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Anal Cancer pp 11–32Cite as

Epidemiology and Pathogenesis of Anal Cancer

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Abstract

Anal squamous cell carcinoma (SCC) is a relatively rare malignancy that in most cases is related to chronic infection from the human papillomavirus (HPV). The association with HPV infection places certain groups at high risk of developing precursor anal intraepithelial lesions and invasive cancer, including patients with chronic immunosuppression from human immunodeficiency virus (HIV) or other etiologies. The introductions of highly active antiretroviral therapy for HIV patients and of the HPV vaccine for adolescents have had a strong influence on the incidence of anal SCC over the past three decades, and this is likely to continue into the future as the full effect of HPV vaccines alters rates of HPV infection. While the rarity of anal SCC precludes screening the population at large, groups at high risk for anal dysplasia and progression to invasive disease may derive benefit from focused screening programs, though the data supporting this are still evolving. Finally, for those patients who are found to have high-grade squamous intraepithelial lesions, there are multiple topical and local ablative options for treatment. This chapter will discuss the incidence of anal SCC and how it has changed over time, risk factors for the development of invasive cancer, the pathogenesis of anal SCC, and the screening programs and treatment modalities available for anal dysplasia.

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Abbreviations

5FU:

5-Fluorouracil

AIDS:

Acquired immunodeficiency syndrome

AIN:

Anal intraepithelial neoplasia

APC:

Antigen-presenting cells

ASC-US:

Atypical cells of undetermined significance

DARE:

Digital anorectal exam

HAART:

Highly active antiretroviral therapy

HIV:

Human immunodeficiency virus

HPV:

Human papillomavirus

HRA:

High-resolution anoscopy

HSIL:

High-grade squamous intraepithelial lesion

LSIL:

Low-grade squamous intraepithelial lesion

MSM:

Men who have sex with men

NA-ACCORD:

North American AIDS Cohort Collaboration on Research and Design

Pap:

Papanicolaou

qHPV:

Quadrivalent HPV vaccine

SCC:

Squamous cell carcinoma

SEER:

Surveillance, Epidemiology, and End Results

SIR:

Standardized incidence ration

TCA:

Trichloroacetic acid

UK:

United Kingdom

US:

United States

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Authors and Affiliations

  1. University of South Alabama College of Medicine, Mobile, AL, USA

    John David Roveda Jr

  2. Department of Radiation Oncology, Ochsner Medical Center, New Orleans, LA, USA

    Clayton A. Smith

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  1. John David Roveda Jr
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Editors and Affiliations

  1. Department of Radiation Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Jeffrey Meyer

  2. Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN, USA

    Lisa Kachnic

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Roveda, J.D., Smith, C.A. (2019). Epidemiology and Pathogenesis of Anal Cancer. In: Meyer, J., Kachnic, L. (eds) Anal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-20253-8_2

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