National Cancer Institute®
Last Modified: January 1, 2002
UI - 11319973
AU - Arany I; Muldrow M; Tyring SK
TI - The endogenous interferon system in anal squamous epithelial lesions with different grades from HIV-positive individuals.
SO - Int J STD AIDS 2001 Apr;12(4):229-33
AD - Department of Microbiology, The University of Texas Medical Branch, Galveston, TX 77555-1070, USA. firstname.lastname@example.org
Anal intraepithelial lesions (ASILs) are considered as precursors of anal cancer. The incidence of high-grade ASIL (HSIL) and progression of low-grade ASIL (LSIL) to HSIL are high in HIV-positive men. Endogenous cytokines, such as interferons (IFNs) play an important role in the regulation of proliferation and immune responses in epithelial cells, and thus, they might control the above-mentioned progression events. Accordingly, we determined mRNA levels of IFN-gamma and IFN-gamma receptors, levels of IFN-gamma receptor-associated kinases (JAK1 and TYK2) and signalling molecules (signal transducer and activator of transcription-1 [STAT1], STAT3, interferon-responsive-factor-1 [IRF-1] and IRF-2) as well as inhibitors of cytokine signalling (protein inhibitor of activated STAT1 [PIAS1] and suppressor of cytokine signalling 2 [SOCS2]) in biopsies of anal condylomas, LSILs as well as HSILs from HIV-positive individuals by a semi-quantitative reverse transcribed polymerase chain reaction (RT-PCR) method. We found that HSIL significantly differs in expression of these genes from LSIL and condylomas. Expression profile of HSIL samples showed activation of STAT3 signalling, probably accounting for the observed high levels of genes that support cellular proliferation (IRF-2, c-fos and c-myc). Decreases in levels of suppressors (IFN-gamma and IRF-1) and JAK1 kinase, but increases in levels of inhibitors of cytokine signalling (PIAS1 and SOCS2) might also contribute to the altered cytokine signalling in HSIL biopsies. These findings might reveal important molecular events associated with progression of LSIL to HSIL in HIV-infected men.
UI - 11370496
AU - Chawla AK; Willett CG
TI - Squamous cell carcinoma of the anal canal and anal margin.
SO - Hematol Oncol Clin North Am 2001 Apr;15(2):321-44, vi
AD - Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Squamous cell carcinomas of the anal canal and margin are relatively uncommon neoplasms of the distal gastrointestinal tract and surrounding skin. The major risk factors for tumor development have been defined through various epidemiologic studies. Randomized, phase III trials have defined the standard of care for anal cancer tumors to be a combined modality approach of radiation therapy and chemotherapy. This nonsurgical, organ-sparing regimen results in good anal sphincter function in the majority of patients, and treatment efficacy is favorable when compared with historic surgical series. Anal margin tumors are staged and treated as skin cancers, with a more favorable prognosis.
UI - 11480798
AU - Kondo R; Hanamura N; Kobayashi M; Seki T; Adachi W; Ishii K
TI - Mucoepidermoid carcinoma of the anal canal: an immunohistochemical study.
SO - J Gastroenterol 2001 Jul;36(7):508-14
AD - Second Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
We present a case of mucoepidermoid carcinoma of the anal canal, with special reference to immunohistochemical analysis of the tumor to clarify its histogenesis. A 36-year-old man underwent surgery for mucoepidermoid carcinoma of the anal canal. Immunohistochemical analysis of the resected specimen was performed. Serial sections were stained immunohistochemically by the labeled streptavidin-biotin peroxidase method for various antigens, including epithelial membrane antigen (EMA); carcinoembryonic antigen (CEA); different types of cytokeratins, including CK10 and CAM 5.2; and p53 oncoprotein. The solid component of the tumor cells was immunohistochemically positive for EMA, CEA, and CAM 5.2, but negative for CK10. These staining patterns were different from those of anal squamous epithelium. These results confirm that mucoepidermoid carcinoma of the anus may arise from the anal transitional zone, and that it is biologically different from squamous cell carcinoma of the anus.
UI - 11484975
AU - Indinnimeo M; Cicchini C; Stazi A; Ghini C; Mingazzini P; Laghi A
TI - Analysis of a follow-up program for anal canal carcinoma.
SO - J Exp Clin Cancer Res 2001 Jun;20(2):199-203
AD - Dept. of Surgery Pietro Valdoni, University of Rome La Sapienza, Italy.
The ideal follow-up program for anal canal cancer remains unclear and controversial. We hereby describe an extensive follow-up program for anal canal carcinoma in order to evaluate which examinations and which diagnostic techniques really had impact on survival and management. We evaluated 25 patients with anal canal carcinoma. Local excision (LE) was performed in 5 patients, radiochemotherapy (RCT) in 13, radiochemotherapy and local excision (RCTE) in 7. Mean follow-up time was 6.3 years (range 20 months-11 years). The follow-up program included clinical examination, serum tumor markers evaluation, transrectal ultrasonography (TRUS), anoscopy with either mucosal or by Tru-cut needle multiple biopsies, standard chest X-ray and hepatic-inguinal ultrasonography, endoanal magnetic resonance imaging and in some cases total-body skeletal scintigraphy. A large multicentered randomized and prospective trial is surely lacking and should be undertaken as soon as possible. Our results suggest that an effective local control, rather than a higher survival is the reachable goal at present for anal canal carcinomas. However, further steps should be made to achieve better results. After this experience we propose a more semplified follow-up protocol which consists in performing only rectal examination, endoscopy, Tru-cut needle biopsies and TRUS for local control and inguinal ultrasound and TC to evidence distant metastases.
UI - 11582966
AU - Guimaraes AP; Matos D; Segreto R; Forones NM
TI - [Squamous cell carcinoma of the canal anal]
SO - Arq Gastroenterol 2001 Jan-Mar;38(1):9-13
AD - Universidade Federal de Sao Paulo, UNIFESP-EPM, Sao Paulo, SP.
BACKGROUND: Anal cancer is an uncommon malignancy accounting for only a small (4%) percentage of intestinal cancer. The authors described the clinical aspects and the treatment of the patients with squamous cell carcinoma of the canal anal. PATIENTS: Eleven patients with squamous cell carcinoma treated among 1995 and 1999, were analyzed retrospectively. Nine were women and two were men. The mean age was 57.6 years old (range 35-82 years old). RESULTS: The most common symptoms were rectal bleeding, local tumor and pain. Six of them had previous anal benign disease and two had metastases at the diagnosis. All were submitted to systemic chemotherapy with 5-fluorouracil and mitomycin and radiotherapy with 4500 cGy. Four patients had residual disease after chemo radiation and salvage surgery with abdominoperineal resection was done. Three patients had recurrence and four died from the disease. CONCLUSION: Most of our patients were women. The chemo radiation can be a curable treatment in patients with local disease; conversely in patients with residual disease, abdominoperineal resection must be done. Although anal cancer is an often curable disease, four patients died because the diagnosis was done in advanced stage.
UI - 11578724
AU - Myerson RJ; Kong F; Birnbaum EH; Fleshman JW; Kodner IJ; Picus J; Ratkin
TI - GA; Read TE; Walz BJ Radiation therapy for epidermoid carcinoma of the anal canal, clinical and treatment factors associated with outcome.
SO - Radiother Oncol 2001 Oct;61(1):15-22
AD - Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
BACKGROUND AND PURPOSE: In recent years, treatment with combined chemotherapy and radiation has become the standard of care for epidermoid carcinoma of the anus. However, optimal radiotherapy techniques and doses are not well established. MATERIALS AND METHODS: During the period 1975-1997, 106 patients with epidermoid carcinoma of the anal canal underwent radiation therapy. Treatment policies evolved from radiation therapy alone or with surgery, to combined chemotherapy and radiation followed by surgery, to combined chemotherapy and radiation. RESULTS: Overall 74% of patients were NED (no evidence of disease) at last follow-up. The most important clinical correlate with ultimate freedom from disease (includes the contribution of salvage surgery) was extent of disease. The 5-year ultimate freedom from disease was 87+/-5% for T1/T2N0, 78+/-10% for T3N0 (15% salvaged by surgery), and 43+/-10% for either T4N0 or any N+ lesions (P<0.001, Tarone-Ware). There was no difference between planned vs. expectant surgery (5-year ultimate NED: 67+/-11% planned surgery vs. 73+/-5% expectant surgery). The most important correlate with late toxicity was a history of major pelvic surgery (surgical vs. non-surgical group: P=0.013, Fisher's exact test, two-tailed summation). Thirty-three additional malignancies have been seen in 26 patients. The most common additional malignancies were gynecologic (nine cases), head and neck (six cases), and lung cancer (five cases). CONCLUSIONS: For T1/T2N0 disease, moderate doses of radiation combined with chemotherapy provided adequate treatment. T4N0 and N+ lesions are the most appropriate candidates for investigational protocols evaluating dose intensification. T3N0 tumors may also be appropriate for investigation; however, dose intensification may ultimately prove counterproductive if the cure rate is not improved and salvage surgery is rendered more difficult. The volume of irradiated small bowel should be minimized for patients who have a past history of major pelvic surgery or who (because of locally advanced tumors) may need salvage surgery in the future. Because of the occurrence of additional malignancy, patients with anal cancer should receive general oncologic screening in long-term follow-up.
UI - 11588276
AU - Martin F; Bower M
TI - Anal intraepithelial neoplasia in HIV positive people.
SO - Sex Transm Infect 2001 Oct;77(5):327-31
AD - Department of Oncology, Chelsea and Westminster Hospital, Fulham Road, London SW10 9NH, UK.
OBJECTIVE: To review the current literature on HIV associated anal intraepithelial neoplasia (AIN). METHODS: A comprehensive Medline/Pubmed search was performed for the years 1980-2001 (January) for articles pertaining to HIV associated anal intraepithelial neoplasia. From the MeSH terms "anal intraepithelial neoplasia" and "anal cancer" the following subheadings were used: HIV, homosexual men, HPV, Epidemiology, Etiology, Mortality, Diagnosis, Screening, Drug Therapy, Surgical Therapy, Radio Therapy, Risk factors, ASIL. The search was limited to "human" for all searches. In the absence of enough "randomised controlled trials" the search was extended to clinical trials, reviews, and case reports. One analysis on cost effectiveness and two abstracts presented at 12th World AIDS Conference and 6th Conference on Retrovirus and Opportunistic Infections were included. The 44 publications referred to originate from the United Kingdom (9), the United States (26), and Denmark (5), with one each from Switzerland, Germany, Australia, and France. The Cochrane Database of systematic reviews yielded 11 complete reviews for "anal cancer" and none for "anal intraepithelial neoplasia." The textbook of AIDS-related cancers and their treatment was consulted. We also included our personal experience from the treatment of patients at the Chelsea and Westminster Hospital, one of the largest centres for the management of HIV disease in Europe. CONCLUSION: Routine anal cytological screening followed by appropriate management of AIN is an important issue for HIV infected patients. The natural history of AIN has not been fully established and this prevents clinicians from defining clear management protocols. There is early evidence that the benefits of highly active antiretroviral therapy (HAART) in terms of restoring immune function and reducing opportunistic infections and some neoplasms may not extend to regression of AIN. Under these circumstances it might be predicted that AIN and subsequent progression to invasive anal cancer would rise as HAART prolongs the lives of seropositive people. However, routine anal cytological screening will surely have to await an effective proved intervention for AIN and this would seem to be a pressing clinical goal.
UI - 11596018
AU - Hobbs CM; Lowry MA; Owen D; Sobin LH
TI - Anal gland carcinoma.
SO - Cancer 2001 Oct 15;92(8):2045-9
AD - Department of Hepatic and Gastrointestinal Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
BACKGROUND: Anal gland carcinoma is a rare entity. The authors conducted a joint study of cases coded as definite or possible anal gland carcinoma from the archives of the Armed Forces Institute of Pathology and the Canadian Reference Center for Cancer Pathology. METHODS: Seven cases of potential anal gland carcinoma were identified from the Canadian files and 12 from the Armed Forces Institute of Pathology archives. Of these 19 cases, 14 had adequate material to allow clinical, histologic, and immunohistochemical analysis. RESULTS: Seven of these 14 cases met a modified World Health Organization (WHO) definition of anal gland carcinoma. The mean age of these patients was 66 years (range, 60-72 years), with a male-to-female ratio of 6:1. The tumors were composed of haphazardly dispersed, small glands with scant mucin production that invaded the wall of the anorectal area with no obvious intraluminal component observed clinically or microscopically. Immunohistochemical studies were performed on all seven of these cases, revealing cytokeratin (CK) 7+/CK 20- expression in six cases, and CK 7+/CK 20+ expression in one case. The remaining seven cases showed no intraluminal component but did not meet a modified WHO definition of anal gland carcinoma. This group included three mucinous adenocarcinomas (two clinically arising in anal fistulas), all of which were CK 7+/CK 20+, and a rectal-type adenocarcinoma that was CK 7-/CK 20+. There was also a tumor interpreted as probable rectal-type adenocarcinoma that was CK 7+/CK 20+, and a tumor interpreted as probable squamous cell carcinoma that was CK 7-/CK 20-. The seventh tumor in this group, which could not be classified, was CK 7+/CK 20-. CONCLUSIONS: A useful and discriminating definition of anal gland carcinoma is an anal canal tumor composed of haphazardly dispersed, small glands with scant mucin production invading the wall of the anorectal area without an intraluminal component. The glands are positive for CK 7. Copyright 2001 American Cancer Society.
UI - 11688571
AU - Miettinen M; Furlong M; Sarlomo-Rikala M; Burke A; Sobin LH; Lasota J
TI - Gastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the rectum and anus: a clinicopathologic, immunohistochemical, and molecular genetic study of 144 cases.
SO - Am J Surg Pathol 2001 Sep;25(9):1121-33
AD - Department of Soft Tissue Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA. email@example.com
Gastrointestinal stromal tumors (GISTs), the specific KIT-positive mesenchymal tumors of the gastrointestinal tract, have been sporadically reported in the rectum, but there are few clinicopathologic series. In this study we analyzed the clinicopathologic features of 133 anorectal GISTs, 3 intramural leiomyomas (LMs), and 8 leiomyosarcomas (LMSs) from the files of the Armed Forces Institute of Pathology and the Haartman Institute of the University of Helsinki. Ninety-six GISTs were documented as KIT-positive and three additional ones as CD34-positive. Thirty-four tumors were included by their histologic similarity to KIT- or CD34-positive cases. GIST-specific c-kit gene mutations, mostly in exon 11, were documented in 18 of 29 cases (62%). The GISTs occurred in adults with the age range of 17-90 years (median 60 years) with a significant male predominance (71%). The tumors ranged from small asymptomatic intramural nodules to large masses that bulged into pelvis causing pain, rectal bleeding, or obstruction. They were mostly highly cellular spindle cell tumors; four tumors had an epithelioid morphology. The tumors coexpressed CD34 and KIT and were rarely positive for smooth muscle actin or desmin and never for S-100 protein. Seventy percent of patients with tumors >5 cm with more than 5 mitoses/50 high power fields (HPF) (n = 31) died of disease, whereas only one tumor <2 cm with <5 mitoses/50 HPF (n = 21) recurred and none caused death. Long latency was common between primary operation and recurrences and metastases; either one occurred in 60 of 111 patients with follow-up (54%). Distant metastases were in the liver, bones, and lungs. Three benign actin- and desmin-positive and KIT-negative intramural LMs, similar to those seen in the esophagus, were identified. There were eight LMSs, six of which formed a polypoid intraluminal mass and were actin-positive and KIT-negative. Despite high mitotic counts, only one LMS patient died of disease. A great majority of rectal smooth muscle and stromal tumors are GISTs, which have a spectrum from minimal indolent tumors to overt sarcomas. Intramural LMs are exceptional, and true LMSs are rare, and similar to colonic ones, often present as intraluminal polypoid masses that appear to have a better prognosis than GISTs with similar mitotic rates.
UI - 11706558
AU - Ishii S; Han S; Shiiba K; Mizoi T; Okabe M; Horii A; Nagura H; Matsuno
TI - S; Sasaki I Allelic loss of the NF1 gene in anal malignant melanoma in a patient with neurofibromatosis type 1.
SO - Int J Clin Oncol 2001 Aug;6(4):201-4
AD - Division of Biological Regulation and Oncology, Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai 980-8574, Japan. firstname.lastname@example.org
A 64-year-old man with neurofibromatosis type 1 (NF1) developed a primary malignant melanoma of the anus. Genetic analysis of the resected tumor confirmed loss of heterozygosity (LOH) of the NF1 gene. Anorectal malignant melanoma in NF1 is extremely rare, and genetic studies of the NF1 gene in such patients have not been reported. The allelic loss detected in the present patient supports the previously raised idea that NF1 can function as a tumor suppressor gene in the development of malignant melanoma in patients with NF1.
UI - 11711729
AU - Remzi FH; Church JM; Bast J; Lavery IC; Strong SA; Hull TL; Harris GJ;
TI - Delaney CP; O'Riordain MG; McGannon EA; Fazio VW Mucosectomy vs. stapled ileal pouch-anal anastomosis in patients with familial adenomatous polyposis: functional outcome and neoplasia control.
SO - Dis Colon Rectum 2001 Nov;44(11):1590-6
AD - Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
PURPOSE: The tradeoff of neoplasia control for better function represented by a stapled ileal pouch-anal anastomosis is still controversial in patients with familial adenomatous polyposis. We compared outcomes after mucosectomy and hand-sewn ileal pouch-anal anastomosis with those after stapled ileal pouch-anal anastomosis in 119 patients with familial adenomatous polyposis who underwent surgery since 1983. METHODS: Age, gender, length of follow-up, complications, quality of life, incontinence, urgency, nighttime and daytime seepage, pad usage, necessity of ileostomy, and incidence of adenomas developing in pouch and anal transitional zone were recorded. RESULTS: There were 42 mucosectomy and 77 stapled patients who were followed up for an average of 5.8 and 3.6 years, respectively, with endoscopic surveillance. There was one postoperative death in the stapled group that prohibited long-term follow-up. Nine of 42 mucosectomy patients developed pouch adenomas vs. 8 of 76 in the stapled group. Six of 42 patients developed adenomas in the mucosectomized anal transitional zone in the mucosectomy group. Twenty-one of 76 patients developed adenomas in the anal transitional zone in the stapled group. All were managed with local procedures or further surveillance. One of 76 patients developed cancer in the residual low rectum; this required further resection. Patients with stapled anastomosis had better outcomes in every category. Differences in incontinence, daytime and nighttime seepage, pad usage, and avoidance of ileostomy were statistically significant. All patients with mucosectomy required ileostomy vs. only 40 of 77 patients with stapled anastomosis. CONCLUSION: Familial adenomatous polyposis patients with stapled ileal pouch-anal anastomosis have better functional outcome and can avoid temporary diversion. This should be balanced against a 28 percent incidence of adenomas in the anal transitional zone.
UI - 11730221
AU - Winburn GB
TI - Anal carcinoma or "just hemorrhoids"?
SO - Am Surg 2001 Nov;67(11):1048-58
AD - Department of Surgery, Medical College of Georgia Hospital and Clinics, Augusta 30912-4004, USA.
Cancers of the anal margin and anal canal are extremely rare and often misdiagnosed. Only one to two per cent of large bowel cancers arise in this area. Current management of these cancers includes surgery, 50 patients were diagnosed with anal cancer at two institutions. This retrospective review includes all available cases of anal cancer including all histologies. Patient charts were analyzed for diagnosis, staging, treatment, survival, and recurrence rate. The patients ranged in age from 27 to 92 years (median age 51 years; mean age 52.8 years); there were 22 men and 28 women. The pathologic diagnosis included 44 (88%) with squamous cell carcinoma, three (6%) with melanoma, two (4%) with adenocarcinoma, and one (2%) with Paget's disease. At presentation nine (18%) were classified as stage 0, five (10%) stage I, 21 (42%) stage II, eight (16%) stage III, and seven (14%) stage IV. Mean follow-up data were available on 100 per cent of the patients. Chemoradiotherapy was the primary treatment modality in 25 patients (50%). Ten patients (20%) underwent abdominoperineal resection (APR) in the study. Three patients (6%) received an APR as primary treatment, three (6%) in combination with chemoradiation, and four (8%) for salvage therapy. Fourteen patients (28%) underwent wide local excision (WLE) as the primary treatment. Two patients (4%) underwent WLE plus chemoradiation therapy. One patient (2%) underwent WLE and chemotherapy. There were 18 deaths (36%) in this series. Thirteen patients (26%) died of anal cancer; the average time to death from diagnosis was 13.2 months. Three of these deaths were in patients with melanoma who presented with stage IV disease. Thirty-two patients (64%) are alive, and 30 (60%) of these patients are free of disease (mean time since diagnosis 32.5 months, range 2-151 months). Six patients (12%) had recurrence after treatment (mean time to recurrence 12.6 months; range 3-26 months). Anal cancers continue to present at an advanced stage, with a high mortality rate. Anal melanoma in particular is an aggressive and highly fatal cancer. APR remains the recommended salvage therapy for advanced anal carcinomas that fail primary treatment. In our series only one of four patients has had a disease-free survival of 4 months. Early recognition and detection of primary and recurrent disease is necessary for improved outcome.
UI - 11764880
AU - Kotlarewsky M; Freeman JB; Cameron W; Grimard LJ
TI - Anal intraepithelial dysplasia and squamous carcinoma in immunosuppressed patients.
SO - Can J Surg 2001 Dec;44(6):450-4
AD - Division of General Surgery, The Ottawa Hospital, Ont.
OBJECTIVE: To describe a treatment and follow-up protocol for HIV patients with anal dysplasia or warts, which are at risk of malignant change. DESIGN: An ongoing study of highly selected patients referred to a single surgeon. SETTING: The Colorectal and HIV/AIDS Clinics, University of Ottawa, General Campus. PATIENTS: Ninteen young men who presented with suspicious anal lesions and were referred to the Colorectal Clinic by the HIV/AIDS Clinic, which sees approximately 800 patients per year. OUTCOME MEASURE: Significance of dysplasia or carcinoma. RESULTS: Of the 19 patients, 14 had dysplasia, carcinoma-in-situ or invasive carcinoma. All were treated with multiple mapped cold biopsies and local or wide excision as indicated. Two patients with invasive carcinoma received radiotherapy or chemotherapy, or both. CONCLUSIONS: The incidence of dysplasia or the sequence by which dysplasia progresses to invasive carcinoma is unknown. Surveillance of HIV patients, especially those with nodules or warts, by flexible sigmoidoscopy and Papanicolaou smears every 3 to 12 months is recommended, depending on the severity of the anal lesion.
UI - 11722509
AU - Levine TS; Rolfe KJ; Crow J; Styles S; Perrett CW; Maclean AB; Reid WM
TI - The use of cytospin monolayer technique in the cytological diagnosis of vulval and anal disease.
SO - Cytopathology 2001 Oct;12(5):297-305
AD - Department of Histopathology and Cytopathology, The Royal Free Hospital NHS Trust, London, UK. Tanya.Levine@rfh.nthames.nhs.uk
This pilot study investigated the use of the non-invasive cytospin monolayer technique in the diagnosis and screening of neoplastic and non-neoplastic vulval disease. Twenty-three patients (age range 34-86 years) attending a vulval disease clinic had brush cytology performed. The samples were prepared with a cytospin monolayer technique and the slides Papanicolaou-stained. Subsequent cytological interpretation and diagnosis were performed without knowledge of the clinical history and correlated with follow-up biopsy histopathology from each patient. Twenty-eight cytospin samples were analysed in total, of which 11 (39%) contained dyskaryotic cells which were assessed and a predicted VIN/AIN grade given. Ten of 11 samples (91%) reported as dyskaryotic had VIN/AIN on biopsy histology. One of 11 samples (9%) was reported as containing occasional squamous cells with borderline nuclear features and, although the corresponding biopsy did not show VIN, basal atypia was reported. One patient had features suggesting invasive carcinoma on cytology which was verified on subsequent biopsy. The 15 cases in which no dyskaryotic cells were identified did not show VIN or AIN on subsequent histology. Two cases were acellular and considered inadequate for cytological interpretation. The cytospin monolayer technique allows the diagnosis of neoplastic from non-neoplastic vulval disease. It is a quick, inexpensive and non-invasive method that may have a role in diagnosis, screening and surveillance of patients.
UI - 11745194
AU - Damascelli B; Cantu G; Mattavelli F; Tamplenizza P; Bidoli P; Leo E;
TI - Dosio F; Cerrotta AM; Di Tolla G; Frigerio LF; Garbagnati F; Lanocita R; Marchiano A; Patelli G; Spreafico C; Ticha V; Vespro V; Zunino F Intraarterial chemotherapy with polyoxyethylated castor oil free paclitaxel, incorporated in albumin nanoparticles (ABI-007): Phase II study of patients with squamous cell carcinoma of the head and neck and anal canal: preliminary evidence of clinical activity.
SO - Cancer 2001 Nov 15;92(10):2592-602
AD - Department of Radiology, Istituto Nazionale Tumori, Milano, Italy. email@example.com
BACKGROUND: This study was designed to determine the feasibility, maximum tolerated dose, and toxicities of intraarterial administration of paclitaxel-albumin nanoparticles in patients with advanced head and neck and recurrent anal canal squamous cell carcinoma. Antitumor activity also was assessed. METHODS: Forty-three patients (31 with advanced head and neck and 12 with recurrent anal canal squamous cell carcinoma) were treated intraarterially with ABI-007 every 4 weeks for 3 cycles. In total, 120 treatment cycles were completed, 86 in patients with head and neck carcinoma (median, 3 cycles; range, 1-4) and 34 in patients with anal canal carcinoma (median, 3 cycles; range, 1-4). ABI-007 was compared preliminarily with Taxol for in vitro cytostatic activity. Increasing dose levels from 120 to 300 mg/m2 were studied in 18 patients. Pharmacokinetic profiles after intraarterial administration were obtained in a restricted number of patients. RESULTS: The dose-limiting toxicity of ABI-007 was myelosuppression consisting of Grade 4 neutropenia in 3 patients. Nonhematologic toxicities included total alopecia (30 patients), gastrointestinal toxicity (3 patients, Grade 2), skin toxicity (5 patients, Grade 2), neurologic toxicity (4 patients, Grade 2) ocular toxicity (1 patient, Grade 2), flu-like syndrome (7 patients, Grade 2; 1 patient, Grade 3). In total, 120 transfemoral, percutaneous catheterization procedure-related complications occurred only during catheterization of the neck vessels in 3 patients (2 TIA, 1 hemiparesis) and resolved spontaneously. CONCLUSIONS: Intraarterial administration of ABI-007 by percutaneous catheterization does not require premedication, is easy and reproducible, and has acceptable toxicity. The maximum tolerated dose in a single administration was 270 mg/m2. Most dose levels showed considerable antitumor activity (42 assessable patients with 80.9% complete response and partial response). The recommended Phase II dose is 230 mg/m2 every 3 weeks. Copyright 2001 American Cancer Society.
UI - 9069302
AU - Peiffert D; Bey P; Pernot M; Guillemin F; Luporsi E; Hoffstetter S;
TI - Aletti P; Boissel P; Bigard MA; Dartois D; Baylac F Conservative treatment by irradiation of epidermoid cancers of the anal canal: prognostic factors of tumoral control and complications.
SO - Int J Radiat Oncol Biol Phys 1997 Jan 15;37(2):313-24
AD - Radiotherapy Department, Centre Alexis Vautrin, Nancy, France.
We analyzed in a retrospective series of patients treated by conservative irradiation for an epidermoid cancer of the anal canal (ECAC) the prognostic factors of locoregional control (LRC), survival, late severe complications (LSC), and sphincter conservation (SC). METHODS AND MATERIALS: From 1976 until 1994, 118 patients presenting with an ECAC were conservatively treated (mean age, 65 years). According to the 1987 International Union Against Cancer (TNM) classification, they were: 19 T1, 70 T2, 22 T3, 7 T4, 94 N0, and 24 N1-3. The treatment started with external beam irradiation (EBI) (36 Gy in 3 weeks or 45 Gy in 5 weeks). Concomitant chemotherapy (5-fluorouracil and mitomycin C) was delivered to 31 patients. Two months later, a boost of 20 Gy was delivered by interstitial 192Ir brachytherapy to 101 patients and EBI in 5. Twelve other patients had an abdominoperineal resection (APR). The mean follow-up was 6 years. RESULTS: At 5 years the overall survival was 60%, and specific survival (SS) was 75%; it was 94% for T1, 79% for T2, 53% for T3, and 19% for T4. In multivariate analysis, tumor size (> or = 4 cm), node involvement, and no response to the EBI were factors of poor prognosis for SS. Thirty-two locoregional recurrences occurred of which 21 were local recurrences in the 106 patients treated by a conservative schedule. Only tumor size and response to the EBI were prognostic factors on multivariate analysis for local and LRC. A total of 17 patients presented with LSC (Grade 3, 16 patients; and Grade 4, 1 patient), which was treated by APR in 4 patients and colostomy in 11 (of which 7 were definitive). The only significant prognostic factor for LSC in the multivariate analysis was the total extrapolated response dose of irradiation. The definitive rate of SC after conservative treatment in cured patients was 100% for T1, 82% for T2, 58% for T3, and 100% for T4. Since 1989, improvements of the technique have allowed reduction of the LSC in maintaining the same local control. CONCLUSION: The results of this series are similar to those of the literature. The confirmation of pretherapeutic prognostic factors related to response to the treatment should allow us to adapt the therapeutic intensity for each case to obtain better tumor control, with as few sequelae as possible, to yield a better rate of SC.
UI - 10613313
AU - Joon DL; Chao MW; Ngan SY; Joon ML; Guiney MJ
TI - Primary adenocarcinoma of the anus: a retrospective analysis.
SO - Int J Radiat Oncol Biol Phys 1999 Dec 1;45(5):1199-205
AD - Department of Radiation Oncology, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia. firstname.lastname@example.org
PURPOSE: To report the clinical features and outcome of patients with primary adenocarcinoma of the anus following radiotherapy with or without chemotherapy. METHODS AND MATERIALS: A retrospective analysis was performed on 15 patients referred to Peter MacCallum Cancer Institute between 1981 to 1998 with primary adenocarcinoma of the anus. The median follow-up was 7.5 years. Six patients underwent treatment with curative intent-either chemoradiation or radiotherapy alone. Surgery was mainly limited to either incisional or excisional biopsy. The remaining nine patients were treated with palliative intent because of advanced age, advanced disease, or poor medical status. The biological equivalent doses were calculated for all patients and correlated with time to progression. RESULTS: None of the curative group had relapsed after a median follow-up of 6.6 years. All except one were alive and well. No patient developed any serious long-term toxicity and all patients avoided colostomy. All patients managed with palliative intent died with persistent locoregional disease with a median survival of 0.8 year. CONCLUSION: Primary adenocarcinoma of the anus is a very rare disease that precludes a rigorous analysis. This study demonstrates that radiation and in particular chemoradiation are effective therapies consistent with other recent series and analogous to squamous cell carcinomas of the anus. It also emphasizes the poor prognosis of patients treated with palliative intent.
UI - 11293433
AU - Wolff P; Peiffert D
TI - In regard to Joon et al. IJROBP 1999;45:1199-1205.
SO - Int J Radiat Oncol Biol Phys 2001 Apr 1;49(5):1517
UI - 11523931
AU - Jaworski RC; Biankin SA; Baird PJ
TI - Squamous cell carcinoma in situ arising in inflammatory cloacogenic polyps: report of two cases with PCR analysis for HPV DNA.
SO - Pathology 2001 Aug;33(3):312-4
AD - Department of Tissue Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, New South Wales, Australia.
Inflammatory cloacogenic polyp (ICP) is regarded as part of the spectrum of pathological changes encountered in mucosal prolapse syndrome (MPS)/solitary rectal ulcer. We present the clinicopathological features of two females with squamous cell carcinoma in situ arising in their ICPs. Human papillomavirus (HPV) type 16 was demonstrated in the areas of squamous carcinoma in situ in both polyps by polymerase chain reaction. These cases highlight the need for close scrutiny of the squamous components of these lesions.
UI - 11669560
AU - Grifaichi F; Padovani A; Romeo F; Trinca C; Moscetti L; Cortesi E
TI - Response of metastatic epidermoid anal cancer to single agent irinotecan: a case report.
SO - Tumori 2001 Jan-Feb;87(1):58-9
AD - Department of Experimental Medicine, University La Sapienza, Policlinico Umberto I, Rome, Italy.
We report a case of a patient affected by epidermoid anal cancer who had hepatic progression after standard therapy with the Nigro regimen (fluorouracil and mitomycin C plus radiotherapy). This is an uncommon neoplasm against which only few chemotherapeutic agents have been tested. In our patient salvage treatment with low dose irinotecan resulted in a partial response.
UI - 11787851
AU - Behrendt GC; Hansmann ML
TI - Carcinomas of the anal canal and anal margin differ in their expression of cadherin, cytokeratins and p53.
SO - Virchows Arch 2001 Dec;439(6):782-6
AD - Department of Histopathology, University College London, UK. Gabriele@behrendt.fsnet.co.uk
Carcinomas of the anus are subdivided into those of the anal canal and those of the anal margin. It has been postulated that the various types of tumours of the anal canal represent a spectrum of differentiation rather than tumours of a separate origin. We compared the expression of Pan-cadherin, cytokeratins (CKs) 5/6, 7, 13, 18 and 19, p53 and MIB-1 in 17 cases of carcinoma of the anal canal and 5 cases of carcinoma of the anal margin. Expression of Pan-cadherin was decreased in 70% of carcinomas of the anal canal but preserved in all five carcinomas of the anal margin. Most of the carcinomas of the anal canal expressed all of the CKs studied. Carcinomas of the anal margin showed expression of CK 5/6 and CK 13, whereas CK7, CK18 and CK19 were rarely expressed. Loss of expression of CK 18 and 19, but not CK 7, is a marker of dedifferentiation in anal canal carcinoma. Of the carcinomas of the anal canal and anal margin, 46% and 80%, respectively, expressed p53. The immunhistochemical findings support the opinion that the various subtypes of carcinoma of the anal canal represent variants in differentiation of squamous cell carcinomas of the anal canal. They confirm the separate histogenetic origin of tumours from the anal canal and anal margin.
UI - 11526690
AU - Peroni M; Visci P
TI - [Colposcopy in human papilloma virus infections of the distal uro-ano-genital tract]
SO - Minerva Ginecol 2000 Dec;52(12 Suppl 1):59-67
AD - Unita Operativa Malattie a Trasmissione Sessuale della Sfera Genitale Femminile, Istituto di Ricovero e Cura a Carattere-Scientifico "L. Spallanzani", Roma.
HPV infections fall within the STDs and certain high-risk types have a significant role in the cancer genesis of the distal genital tract. The infection results can be clinically evident or be subclinical and in this latter case they are revealed by a highly-sensitive colposcopic examination after acetic acid application at 3% followed by Schiller's test with Lugol solution in weak iodine concentration. Indeed, the distal districts of male and female uroano-genital tracts takes advantage of the colposcopic diagnostics although complementary analysis like histology or DNA tests for HPV typing have sometimes to be performed to confirm the results or to evaluate the prognosis. HPV subclinical lesions, above all at cervical and vaginal level, are those mostly involved with the cancer genesis: the bright-white acidophilia often combined with irregular surface, atypical vascularization and discrete iodine caption represents a colposcopic indication to complementary diagnostic analysis aiming at choosing the most suitable therapy for which colposcopy can show the lesion topography and its frequent plurilocalizations.
UI - 11817122
AU - Chapet O; Corcelle-Requin A; Padovani L; Bizollon MH; Merieux C;
TI - Trillet-Lenoir V; Gerard JP [Anorectal neuroendocrine carcinoma and small cell carcinoma. Report of two cases]
SO - Rev Med Interne 2001 Nov;22(11):1109-15
AD - Service de radiotherapie-oncologie, centre hospitalier Lyon-Sud, 69495 Pierre-Benite, France.
INTRODUCTION: Anorectal neuroendocrine small cell carcinomas are rare and frequently difficult to treat. EXEGESIS: Two women presented with a fungating tumor located on the upper part of the anal canal. Histology displayed neuron-specific enolase and chromogranin A immunoreactive small cell tumors. A plasmatic neuron-specific enolase secretion was noticed in one case. Tumors were poorly reactive to chemotherapy and irradiation, less than in usual epidermoid anal canal cancer. Evolution was quickly leading to hepatic and pulmonary metastases in both cases. CONCLUSION: Anorectal neuroendocrine small cell carcinomas are rare but need to be individualized from epidermoid anal canal tumors owing to their poor prognosis with a frequent occurrence of hepatic and pulmonary metastasis.
UI - 11744829
AU - Palefsky JM; Holly EA; Ralston ML; Da Costa M; Bonner H; Jay N; Berry
TI - JM; Darragh TM Effect of highly active antiretroviral therapy on the natural history of anal squamous intraepithelial lesions and anal human papillomavirus infection.
SO - J Acquir Immune Defic Syndr 2001 Dec 15;28(5):422-8
AD - Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California 94143, USA. email@example.com
The effect of highly active antiretroviral therapy (HAART) on the natural history of anal squamous intraepithelial lesions (ASIL)-the likely anal cancer precursor-and anal human papillomavirus (HPV) infection is unknown. ASIL severity and level of anal HPV DNA were evaluated among HIV-positive men who have sex with men (MSM) for at least 6 months before initiation of HAART. The results were compared with those from a 6-month period after initiation of HAART. Anal swabs for cytology and HPV studies were obtained, followed by high-resolution anoscopy and biopsy. Among men whose most severe pre-HAART diagnosis was atypical squamous cells of undetermined significance or low-grade ASIL, 18% (confidence interval [CI], 6-31%, 7 of 38) progressed and 21% (CI, 8-34%, 8 of 38) regressed 6 months after starting HAART. Seventeen percent (CI, 0-38%, 2 of 12) of study subjects who began with a normal diagnosis developed ASIL. Only 4% (CI, 0-10%, 1 of 28) of study subjects with high-grade ASIL regressed to normal. There was no reduction in the proportion of study subjects who tested positive for HPV DNA or HPV DNA levels after HAART initiation. The ASIL and HPV data were similar to those of the pre-HAART comparison period. These results indicate that HAART has little effect on either ASIL or HPV in the first 6 months after HAART initiation.
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