefan Münch
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU München, Munich, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU München, Munich, Germany
| | - Michael Mayinger
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU München, Munich, Germany
| | - Christina Sauter
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU München, Munich, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU München, Munich, Germany
- Institute for Innovative Radiotherapie (iRT), Helmholtz Zentrum München, Neuherberg, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany
| | - Daniel Habermehl
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU München, Munich, Germany
- Institute for Innovative Radiotherapie (iRT), Helmholtz Zentrum München, Neuherberg, Germany
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An Exceptional Adenocarcinoma in a Girl. Case Rep Oncol Med 2018; 2018:4017043. [PMID: 29808139 PMCID: PMC5902086 DOI: 10.1155/2018/4017043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/25/2018] [Indexed: 11/17/2022] Open
Abstract
Anal adenocarcinoma is very rare and usually occurs in the elderly. We present a case of a 12-year-old girl with an anal margin painful tumor infiltrating the lower rectum, with perineal and vulvar permeation nodules and bilateral fixed inguinal and iliac lymph nodes. Histology showed anal adenocarcinoma with mucosecreting component and independent cells. She had no extra pelvic metastasis on CT scan. She underwent a colostomy and palliative care. This exceptional case challenges us on the diversity of forms of anal cancers that require a multidisciplinary approach. The precarious social context and the age of onset make it difficult to manage this rare cancer.
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Dell'Acqua V, Kobiela J, Kraja F, Leonardi MC, Surgo A, Zerella MA, Arculeo S, Fodor C, Ricotti R, Zampino MG, Ravenda S, Spinoglio G, Biffi R, Bazani A, Luraschi R, Vigorito S, Spychalski P, Orecchia R, Glynne-Jones R, Jereczek-Fossa BA. Genital marginal failures after intensity-modulated radiation therapy (IMRT) in squamous cell anal cancer: no higher risk with IMRT when compared to 3DCRT. Med Oncol 2018; 35:59. [PMID: 29594584 DOI: 10.1007/s12032-018-1118-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/22/2018] [Indexed: 12/16/2022]
Abstract
Intensity-modulated radiotherapy (IMRT) is considered the preferred option in squamous cell canal cancer (SCAC), delivering high doses to tumor volumes while minimizing dose to surrounding normal tissues. IMRT has steep dose gradients, but the technique is more demanding as deep understanding of target structures is required. To evaluate genital marginal failure in a cohort of patients with non-metastatic SCAC treated either with IMRT or 3DCRT and concurrent chemotherapy, 117 patients with SCAC were evaluated: 64 and 53 patients were treated with IMRT and 3DCRT techniques, respectively. All patients underwent clinical and radiological examination during their follow-up. Tumor response was evaluated with response evaluation criteria in solid tumors v1.1 guideline on regular basis. All patients' data were analyzed, and patients with marginal failure were identified. Concomitant chemotherapy was administered in 97 and 77.4% of patients in the IMRT and 3DCRT groups, respectively. In the IMRT group, the median follow-up was 25 months (range 6-78). Progressive disease was registered in 15.6% of patients; infield recurrence, distant recurrence and both infield recurrence and distant recurrence were identified in 5, 4 and 1 patient, respectively. Two out of 64 patients (3.1%) had marginal failures, localized at vagina/recto-vaginal septum and left perineal region. In the 3DCRT group, the median follow-up was 71.3 months (range 6-194 months). Two out of 53 patients (3.8%) had marginal failures, localized at recto-vaginal septum and perigenital structures. The rate of marginal failures was comparable in IMRT and 3DCRT groups (χ2 test p = 0.85). In this series, the use of IMRT for the treatment of SCAC did not increase the rate of marginal failures offering improved dose conformity to the target. Dose constraints should be applied with caution-particularly in females with involvement of the vagina or the vaginal septum.
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Affiliation(s)
- V Dell'Acqua
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - J Kobiela
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - F Kraja
- Division of Oncology, University Hospital Centre "Mother Theresa", Tirana, Albania
| | - M C Leonardi
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy.
| | - A Surgo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - M A Zerella
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - S Arculeo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - C Fodor
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - R Ricotti
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - M G Zampino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy
| | - S Ravenda
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy
| | | | - R Biffi
- Unit of Peritoneal Cancer Surgery, European Institute of Oncology, Milan, Italy
| | - A Bazani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - R Luraschi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - S Vigorito
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - P Spychalski
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - R Orecchia
- Scientific Directorate, European Institute of Oncology, Milan, Italy
| | - R Glynne-Jones
- Mount Vernon Centre for Cancer Treatment, Northwood, Middlesex, HA6 2RN, UK
| | - B A Jereczek-Fossa
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Soares PC, Abdelhay ES, Thuler LCS, Soares BM, Demachki S, Ferro GVR, Assumpção PP, Lamarão LM, Ribeiro Pinto LF, Burbano RMR. HPV positive, wild type TP53, and p16 overexpression correlate with the absence of residual tumors after chemoradiotherapy in anal squamous cell carcinoma. BMC Gastroenterol 2018; 18:30. [PMID: 29466950 PMCID: PMC5822520 DOI: 10.1186/s12876-018-0758-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 02/13/2018] [Indexed: 01/05/2023] Open
Abstract
Background Anal residual tumors are consensually identified within six months of chemoradiotherapy and represent a persistent lesion that may have prognostic value for overall survival. The aim of this study was to evaluate the association of HPV and HIV status, p16 expression level and TP53 mutations with the absence of residual tumors (local response) in Squamous Cell Carcinoma (SCC) of the anal canal after chemoradiotherapy. Methods We performed a study on 78 patients with SCC of the anal canal who submitted to chemoradiotherapy and were followed for a six-month period to identify the absence or presence of residual tumors. HPV DNA was identified by polymerase chain reaction and direct sequencing, HIV RNA was detected by TaqMan amplification, p16 expression was detected by western blotting, and the mutational analysis of TP53 was performed by direct sequencing; additionally, samples carrying mutations underwent fluorescent in sit hybridization. The evaluation of the tumor response to treatment was conducted six months after the conclusion of chemoradiotherapy. The following classifications were used to evaluate the outcomes: a) no response (presence of residual tumor) and b) complete response (absence of residual tumor). Results The significant variables associated with the absence of residual tumors were HPV positive, p16 overexpressed, wild-type TP53, female gender, and stages I and II. Only the presence of HPV was independently correlated with the clinical response; this variable increased the chances of a response within six months by 31-fold. Conclusions The presence of HPV in tumor cells was correlated with the absence of a residual tumor. This correlation is valuable and can direct future therapeutic approaches in the anal canal.
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Affiliation(s)
- Paulo C Soares
- Hospital Ophir Loyola, Belém, Pará, 66060-281, Brazil. .,Universidade do Estado do Pará, Belém, Pará, Brazil.
| | | | | | - Bruno Moreira Soares
- Laboratório de Citogenética Humana, Instituto de Ciências Biológicas, Belém, Pará, Brazil
| | - Samia Demachki
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, Pará, Brazil
| | | | - Paulo P Assumpção
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, Pará, Brazil
| | | | | | - Rommel Mario Rodríguez Burbano
- Hospital Ophir Loyola, Belém, Pará, 66060-281, Brazil.,Laboratório de Citogenética Humana, Instituto de Ciências Biológicas, Belém, Pará, Brazil
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Cruz A, Chen D, Hsu P, Pandit V, Omesiete P, Vij P, Nfonsam V. Racial and gender disparities in the incidence of anal cancer: analysis of the Nationwide Inpatient Sample (NIS). J Gastrointest Oncol 2018; 10:37-41. [PMID: 30788157 DOI: 10.21037/jgo.2018.10.09] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Racial and gender disparities have been shown in other gastrointestinal cancers. However, there is a paucity of data on racial and gender disparities in anal cancer (AC). The aim of this study was to assess racial and gender disparities among patients with AC. Methods We analyzed data from the National Inpatient Sample (NIS) 2011 database of patients diagnosed with AC with age ≥18. Demographic data including age, race and gender were assessed. Patients were stratified based on race and gender. Log binomial regression was used to generate risk ratios. Results A total of 6,013,105 patients were assessed and 1,956 (0.03%) patients had AC. Female patients were more at risk of developing AC [relative risk (RR): 1.14, P=0.02]. Whites and Blacks had the highest incidence followed by Asians/Pacific Islanders. Black males had increased risk of AC (RR: 1.43, P<0.01). Amongst Hispanics; both males (RR: 0.69, P=0.05) and females (RR: 0.46, P<0.0001) had decreased risk of developing AC. Finally, we saw that Asian females had a much lower risk of developing AC (RR: 0.33, P<0.01). Conclusions Racial disparities and gender differences exist in the incidence of AC. Potential causes for this disparity are disparate access to healthcare, lack of education, and lack of awareness. Greater understanding of the racial disparity in AC can help identify at risk population and eventually lead to improved preventative measures to ultimately reduce the incidence of AC.
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Affiliation(s)
- Alejandro Cruz
- Department of Surgery, The University of Arizona, Tucson, AZ, USA
| | - Debbie Chen
- Department of Surgery, The University of Arizona, Tucson, AZ, USA
| | - Paul Hsu
- Department of Biostatistics and Epidemiology, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - Viraj Pandit
- Department of Surgery, The University of Arizona, Tucson, AZ, USA
| | - Pamela Omesiete
- Department of Surgery, The University of Arizona, Tucson, AZ, USA
| | - Priyanka Vij
- Department of Surgery, The University of Arizona, Tucson, AZ, USA
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Dralle H, Kols K, Witzigmann H, Viebahn R. Primärtherapie des Analkarzinoms. Chirurg 2018; 89:152-154. [DOI: 10.1007/s00104-017-0573-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Seng LM, Rosman AN, Khan A, Haris NM, Mustapha NAS, Husaini NSM, Zahari NF. Awareness of cervical cancer among women in Malaysia. Int J Health Sci (Qassim) 2018; 12:42-48. [PMID: 30022903 PMCID: PMC6040851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The purpose of this study is to evaluate and ascertain the current knowledge, perception, level of awareness, and attitudes toward cervical cancer (CC) among women in Malaysia. METHODS A cross-sectional study was conducted which involved 210 women aged between 21 and 60 years old at the public in Malaysia, a subsequent statistical analysis was performed by SPSS version 22. RESULTS In comparison with other studies, there is still lacking of awareness on CC and these induced informal cluelessness and poor attitudes toward it. In terms of risk factors, there are two factors with some degree of awareness among women in Malaysia, i.e., multiple sexual partners and sexually transmitted diseases. Women in Malaysia have less awareness on the causes and clinical manifestations of the disease (P < 0.05). They are aware that regular papanicolaou (Pap) smear would screen CC and surgery could be a treatment of choice. In addition, women in Malaysia also have moderate awareness about Pap smear as prevention to detect and prevent CC at the early stage. CONCLUSIONS Women in Malaysia only has a good awareness about multiple sex partner and sexually transmitted disease as a risk factor for CC, they also have good knowledge on regular Pap smear as a tool to diagnose and surgery as a treatment. Future, further effort is required to promote awareness of women's perception and attitudes toward CC.
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Affiliation(s)
- Lee Mun Seng
- Department of Clinical, Faculty of Medicine, Quest International University Perak, No. 122A, Jalan Hj. Eusoff, Housing Trust, 30250 Ipoh, Perak Darul Ridzuan, Malaysia,Address for correspondence: Dr. Lee Mun Seng, Faculty of Medicine, Quest International University Perak, No. 122A, Jalan Hj. Eusoff, Housing Trust, 30250 Ipoh, Perak Darul Ridzuan, Malaysia. E-mail:
| | - Aina Najwa Rosman
- Department of Clinical, Faculty of Medicine, Quest International University Perak, No. 122A, Jalan Hj. Eusoff, Housing Trust, 30250 Ipoh, Perak Darul Ridzuan, Malaysia
| | - Almas Khan
- Department of Clinical, Faculty of Medicine, Quest International University Perak, No. 122A, Jalan Hj. Eusoff, Housing Trust, 30250 Ipoh, Perak Darul Ridzuan, Malaysia
| | - Najwa Md Haris
- Department of Clinical, Faculty of Medicine, Quest International University Perak, No. 122A, Jalan Hj. Eusoff, Housing Trust, 30250 Ipoh, Perak Darul Ridzuan, Malaysia
| | - Nur Alyan Syahmi Mustapha
- Department of Clinical, Faculty of Medicine, Quest International University Perak, No. 122A, Jalan Hj. Eusoff, Housing Trust, 30250 Ipoh, Perak Darul Ridzuan, Malaysia
| | - Nur Sakina Muhammad Husaini
- Department of Clinical, Faculty of Medicine, Quest International University Perak, No. 122A, Jalan Hj. Eusoff, Housing Trust, 30250 Ipoh, Perak Darul Ridzuan, Malaysia
| | - Nurul Fadhilah Zahari
- Department of Clinical, Faculty of Medicine, Quest International University Perak, No. 122A, Jalan Hj. Eusoff, Housing Trust, 30250 Ipoh, Perak Darul Ridzuan, Malaysia
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Krilaviciute A, Stock C, Brenner H. International variation in the prevalence of preclinical colorectal cancer: Implications for predictive values of noninvasive screening tests and potential target populations for screening. Int J Cancer 2017; 141:1566-1575. [PMID: 28670788 PMCID: PMC5601285 DOI: 10.1002/ijc.30867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/13/2017] [Accepted: 06/23/2017] [Indexed: 02/06/2023]
Abstract
Screening for colorectal cancer (CRC) is implemented in an increasing number of countries. We aimed to assess international variation in the prevalence of preclinical CRC and the resulting variation in positive and negative predictive values (PPVs, NPVs) of existing and potential CRC screening tests in various countries. Using age‐ and sex‐specific CRC incidence data and transition rates from preclinical to clinical CRC we estimated overall and age‐ and sex‐specific prevalence of preclinical CRC in the target population aged 50–74 years in different parts of the world. These prevalence estimates were used to derive PPVs and NPVs for existing and potential noninvasive screening tests with varying levels of sensitivity and specificity. Within all regions and countries, prevalence strongly increases with age and is higher in men than in women. In addition, major variation was seen between regions and countries, with overall prevalence varying between 1 and 0.1%. As a result, PPVs are expected to strongly vary between ∼10% for men in high incidence countries, such as Australia and Germany, and 1% for women in low incidence countries, whereas NPVs are expected to be consistently well above 99%. Variation in CRC prevalence profoundly affects expected PPVs of screening tests, and PPVs should be carefully considered when decisions on screening tests and strategies are made for specific populations and health care systems. Here, we provide estimates of preclinical CRC and expected PPVs and NPVs of noninvasive screening tests, which may enhance the empirical basis for planning of population‐based CRC screening strategies. What's new? Colorectal cancer (CRC) screening is implemented in an increasing number of countries, usually in a two‐step approach consisting in a noninvasive test followed by colonoscopy in case of a positive result. Prevalence of preclinical colorectal cancer strongly affects screening efficiency, but such data is scarce. Here, the authors provide detailed age‐ and sex‐specific preclinical CRC prevalence estimates for various countries and geographical regions and show their implications on expected positive and negative predictive values of existing and potential noninvasive screening tests. Knowledge of these predictive values should enhance the empirical basis for decisions on CRC screening tests and target populations.
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Affiliation(s)
- Agne Krilaviciute
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Stock
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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Fredman ET, Abdel-Wahab M, Kumar AMS. Influence of radiation treatment technique on outcome and toxicity in anal cancer. ACTA ACUST UNITED AC 2017; 6:413-421. [PMID: 29213359 PMCID: PMC5700990 DOI: 10.1007/s13566-017-0326-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/09/2017] [Indexed: 01/26/2023]
Abstract
Objective Intensity-modulated radiation therapy (IMRT) has largely supplanted three-dimensional conformal radiation (3D-CRT) for definitive anal cancer treatment due to decreased toxicity and potentially improved outcomes. Convincing data demonstrating its advantages, however, remain limited. We compared outcomes and toxicity with concurrent chemotherapy and IMRT vs 3D-CRT for anal cancer. Methods We performed a single-institution retrospective review of patients treated with IMRT or 3D-CRT as part of definitive mitomycin-C/5-fluorouricil-based chemoradiation for anal cancer from January 2003 to December 2012. Results One hundred sixty-five patients were included, with 61 and 104 receiving IMRT and 3D-CRT, respectively. Overall, 92.7% had squamous cell carcinoma. The mean initial pelvic dose was 48.3 and 44 Gy for IMRT and 3D-CRT, respectively. Complete response, partial response, and disease progression rates were similar (IMRT 83.6, 8.2, 8.2%; 3D-CRT 85.6, 6.7, 7.7%; p = 0.608, p = 0.728, p = 0.729). There was no significant difference in overall survival (p = 0.971), event-free survival (p = 0.900), or local or distant recurrence rates (p = 0.118, p = 0.373). IMRT caused significantly less acute grade 1–2 incontinence (p = 0.035), grade 3–4 pain (p = 0.033), and fatigue (p = 0.030). IMRT patients had significantly fewer chronic post-treatment toxicities (p = 0.008), outperforming 3D-CRT in six of eight toxicities reviewed. Though total treatment length was comparable (43.6 and 44.5 days), IMRT recipients had fewer (27.9 vs 41.3% of patients, p = 0.89), shorter treatment breaks (mean 2.9 vs 4.1 days, p = 0.229). Conclusion This report represents the largest series directly comparing concurrent chemotherapy with IMRT vs 3D-CRT for definitive treatment of anal cancer. IMRT significantly reduced acute and post-treatment toxicities and allowed for safe and effective pelvic dose escalation.
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Affiliation(s)
- Elisha T Fredman
- Department of Radiation Oncology, Seidman Cancer Center, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106 USA
| | - May Abdel-Wahab
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency's (IAEA) Division of Human Health, Vienna, Austria
| | - Aryavarta M S Kumar
- Department of Radiation Oncology, Seidman Cancer Center, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106 USA.,University Hospitals Parma Seidman Cancer Center, Parma, OH USA
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Hidalgo-Tenorio C, Ramírez-Taboada J, Gil-Anguita C, Esquivias J, Omar-Mohamed-Balgahata M, SamPedro A, Lopez-Ruz M, Pasquau J. Safety and immunogenicity of the quadrivalent human papillomavirus (qHPV) vaccine in HIV-positive Spanish men who have sex with men (MSM). AIDS Res Ther 2017; 14:34. [PMID: 28720147 PMCID: PMC5516305 DOI: 10.1186/s12981-017-0160-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/11/2017] [Indexed: 01/05/2023] Open
Abstract
Background Safety and immunogenicity of the quadrivalent human papillomavirus (qHPV) vaccine were evaluated in HIV-positive Spanish MSM. The prevalence of High Squamous Intraepithelial Lesions (HSIL) and genotypes of high-risk human papillomavirus (HR-HPV) were also determined, as well as risk factors associated with the presence of HR-HPV in anal mucosa. Methods This is a randomised, double blind, placebo-controlled trial of the quadrivalent HPV (qHPV) vaccine. The study enrolled from May 2012 to May 2014. Vaccine and placebo were administered at 0, 2 and 6 months (V1, V2, V3 clinical visits). Vaccine antibody titres were evaluated at 7 months. Cytology (Thin Prep® Pap Test), HPV PCR genotyping (Linear Array HPV Genotyping Test), and high-resolution anoscopy (Zeiss 150 fc© colposcope) were performed at V1. Results Patients (n = 162; mean age 37.9 years) were screened for inclusion; 14.2% had HSIL, 73.1% HR-HPV and 4.5% simultaneous infection with HPV16 and 18. Study participants (n = 129) were randomized to qHPV vaccine or placebo. The most common adverse event was injection-site pain predominating in the placebo group [the first dose (83.6% vs. 56.1%; p = 0.0001]; the second dose (87.8% vs. 98.4%; p = 0.0001); the third dose (67.7% vs. 91.9%; p = 0.0001). The vaccine did not influence either the viral load of HIV or the levels of CD4. Of those vaccinated, 76% had antibodies to HPV vs. 30.2% of those receiving placebo (p = 0.0001). In the multivariate analysis, Older age was associated with lower HR-HPV infection (RR 0.97; 95% CI 0.96–0.99), and risk factor were viral load of HIV >200 copies/µL (RR 1.42 95% CI 1.17–1.73) and early commencement of sexual activity (RR 1.35; 95% CI 1.001–1.811). Conclusions This trial showed significantly higher anti-HR-HPV antibody titres in vaccinated individuals than in unvaccinated controls. There were no serious adverse events attributable to the vaccine. In our cohort, 1 of every 7 patients had HSIL and the prevalence of combined infection by genotypes 16 and 18 was low. This suggests that patients could benefit from receiving qHPV vaccine. Older age was the main protective factor against HR-HPV infection, and non-suppressed HIV viremia was a risk factor. Clinical trial registration: ISRCTN14732216 (http://www.isrctn.com/ISRCTN14732216).
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Wang B, Jaiswal S, Saif MW. First Case of the Cervical Lymph Node as the Only Site of Metastasis from Anal Cancer. Cureus 2017; 9:e1291. [PMID: 28680779 PMCID: PMC5493460 DOI: 10.7759/cureus.1291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Anal squamous cell carcinoma was a previously uncommon malignancy that has steadily increased in incidence with the increased prevalence of human papillomavirus (HPV) and human immunodeficiency virus (HIV). Anal squamous cell carcinoma is typically characterized by local and regional involvement and distant metastases are far less common. Here, we report a case of a 36-year-old female initially diagnosed with anal squamous cell carcinoma manifesting as an anal mass along with an enlarged inguinal lymph node. After receiving chemoradiation therapy, she remained disease-free until recently, when she presented with an isolated left infraclavicular lymph node found on physical examination followed by a biopsy that was consistent with recurrent anal squamous cell carcinoma. The positron emission tomography–computed tomography (PET-CT) uptake of her original left inguinal lymph node was decreased, suggesting improved regional disease, and no other metastases were found. Our case represents a rare occurrence of metastatic anal squamous cell carcinoma to an isolated distal lymph node and reminds physicians not to forget a unusual site of metastasis and prevent any delay in treatment.
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Affiliation(s)
- Bo Wang
- Internal Medicine, Tufts Medical Center
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Long-standing Crohn's disease and its implication on anal squamous cell cancer management. Int J Colorectal Dis 2017; 32:661-666. [PMID: 28293746 DOI: 10.1007/s00384-017-2794-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anal squamous cell carcinoma (ASCC) is rare, accounting for only 1% of gastrointestinal malignancies. We sought to better understand management strategies for ASCC in the setting of Crohn's disease (CD). METHODS A retrospective chart review from 2001 to 2016 was conducted using ICD-9/10 codes for CD (555.9/K50) and ASCC (154.3/C44.520). Adult patients with a diagnosis of CD at the time of ASCC diagnosis were included. RESULTS Seven patients (five female) were included with a median age of 50 years. The majority presented with perianal pain (three) and bleeding (four). Mean duration of CD was 20 years. Five patients had active perianal fistulizing disease at the time of ASCC diagnosis. Clinical stage at diagnosis of ASCC was stage 0 (n = 1), stage I (n = 1), stage II (n = 1), stage III (n = 2), stage IV (n = 1), and unknown (n = 1). All patients were treated with radiation and chemotherapy. Three patients experienced complications during radiation therapy: fistulizing disease, stenotic disease, and flap necrosis. Two patients had persistent disease at 6 months; one patient underwent abdominoperineal resection (APR) and the other chemotherapy and radiation. Two patients developed locally residual and metastatic disease and died within 1 year of diagnosis. Five-year disease-free survival was 56%. CONCLUSIONS While the standard Nigro protocol remains standard of care in patients with ASCC, in the setting of CD, patients may be best approached as a case-by-case basis and may even require an operation first due to complications from radiation and aggressive nature of disease. Due to poor treatment outcomes, surveillance guidelines for this patient population are necessary.
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Ssi-Yan-Kai G, Thubert T, Rivain AL, Prevot S, Deffieux X, De Laveaucoupet J. Female perineal diseases: spectrum of imaging findings. ACTA ACUST UNITED AC 2016; 40:2690-709. [PMID: 25896612 DOI: 10.1007/s00261-015-0427-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The female perineum, which is divided into the anterior urogenital triangle and the posterior anal triangle, is a surface structure often overlooked. Female perineal diseases may present with nonspecific clinical signs due to its close anatomical relationship between the different compartments. Diagnosis of the origin of a perineal disorder may also be a difficult problem encountered in pelvi-perineal imaging. Therefore, a precise knowledge of the female perineal anatomy and the associated disease processes is essential to radiologists, pathologists, and surgeons alike who are involved in the evaluation of the patient who presents with a perineal mass. Cross-sectional imaging plays a crucial role for proper management. Due to the robust contrast resolution of MR, MR imaging is the modality of choice for evaluation of the extent of a complex perineal lesion, its relationship to the adjacent structures. It has a greater sensitivity and specificity for the diagnosis than the other non-invasive imaging techniques and is helpful in guidance for surgical planning. The purpose of this article is to highlight the spectrum of imaging findings of female perineal diseases.
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Affiliation(s)
- Guillaume Ssi-Yan-Kai
- Service de Radiologie, AP-HP, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140, Clamart, France.
| | - Thibault Thubert
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140, Clamart, France
| | - Anne-Laure Rivain
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140, Clamart, France
| | - Sophie Prevot
- Service d'Anatomie-Pathologie, AP-HP, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140, Clamart, France
| | - Xavier Deffieux
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140, Clamart, France
| | - Jocelyne De Laveaucoupet
- Service de Radiologie, AP-HP, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140, Clamart, France
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