Anal Cancer

  • Jim Hill


Anal cancer comprises 1% of lower gastrointestinal tract cancers with approximately 800 reported new cases per year in the UK. Nearly all cases are of epidermoid type (squamous, basaloid, or cloacogenic); malignant melanoma, and other primary malignancies are very rare and respond poorly to any treatment modality. Anal canal lesions are twice as common as margin cancers; canal lesions are twice as common in women with the reverse ratio for margin lesions. The distinction between the two lesion sites is clinically important for two reasons: firstly, that canal lesions can invade adjacent organs (vagina, urethra, prostate, and bladder) and may require different treatment strategies and, secondly, that T1 margin lesions can be excised locally. Presenting symptoms include pain (49%), bleeding (44%), change in bowel habit (34%), a mass (24%), and pruritus/discharge (23%) [1].


Anal Canal Complete Response Rate Anal Cancer Myocutaneous Flap Anal Margin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Wolfe HR, Bussey HJ. Squamous-cell carcinoma of the anus. Br J Surg. 1968;55:295–301.PubMedCrossRefGoogle Scholar
  2. 2.
    O’Brien PH, Jenrette JM, Wallace KM, et al. Epidermoid cancer of the anus. Surg Gynecol Obstet. 1982;155:745–51.PubMedGoogle Scholar
  3. 3.
    Hardcastle JD, Bussey HJR. Results of surgical treatment of squamous cell carcinoma of the anal canal and anal margin seen at St. Mark’s Hospital 1928–1966. Proc R Soc Med. 1968;61:629–30.PubMedGoogle Scholar
  4. 4.
    Boman BM, Moertel CG, O’Connell MJ, et al. Carcinoma of the anal canal: a clinical and pathological study of 188 cases. Cancer. 1984;54:114–25.PubMedCrossRefGoogle Scholar
  5. 5.
    Nigro ND. An evaluation of combined therapy for squamous cell cancer of the anal canal. Dis Colon Rectum. 1984;27:763–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Flam M, Madhu J, Pajak TF, et al. Role of mitomycin in combination with fluorouracil and radiotherapy and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol. 1996;14:2527–39.PubMedGoogle Scholar
  7. 7.
    Bartelink H, Roelofsen F, Eschwege R, et al. Concomitant radiotherapy and chemotherapy superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the EORTC Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol. 1997;15:1040–9.Google Scholar
  8. 8.
    UKCCCR Anal Cancer Trial Working Party. Epidermoid anal cancer: results from the UKCCCR randomized trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. Lancet. 1996;348:1049–54.CrossRefGoogle Scholar
  9. 9.
    Northover J, Glynne-Jones R, Sebag-Montefiore D, et al. Chemoradiation for the treatment of epidermoid anal cancer: 13 year follow-up of the first randomised UKCCCR Anal Cancer Trial (ACT 1). Br J Cancer. 2010;30:1123–8.CrossRefGoogle Scholar
  10. 10.
    James R, Wan S, Glynne-Jones R, et al. A randomized trial of chemoradiation using mitomycin or cisplatin, with or without maintenance cisplatin/5FU in squamous cell carcinoma of the anus (ACT II). J Clin Oncol. 2009;27:18 (suppl; abstr LBA4009).CrossRefGoogle Scholar
  11. 11.
    Das P, Cantor SB, Zampieri JB, et al. Long term quality of life after radiotherapy for the treatment of anal cancer. Cancer. 2010;116:822–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Mendenhall WM, Zlotecki RA, Vauthey J-N, et al. Squamous cell carcinoma of the anal margin. Oncology. 1996;10:1843–54.PubMedGoogle Scholar
  13. 13.
    Radice E, Nelson H, Mercill S, et al. Primary myocutaneous flap closure following resection of locally advanced pelvic malignancies. Br J Surg. 1999;86:349–54.PubMedCrossRefGoogle Scholar
  14. 14.
    Mann CV, Springall R. The use of a muscle graft for unhealed perineal sinus. Br J Surg. 1986;73:1000–1.PubMedCrossRefGoogle Scholar
  15. 15.
    Brough WA, Schofield PF. The value of the rectus abdominis myocutaneous flap in the treatment of complex perineal fistula. Dis Colon Rectum. 1991;34:148–50.PubMedCrossRefGoogle Scholar
  16. 16.
    Zelnick RS, Haas PA, Ajlouni M, Szilagyi E, Fox TA. Results of abdominoperineal resections for failures after combination chemotherapy and radiation therapy for anal canal cancers. Dis Colon Rectum. 1992;35:574–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Tanum G. Treatment of relapsing anal carcinoma. Acta Oncol. 1993;32:33–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Ellenhorn JD, Enker WE, Quan SH. Salvage abdominoperineal resection following combined chemotherapy and radiotherapy for epidermoid carcinoma of the anus. Ann Surg Oncol. 1994;2:105–10.CrossRefGoogle Scholar
  19. 19.
    Longo WE, Veranva III AM, Wade TP, et al. Recurrent squamous cell carcinoma of the anal canal. Predictors of initial treatment failure and results of salvage surgery. Ann Surg. 1994;220:40–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Pocard M, Tiret E, Nugent K, Dehni N, Parc R. Results of salvage abdominoperineal resection for anal cancer after radiotherapy. Dis Colon Rectum. 1998;4:1488–93.CrossRefGoogle Scholar
  21. 21.
    Ghouti L, Houvenaeghel G, Moutardier V. Salvage abdominoperineal resection after failure of conservative treatment in anal epidermoid cancer. Dis Colon Rectum. 2005;48:16–22.PubMedCrossRefGoogle Scholar
  22. 22.
    Papaconstantinou HT, Bullard K, Rothenberger DA, Modoff RD. Salvage abdominoperineal resection after failed Nigro protocol: modest success, major morbidity. Colorectal Dis. 2006;8(2):124–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Schiller DE, Cummings BJ, Rai S. Outcomes of salvage surgery for squamous cell carcinoma of the anal canal. Ann Surg Oncol. 2007;14:2780–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Mullen JT, Rodriquez-Bigas MA, Chang GJ. Results of surgical salvage after failed chemoradiation therapy for epidermoid carcinoma of the anal canal. Ann Surg Oncol. 2007;14:478–83.PubMedCrossRefGoogle Scholar
  25. 25.
    Hill J, Meadows H, et al. Pathological staging of epidermoid anal carcinoma for the new era. Colorectal Dis. 2003;5(3):206–13.PubMedCrossRefGoogle Scholar
  26. 26.
    Goldstone SE, Moshier E. Detection of oncogenic human papillomavirus impacts anal screening guidelines in men who have sex with men. Dis Colon Rectum. 2010;53:1135–42.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  1. 1.Department of SurgeryManchester Royal InfirmaryManchesterUK

Personalised recommendations