Skip to main content

Treatment of Non-squamous Histologies in Anal Cancer

  • Chapter
  • First Online:
Anal Cancer
  • 459 Accesses

Abstract

Most anal canal cancers are of squamous histology; however, practitioners will occasionally encounter the non-squamous histologies such as melanoma, large-cell neuroendocrine tumors, classic small-cell carcinoma, and adenocarcinoma. Each of these tumors has a unique natural history and distinct response to therapy. So while the treatment approach requires familiar combinations of surgical, systemic, and radiation therapy techniques, this chapter highlights the similarities and differences between these tumors and provides a rational and evidence-based treatment approach.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 49.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 64.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67:7–30.

    Article  Google Scholar 

  2. Metildi C, McLemore EC, Tran T, Chang D, Cosman B, Ramamoorthy SL, et al. Incidence and survival patterns of rare anal canal neoplasms using surveillance epidemiology and end result registry. Am Surg. 2013;79:1068–74.

    PubMed  PubMed Central  Google Scholar 

  3. Falch C, Stojadinovic A, Hann-von-Weyern C, Protic M, Nissan A, Faries MB, et al. Anorectal malignant melanoma: extensive 45-year review and proposal for a novel staging classification. J Am Coll Surg. 2013;217:324–35.

    Article  Google Scholar 

  4. Ologun GO, Stevenson Y, Shen A, Rana NK, Hussain A, Bertsch D, et al. Anal melanoma in an elderly woman masquerading a hemorrhoid. Cureus. 2017;9(11):e1880.

    PubMed  PubMed Central  Google Scholar 

  5. Tariq MU, Ud Din N, Ud Din NF, Fatima S, Ahmad Z. Malignant melanoma of the anorectal region: a clinicopathologic study of 61 cases. Ann Diagn Pathol. 2014;18:275–81.

    Article  Google Scholar 

  6. Ross M, Pezzi C, Pezzi T, Meurer D, Hickey R, Balch C. Patterns of failure in anorectal melanoma. Arch Surg. 1990;125:313–6.

    Article  CAS  Google Scholar 

  7. Konstadoulakis MM, Ricaniadis N, Walsh D, Karakousis CP. Malignant melanoma of the anorectal region. J Surg Oncol. 1995;58:118–20.

    Article  CAS  Google Scholar 

  8. Perez DR, Trakarnsanga A, Shia J, Nash GM, Temple LK, Paty PB, et al. Locoregional lymphadenectomy in the surgical management of anorectal melanoma. Ann Surg Oncol. 2013;20:2339–44.

    Article  Google Scholar 

  9. Goldman S, Glimelius B, Påhlman L. Anorectal malignant melanoma in Sweden: report of 49 patients. Dis Colon Rectum. 1990;33:874–7.

    Article  CAS  Google Scholar 

  10. Slingluff CL, Vollmer RT, Seigler HF. Anorectal melanoma: clinical characteristics and results of surgical management in twenty-four patients. Surgery. 1990;107:1–9.

    PubMed  Google Scholar 

  11. Luna-Perez P, Rodriguez DF, Macouzet JG, Labastida S. Anorectal malignant melanoma. Surg Oncol. 1996;5:165–8.

    Article  CAS  Google Scholar 

  12. Roumen RMH. Anorectal melanoma in the Netherlands: a report of 63 patients. Eur J Surg Oncol. 1996;22:598–601.

    Article  CAS  Google Scholar 

  13. Pessaux P, Pocard M, Elias D, Duvillard P, Avril MF, Zimmerman P, et al. Surgical management of primary anorectal melanoma. Br J Surg. 2004;91:1183–7.

    Article  CAS  Google Scholar 

  14. Belli F, Gallino GF, Vullo SL, Mariani L. Melanoma of the anorectal region. The experience of the National Cancer Institute Milano. Eur J Surg Oncol. 2009;35:757–62.

    Article  CAS  Google Scholar 

  15. Zhang S, Gao F, Wan D. Abdominoperineal resection or local excision? A survival analysis of anorectal malignant melanoma with surgical management. Melanoma Res. 2010;20:338–41.

    Article  Google Scholar 

  16. Ballo MT, Gershenwald JE, Zagars GK, Lee JE, Mansfield PF, Strom EA, et al. Sphincter sparing local excision and adjuvant radiation for anal-rectal melanoma. J Clin Oncol. 2002;20:4555–8.

    Article  Google Scholar 

  17. Kelly P, Zagars GK, Cormier JN, Ross MI, Guadagnolo BA. Sphincter-sparing local excision and hypofractionated radiation therapy for anorectal melanoma. Cancer. 2011;117:4747–55.

    Article  Google Scholar 

  18. Malaguarnera G, Madeddu R, Catania VE, Bertino G, Morelli L, Perrotta RE, et al. Anorectal mucosal melanoma. Oncotarget. 2018;9(9):8785–800.

    Article  Google Scholar 

  19. Bentzen SM, Overgaard J, Thames HD, Overgaard M, Vejby Hansen P, von der Maase H, et al. Clinical radiobiology of malignant melanoma. Radiother Oncol. 1989;16:169–82.

    Article  CAS  Google Scholar 

  20. Ballo MT, Ross MI, Cormier JN, Myers JN, Lee JE, Gershenwald JE, et al. Combined-modality therapy for patients with regional nodal metastases from melanoma. Int J Radiat Oncol Biol Phys. 2006;64:106–13.

    Article  Google Scholar 

  21. Herfs M, Roncarati P, Koopmansch B, Peulen O, Bruyere D, Lebeau A, et al. A dualistic model of primary anal canal adenocaracinoma with distinct cellular origins, etiologies, inflammatory microenvironments and mutational signatures: implications for personalised medicine. Br J Cancer. 2018;118(10):1302–12.

    Article  CAS  Google Scholar 

  22. Belkacemi Y, Berger C, Poortmans P, Piel G, Zouhair A, Méric JB, et al. Management of primary anal canal adenocarcinoma: a large retrospective study from the rare cancer network. Int J Radiat Oncol Biol Phys. 2003;56:1274–83.

    Article  Google Scholar 

  23. Papagikos M, Crane CH, Skibber J, Janjan NA, Feig B, Rodriguez-Bigas MA, et al. Chemoradiation for adenocarcinoma of the anus. Int J Radiat Oncol Biol Phys. 2003;55:669–78.

    Article  Google Scholar 

  24. Chang GJ, Gonzalez RJ, Skibber JM, Eng C, Das P, Rodriguez-Bigas MA. A twenty-year experience with adenocarcinoma of the anal canal. Dis Colon Rectum. 2009;52:1375–80.

    Article  Google Scholar 

  25. Iesalnieks I, Gaertner WB, Glaβ H, Strauch U, Hipp M, Agha A, et al. Fistula-associated anal adenocarcinoma in Chrohn’s disease. Inflamm Bowel Dis. 2010;16:1643–8.

    Article  Google Scholar 

  26. Oronsky B, Ma PC, Morgensztern D, Carter CA. Nothing but NET: a review of neuroendocrine tumors and carcinomas. Neoplasia. 2017;19(12):991–1002.

    Article  CAS  Google Scholar 

  27. Andre TR, Brito M, Freire JG, Moreira A. Rectal and anal canal neuroendocrine tumors. J Gastrointest Oncol. 2018;9:354–7.

    Article  Google Scholar 

  28. National Cancer Institute. Gastrointestinal carcinoid tumors treatment (PDQ): health professional version; 2018. Retrieved from https://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq/

  29. Strosberg J. Evolving treatment strategies for management of carcinoid tumors. Curr Treat Options Oncol. 2013;14:374–88.

    Article  Google Scholar 

  30. Cimino-Mathews A, Sharma R, Illei PB. Detection of human papillomavirus in small cell carcinomas of the anus and rectum. Am J Surg Pathol. 2012;36:1087–92.

    Article  Google Scholar 

  31. Stoler MH, Mills SE, Gersell DJ, Walker AN. Small-cell neuroendocrine carcinoma of the cervix. A human papillomavirus type 18-associated cancer. Am J Surg Pathol. 1991;15:28–32.

    Article  CAS  Google Scholar 

  32. Bishop JA, Westra WH. Human papillomavirus-related small cell carcinoma of the oropharynx. Am J Surg Pathol. 2011;35:1679–84.

    Article  Google Scholar 

  33. Khan GN, Siddiqui M, Ben-Josef E, Zalupski MM. An unusual case of small cell carcinoma of the anal canal. Am J Clin Oncol. 2009;32:543–4.

    Article  Google Scholar 

  34. Carvalho N, Albergaria D, Lebre R, Giria J, Fernandes V, Vidal H, et al. Anal canal gastrointestinal stromal tumors: case report and literature review. World J Gastroenterol. 2014;20:319–22.

    Article  Google Scholar 

  35. Grann A, Paty PB, Guillem JG, Cohen AM, Minsky BD. Sphincter preservation of leiomyosarcoma of the rectum and anus with local excision and brachytherapy. Dis Colon Rectum. 1999;42:1296–9.

    Article  CAS  Google Scholar 

  36. Thalheimer L, Richmond B, Lohan J. Leiomyosarcoma of the anal canal: case report and review of the literature. Am Surg. 2008;74:76–8.

    PubMed  Google Scholar 

  37. Rowe NM, Meisher IE, Sheka KP, Bopaiah V. Leiomyosarcoma of the anal canal: a case report. Int J Surg. 2007;5:345–50.

    Article  Google Scholar 

  38. Kim BG, Chang IT, Park JS, Choi YS, Kim GH, Park ES, et al. Transanal excision of a malignant fibrous histiocytoma of anal canal: a case report and literature review. World J Gastroenterol. 2008;14:1449–62.

    Google Scholar 

  39. DeMatteo RP, Ballman KV, Antonescu CR, Corless C, Kolesnikova V, von Mehren M, et al. Long-term results of adjuvant imatinib mesylate in localized, high-risk, primary gastrointestinal stromal tumor: ACOSOG Z9000 (Alliance) intergroup phase 2 trial. Ann Surg. 2013;258:422–9.

    Article  Google Scholar 

  40. Rutkowski P, Gronchi A, Hohenberger P, Bonvalot S, Schöffski P, Bauer S, et al. Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors (GIST): the EORTC STBSG experience. Ann Surg Oncol. 2013;20:2937–43.

    Article  Google Scholar 

  41. Cavnar MJ, Wang L, Balachandran VP, Antonescu CR, Tap WD, Keohan M, et al. Rectal gastrointestinal stromal tumor (GIST) in the era of imatinib: organ preservation and improved oncologic outcome. Ann Surg Oncol. 2017;24:3972–80.

    Article  Google Scholar 

  42. Al-Tarakji M, Feilchenfeldt J, Haidar A, Szabados L, Abdelaziem S, Sayed A, et al. Rare occurrence of metastasis from lung cancer to the anus: case report and review of the literature. World J Surg Oncol. 2016;12:157.

    Article  Google Scholar 

  43. Ruymbeke H, Harlet L, Stragier B, Steenkiste E, Ryckx M, Marolleau F. Anorectal metastasis from breast carcinoma; a case report and review of the literature. BMC Res Notes. 2018;11:268.

    Article  Google Scholar 

  44. Park J, Ng K, Saw RPM, Thompson JF, Young CJ. Metastatic melanoma to the colon, rectum, and anus: a 50-year experience. Ann Surg Oncol. 2018;25(8):2178–83.

    Article  Google Scholar 

  45. Ejtehadi F, Chatzizacharias NA, Brais RJ, Hall NR, Godfrey EM, Huguet E, et al. Colonic and anal metastases from pancreato-biliary malignancies. World J Gastroenterol. 2014;20:3693–7.

    Article  Google Scholar 

  46. Sawh RN, Borkowski J, Broaddus R. Metastatic renal cell carcinoma presenting as a hemorrhoid. Arch Pathol Lab Med. 2002;126:856–8.

    PubMed  Google Scholar 

  47. Nishikawa T, Ishihara S, Ushiku T, Hata K, Sasaki K, Murono K, et al. Anal metastasis from rectal adenocarcinoma. Clin J Gastroenterol. 2016;9:379–83.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Matthew T. Ballo .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ballo, M.T. (2019). Treatment of Non-squamous Histologies in Anal Cancer. In: Meyer, J., Kachnic, L. (eds) Anal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-20253-8_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-20253-8_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-20252-1

  • Online ISBN: 978-3-030-20253-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics