Anal Carcinoma: A Series of Cases with a Literature Review

Abstract

Abstract The aim of this study was to analyze the cases of five patients with squamous cell carcinoma (SCC) and to draw attention to the dilemma in the treatment of incontinence on admission of these patients and to present, through a literature review, locations of the surgical treatment. The anal carcinoma is a rare disease which involves different histopathological (HP) types of cancer. They account for about 2.5% of all digestive cancers. The treatment of the disease is multimodal. There are dilemmas about screening of precancerous lesions and treatment of diagnosed incontinence. There is a high similarity between HPV infection and SCC. Our methods and results were compared with the data from the literature. In the period of three years (from 2013 to 2015), five cases of the anal carcinoma were diagnosed and treated in the regional hospital. In all of our cases, the disease was histopathologically confirmed as SCC of the anal and perianal areas. It excluded the cases of anal adenocarcinoma (AAC). Nearly half of the patients (40%) were incontinent and the rectum excision was one of the possible solutions. Distinction in histopathological structure created the confusion in the treatment of these patients. The dilemma we had was whether to do an amputation of the rectum in patients with incontinence before the standardized Chemoradiation therapy (CRT). The review of the literature sums up certain conclusions. The diagnosis of SCC includes the perianal "ulcer" that does not heal, as well as atypical anoperianal growths. Surgical treatment of SCC is indicated when the diameter of lesion is small (2 cm), or the disease is persistent or recurrent. In the case of anal incontinence because of the tumor changes, the abdominoperineal resection of the rectum (APR) is an alternative to performing bipolar colostomy and CRT. The review of the literature using MEDLINE/PubMed databases did not find the case with restoring anal continence after this treatment. Testing a larger number of patients with incontinence on admission would provide a more clear answer to the question of the treatment of these patients.