Malignant Tumors of the Anal Canal and Anus

  • A. Roth
  • M.-C. Marti


Cancer of the anus comprises several different histologic types and accounts for 1%–2.5% of all malignant tumors of the large bowel. Several histopathologic varieties have been described requiring different therapeutic options. Knowledge about the histogenesis of the tissues of the anal canal is necessary to understand pathologic findings.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ajani JA, Carrasco CH, Jackson DE, Wallace S (1989) Combination of cisplatin plus fluoropyrimidine chemotherapy effective against liver metastases from carcinoma of the anal canal. Am J Med 87:221–224PubMedGoogle Scholar
  2. 2.
    AM AS, Mermillod B, Roth AD, Marti MC, Kurtz JM (1997) The impact of treatment factors on local control in T2-T3 anal carcinomas treated by radiotherapy with or without chemotherapy. Cancer 79:2329–2335Google Scholar
  3. 3.
    Al Jurf AS, Turnbull RB, Fazio VW (1979) Local treatment of squamous cell carcinoma of the anus. SURG Gynecol Obstet 148:574–578Google Scholar
  4. 4.
    Austin DF (1982) Etiological clues from descriptive epidemiology: squamous carcinoma of the rectum or anus. Natl Cancer Inst Monogr 62:89–90PubMedGoogle Scholar
  5. 5.
    Bartelink H, Roelofsen F, Eschwege F et al (1997) Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol 15:2040–2049PubMedGoogle Scholar
  6. 6.
    Barthelemy N, Loygue J, Parc R et al (1986) Etude d’une serie de 204 cas de cancer du canal anal traites de 1972 a 1982. Societe Française de Radiologic J Eur Radiother 7:133–140Google Scholar
  7. 7.
    Beahrs OH (1979) Management of cancer of the anus. Am J Roentgenol 133:791–795Google Scholar
  8. 8.
    Beck DE (1995) Paget’s disease and Bowen’s disease of the anus. Semin Colon Rect Surg 6:143–149Google Scholar
  9. 9.
    Bender MD, Lechago J (1976) Leukoplakia of the anal canal. Dig Dis Sci 21:867–872Google Scholar
  10. 10.
    Berney C, Roth AD, Rohner S, Becker C, Marti RC, Alberto P (1996) Potentiel curatif de la chimiotherapie (CHIMIO) in-tra-arterielle (IA) dans les cancers du penis (PE) et du canal anal (CA) avances ou en rechute. Societe Suisse de Chirurgie, Geneva, June 1996Google Scholar
  11. 11.
    Boman BM, Moertel CG, O’Connell MJ et al (1984) Carcinoma of the anal canal. A clinical and pathologic study of 188 cases. Cancer 54:114–125PubMedGoogle Scholar
  12. 12.
    Boulis Wassif S, Caspers RJL (1983) Die Therapie des analen Karzinoms. Coloproctology 4: 228–231Google Scholar
  13. 13.
    Buschke A, Lowenstein L (1925) Uber karzinomahnliche Condylomata Acuminata des Penis. Klin Wochenschr 4:1726–1728Google Scholar
  14. 14.
    Cantril ST, Green JP, Schall GL, Schaupp WC (1983) Primary radiation therapy in the treatment of anal carcinoma. Int J Radiat Oncol Biol Phys 9:1271–1280PubMedGoogle Scholar
  15. 15.
    Cho CC, Taylor CW, Padmanabban A et al (1991) Squamous cell carcinoma of the anal canal: management with combined chemo-radiation therapy. Dis Colon Rectum 34:675–681PubMedGoogle Scholar
  16. 16.
    Clark J, Petrelli N, Herrera LM, Helmann A (1986) Epidermoid carcinoma of the anal canal. Cancer 57:400–406PubMedGoogle Scholar
  17. 17.
    Collins JM (1984) Pharmacologic rationale for regional drug delivery. J Clin Oncol 2:498–504PubMedGoogle Scholar
  18. 18.
    Cooper PH, Millis SE, Allen MS (1982) Malignant melanoma of the anus. Report of 12 patients and analysis of 225 additional cases. Dis Colon Rectum 25:693–703PubMedGoogle Scholar
  19. 19.
    Courtial J, Fernandez Colmeiro JM (1960) Les indications et les resultats de la roentgentherapie et de la curietherapie dans les cancers du canal anal. Arch Mai Appar Dig 49:43Google Scholar
  20. 20.
    Cummings B, Keane TJ, Thomas G et al (1984) Results and toxicity of the treatment of anal canal carcinoma by radiation therapy or radiation therapy and chemotherapy. Cancer 54:2062–2068PubMedGoogle Scholar
  21. 21.
    Cummings BJ, Keane TJ, Hawkins NV, O’Sullivan B (1986) Treatment of perianal carcinoma by radiation or radiation plus chemotherapy. Int J Radiat Oncol Biol Phys 12 [Suppl 1]:170Google Scholar
  22. 22.
    Cummings BJ (1990) Anal cancer. Int J Radiat Oncol Biol Phys 19:1309–1315PubMedGoogle Scholar
  23. 23.
    Cummings BJ (1983) Radiation therapy and chemotherapy in the treatment of primary anal canal carcinoma. Compr Ther 9:59–63PubMedGoogle Scholar
  24. 24.
    Cummings BJ (1992) Concomitant radiotherapy and chemotherapy for anal cancer. Semin Oncol 19:102–108PubMedGoogle Scholar
  25. 25.
    Cutuli B, Fenton J, Labib et al (1988) Anal margin carcinoma: 21 cases treated at the Institute Curie by exclusive conservative radiotherapy. Radiother Oncol 11:1–6PubMedGoogle Scholar
  26. 26.
    Dahlin JR, Weiss NS, Klopfenstein LL et al (1982) Correlates of homosexual behavior and the incidence of anal cancer. JAMA 247:1988–1990Google Scholar
  27. 27.
    Dalby JE, Pointon RS (1961) The treatment of anal carcinoma by interstitial irradiation. Am J Roentgenol 85:515–520Google Scholar
  28. 28.
    de Gara CJ, Basrur V, Figueredo A et al (1995) The influence of age on the management of anal cancer. Hepatogastroen-terology 42:73–76Google Scholar
  29. 29.
    Devois A, Decker R (1960) La curiepuncture du cancer de l’anus. Arch Fr Mai App Dig 49: 54–67Google Scholar
  30. 30.
    Doci R, Zucali R, Bombelli L et al (1992) Combined chemoradiation therapy for anal cancer. A report of 56 cases. Ann Surg 215:150–155PubMedGoogle Scholar
  31. 31.
    Doci R, Zucali R, La Monica G et al (1996) Primary chemoradiation therapy with fluorouracil and cisplatin for cancer of the anus: results in consecutive patients. J Clin Oncol 14:3121–3125PubMedGoogle Scholar
  32. 32.
    DuBois JB, Garrigues JM, Pujol H (1991) Cancer of the anal canal: report on the experience of 61 patients. Int J Radiat Oncol Biol Phys 20:575–580PubMedGoogle Scholar
  33. 33.
    Dunst J, Wolf N, Sauer R (1988) Radiochemotherapie des Analkanalkarzinoms: Friihergebnisse des Erlanger Krankengutes. In: Wolf N (ed) Fortschritte in der Proktolo-gie. Zuckerschwerdt, MunichGoogle Scholar
  34. 34.
    Ellenhorn JDI, Enker WE, Quan SHQ (1993) Salvage abdominoperineal resection following combined chemotherapy and radiotherapy for epidermoid carcinoma of the anus. Ann Surg Oncol 1:105–110Google Scholar
  35. 35.
    Fischerman K, Briand P, Olsen J, Nielsen OV(1974) Intra-ar-terial combined cancer chemotherapy in technically inoperable carcinoma of the anus and rectum. Acta Chir Scand 140:416–421PubMedGoogle Scholar
  36. 36.
    Flam M, John M, Pajak TF et al (1996) 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 14:2527–2539PubMedGoogle Scholar
  37. 37.
    Frisch M, Glimelius B, Van den Brule A et al (1997) Sexually transmitted infection as a cause of anal cancer. N Engl J Med 337:1350–1358PubMedGoogle Scholar
  38. 38.
    Frost DB, Richards PC, Montague ED, Giacco GG, Martin RG (1984) Epidermoid cancer of the ano-rectum. Cancer 53:525–530Google Scholar
  39. 39.
    Gebbers JO, Laissue JA (1984) Pathologie der Analtumoren. Schweiz Rundschau Med (Praxis) 27:847–862Google Scholar
  40. 40.
    Goligher JC (1984) Surgery of anus, rectum and colon. Bail-liere-Tindall, EastbourneGoogle Scholar
  41. 41.
    Gray’s anatomy, 36th edn (1980) Churchill Livingstone, EdinburghGoogle Scholar
  42. 42.
    Greenall MJ, Quan SHQ, DeCosse JJ (1985) Epidermoid cancer of the anus. Br J Surg 72 [Suppl]:97–103Google Scholar
  43. 43.
    Greenall MJ, Magill GB, Quan SHQ, DeCosse JJ (1986) Recurrent epidermoid cancer of the anus. Cancer 57: 1437–1441PubMedGoogle Scholar
  44. 44.
    Hardcastle JD, Bussey HJR (1986) Results of surgical treatment of squamous cell carcinoma of the anal canal and anal margin at the St. Mark’s Hospital 1928–1966. J R Soc Med 61: 629–630Google Scholar
  45. 45.
    Hermanek P, Sobin LH (eds) (1987) TNM classification of malignant tumors, UICC, 4th edn. Springer, Berlin Heidelberg New YorkGoogle Scholar
  46. 46.
    Jaiyesimi IA, Pazdur R (1993) Cisplatin and 5-fluorouracil as salvage therapy for recurrent metastatic squamous cell carcinoma of the anal canal. Am J Clin Oncol (CTT) 16:536–540Google Scholar
  47. 47.
    Jensen SL, Hagen K, Shokouh-Amiri MH et al (1987) Does an erroneous diagnosis of squamous cell carcinoma of the anal canal and anal margin at first physician visit influence prognosis. Dis Colon Rectum 30:345–351PubMedGoogle Scholar
  48. 48.
    John MJ, Flam M, Lovalvo L, Mowry PA (1987) Feasibility of non-surgical definitive management of anal canal carcinoma. Int J Radiat Oncol Biol Phys 13:299–303PubMedGoogle Scholar
  49. 49.
    Kavanagh JJ Jr (1984) Regional chemotherapeutic approaches to the management of pelvic malignancies. Cancer Bull 36:52–55Google Scholar
  50. 50.
    Keihr S, Hickey RC, Martin RG et al (1972) Cloacogenic carcinoma of the anal canal. Arch Surg 104:407–415Google Scholar
  51. 51.
    Keiling R, Grunewald JM, Achille E (1973) Radiotherapie des cancers malpighiens de l’anus: la curietherapie interstitielle a Piridium 192 des epitheliomas du canal anal. J Radiol Electrol Med Nucl 54:634–635PubMedGoogle Scholar
  52. 52.
    Keighley MRB, Williams NS (1993) Surgery of the anus, rectum and colon. Lippincott, LondonGoogle Scholar
  53. 53.
    Klotz RG, Pamukoglu T, Souillard DH (1967) Transitional cloacogenic carcinoma of the anal canal. Clinicopathologi-cal study of 373 cases. Cancer 20:1727–1747PubMedGoogle Scholar
  54. 54.
    Kuehn PG, Eisenberg H, Reed JF (1968) Epidermoid carcinoma of the perianal skin and anal canal. Cancer 22:932–938PubMedGoogle Scholar
  55. 55.
    Lee SH, MacGregor DH, Kuziez MN (1981) Malignant transformation of perianal condyloma accuminatum. Dis Colon Rectum 24:462–467PubMedGoogle Scholar
  56. 56.
    Liggett W Jr, Forastiere AA (1995) Chemotherapy advances in head and neck oncology. Semin Surg Oncol 11:265–271PubMedGoogle Scholar
  57. 57.
    Lock MR, Katz DR, Parks A, Thomson JPS (1977) Perianal Pagefs disease. Postgrad Med J 53:768–772PubMedGoogle Scholar
  58. 58.
    Longo WE, Vernava AM, Wade TP et al (1994) Recurrent squamous cell carcinoma of the anal canal. Predictors of initial treatment failure and results of salvage therapy. Ann Surg 220:4049Google Scholar
  59. 59.
    Loygue J, Laugier A, Parc A, Weisgerber G (1980) Cancer epidermoide de l’anus. A propos de 149 observations. Chirurgie 6:710–716Google Scholar
  60. 60.
    Marti MC, Pipard G (1986) Die epidermoiden Karzinome des Analkanals. Chir Gastroenterolog 2: 57–66Google Scholar
  61. 61.
    Marti M-C (1991) Cancer de l’anus: considerations anatomo-cliniques. Lyon Chir 87:49–52Google Scholar
  62. 62.
    McAnally AK, Dockerty MB (1949) Carcinoma developing in chronic draining cutaneous sinuses and fistula. Surg Gynecol Obstet 188:87–96Google Scholar
  63. 63.
    Merlini M, Eckert P (1985) Malignant tumors of the anus. Am J Surg 150:370–372PubMedGoogle Scholar
  64. 64.
    Michaelson RA, Magill GB, Quan SHQ et al (1983) Preoperative chemotherapy and radiation therapy in the management of anal epidermoid carcinoma. Cancer 51:390–395PubMedGoogle Scholar
  65. 65.
    Mieno K, Takeda Y, Satoi Y et al (1989) Effects of intra-arterial infusion chemotherapy in local recurrence of anal cancer (in Japanese). Gan To Kagaku Ryoho 16:3007–3010PubMedGoogle Scholar
  66. 66.
    Morson BC, Sobin LH (1976) Histological typing of intestinal tumors. International histological classification of tumours, no. 15. World Health Organization, Geneva, pp 67–69Google Scholar
  67. 67.
    Miscusi G, Masoni L, Dell’Anna A et al (1987) Normal lymphatic drainage of the rectum and the anal canal revealed by lymphoscintigraphy. Coloproctology 9:171Google Scholar
  68. 68.
    Nigro MD (1984) An evaluation of combined therapy for squamous cell carcinoma of the anal canal. Dis Colon Rectum 27:763–766PubMedGoogle Scholar
  69. 69.
    Nigro MD, Vaitkevicius VK, Considine B (1974) Combined therapy for cancer of the anal canal: a preliminary report. Dis Col Rectum 17:354Google Scholar
  70. 70.
    O’Brien PH, Jenrette JM, Wallace KM, Metcalf JS (1982) Epidermoid carcinoma of the anus. Surg Gynecol Obstet 155:745–751PubMedGoogle Scholar
  71. 71.
    Palmer IC, Scholefield JH, Coates PL et al (1989) Anal cancer and human papillomaviruses. Dis Colon Rectum 32:1016–1022PubMedGoogle Scholar
  72. 72.
    Papillon J (1982) Rectal and anal cancers. Springer, Berlin Heidelberg New YorkGoogle Scholar
  73. 73.
    Papillon J, Montbarbon MD (1987) Epidermoid carcinoma of the anal canal. Dis Col Rectum 30:324–334Google Scholar
  74. 74.
    Patt YZ, Mavligit GM (1991) Arterial chemotherapy in the management of colorectal cancer: an overview. Semin Oncol 18:478–490PubMedGoogle Scholar
  75. 75.
    Patt YZ (1993) Regional hepatic arterial chemotherapy for colorectal cancer metastatic to the liver: the controversy continues. J Clin Oncol 11:815–819PubMedGoogle Scholar
  76. 76.
    Penn I (1986) Cancers of the anogenital region in renal transplant recipients — analysis of 65 cases. Cancer 58:611–616PubMedGoogle Scholar
  77. 77.
    Petrelli NJ, Shaw N, Bhargava A, Daufeldt J, Herrera L, Stulc JP, Sischy B, Mittelman A (1988) Squamous cell carcinoma antigen as a marker for squamous cell carcinoma of the anal canal. J Clin Oncol 6:782–785PubMedGoogle Scholar
  78. 78.
    Pipard G (1989) Combination therapy of anal carcinoma. In: Sauer R (ed) Diagnostic imaging and radiation oncology, vol 12. Interventional therapy brachycurie therapy. Springer, Berlin Heidelberg New YorkGoogle Scholar
  79. 79.
    Poletti P-A (1994) Papovavirus et cancer du canal anal. Thesis no. 9531, University of GenevaGoogle Scholar
  80. 80.
    Preston DM, Fowler EF, Lennard-Jones JE, Hawley PR (1983) Carcinoma of the anus in Crohn’s disease. Br J Surg 70:346–347PubMedGoogle Scholar
  81. 81.
    Pyper PC, Parks TG (1984) Melanoma of the anal canal. Br J Surg 71: 672–673Google Scholar
  82. 82.
    Pyper PC, Parks TG (1985) The results of surgery for epidermoid carcinoma of the anus. Br J Surg 72:712–714PubMedGoogle Scholar
  83. 83.
    Quan SHQ (1986) Cancer of the anus. In: Beahrs OH, Higgins GA, Weinstein JJ (eds) Colorectal tumors. Lippincott, Philadelphia, p 217Google Scholar
  84. 84.
    Rohner A, Schopfer P, Paunier JP, Garcia J (1984) Le cancer de la region anale. Med Hyg 32:1127Google Scholar
  85. 85.
    Salmon RJ, Fenton J, Asselain B, Mathieu G, Girodet J, Durand JC (1984) Treatment of epidermoid anal canal cancer. Am J Surg 147:43–48PubMedGoogle Scholar
  86. 86.
    Shank B, Cohen AM, Kelser DP (1997) Cancer of the anal region. In: DeVita VT, Hellman S, Rosenberg SA (eds): Cancer: principles and practice of oncology, 5th edn. Lippincott, Philadelphia, pp 1234–1251Google Scholar
  87. 87.
    Scarabelli C, Tumolo S, De Paoli A et al (1987) Intermittent pelvic arterial infusion with peptichemio, doxorubicin, and cisplatin for locally advanced and recurrent carcinoma of the uterine cervix. Cancer 60:25–30PubMedGoogle Scholar
  88. 88.
    Scholefield JH, Sonnex C, Palmer JG et al (1989) Anal and cervical intraepithelial neoplasia: possible parallel. Lancet 11:765–768Google Scholar
  89. 89.
    Scholefield JH, Hickson WG, Smith JH, et al (1992) Anal intraepithelial neoplasia: part of a multifocal disease process. Lancet 11:1271–1273Google Scholar
  90. 90.
    Schneider TC, Schulte WJ (1981) Management of carcinoma of anal canal. Surgery 90:729–733PubMedGoogle Scholar
  91. 91.
    Schraut WH, Wang C, Dawson P J, Block GE (1983) Depth of invasion, location and size of cancer of the anus dictate operative treatment. Cancer 51:1291–1296PubMedGoogle Scholar
  92. 92.
    Singh R, Nime F, Mittelmann A (1981) Malignant epithelial tumors of the anal canal. Cancer 48: 411–414PubMedGoogle Scholar
  93. 93.
    Sischy B (1985) The use of radiation therapy combined with chemotherapy in the management of squamous cell carcinoma of the anus and marginally resectable adenocarcinoma of the rectum. Int J Radiat Oncol Biol Phys 11:1587–1597PubMedGoogle Scholar
  94. 94.
    Slater G, Greenstein A, Aufses A(1984) Anal carcinoma in patients with Crohn’s disease. Ann Surg 199:348Google Scholar
  95. 95.
    Sloan PJM, Goepel G (1981) Lichen sclerosus et atrophicus and perianal carcinoma: a case report. Clin Exp Dermatol 6:399–402PubMedGoogle Scholar
  96. 96.
    Sobin LH, Wittekind C (1997) UICC International Union Against Cancer: TNM classification of malignant tumours. Wiley, New YorkGoogle Scholar
  97. 97.
    Stearns MV, Quan SH (1970) Epidermoid carcinoma of the anorectum. Surg Gynecol Obstet 131:953–957PubMedGoogle Scholar
  98. 98.
    Stearns MW, Urmacher C, Steinberg SS et al (1980) Cancer of the anal canal. Curr Probl Cancer 4:1–44PubMedGoogle Scholar
  99. 99.
    Stephens FO, Harker GJ, Crea P (1980) The intraarterial infusion of chemotherapeutic agents as “basal” treatment of cancer: evidence of increased drug activity in regionally infused tissues. Aust N Z J Surg 50:597–602PubMedGoogle Scholar
  100. 100.
    Strauss RJ, Fazio VW (1979) Bowen’s disease of the anal and perianal area: a report and analysis of twelve cases. Am J Surg 137:231–234PubMedGoogle Scholar
  101. 101.
    Sun XW, Kuhn L, Ellerbrock TV et al (1997) Human papillomavirus infection in women infected with the human immunodeficiency virus. N Engl J Med 337:1343–1349PubMedGoogle Scholar
  102. 102.
    Tanum G (1993) Treatment of relapsing anal carcinoma. Acta Oncol 32:33–35PubMedGoogle Scholar
  103. 103.
    Touboul E, Schlienger M, Buffat L et al (1994) Epidermoid carcinoma of the anal canal. Results of curative-intent radiation therapy in a series of 270 patients. Cancer 73:1569–1579PubMedGoogle Scholar
  104. 104.
    UKCCR (1996) Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet 348:1049–1054Google Scholar
  105. 105.
    Vokes EE, Athanasiadis I (1996) Chemotherapy of squamous cell carcinoma of head and neck: the future is now. Ann Oncol 7:15–29PubMedGoogle Scholar
  106. 106.
    Vokes EE, Haraf DJ, Stenson K et al (1995) The role of paclitaxel in the treatment of head and neck cancer. Semin Oncol 22:8–12PubMedGoogle Scholar
  107. 107.
    Wade DS, Herrera L, Castillo NB et al (1989) Metastases to the lymph nodes in epidermoid carcinoma of the anal canal studied by a clearing technique. Surg Gynecol Obstet 169:238PubMedGoogle Scholar
  108. 108.
    Wilking N, Petrelli N, Herrera L, Mittelman A (1985) Phase II study of combination bleomycin, vincristine and high-dose methotrexate (BOM) with leucovorin rescue in advanced squamous cell carcinoma of the anal canal. Cancer Chemother Pharmacol 15:300–302PubMedGoogle Scholar
  109. 109.
    Young JL, Percy CL, Asire AJ (1981) Surveillance, epidemiology and end results: incidence and mortality data 1973–1977. Natl Cancer Inst Monogr 57:1066Google Scholar
  110. 110.
    Zachow KR, Ostrow RS, Bender M, Watts S, Okagaki T, Pass F, Faras AJ (1982) Detection of human papillomavirus DNA in ano-genital neoplasia. Nature 300:771–772PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1998

Authors and Affiliations

  • A. Roth
  • M.-C. Marti

There are no affiliations available

Personalised recommendations