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The British Journal of Surgery Mar 2021This was a cross-sectional and retrospective study of the short-term effects of the COVID-19 pandemic among patients with colorectal or anal cancer treated at AA Camargo... (Observational Study)
Observational Study
This was a cross-sectional and retrospective study of the short-term effects of the COVID-19 pandemic among patients with colorectal or anal cancer treated at AA Camargo Cancer Centre, a large and comprehensive cancer centre located in Sao Paulo, the epicentre of the pandemic in Brazil. The aim was to quantify the barriers to access to treatment and diagnosis of these tumours during the pandemic in comparison with the previous year. The results showed a significant decrease in newly diagnosed patients with colorectal or anal cancer, a significant increase in patients with locally advanced disease at presentation, and an increase in the proportion of patients without insurance for coverage of costs.
Topics: Adult; Aged; Aged, 80 and over; Anus Neoplasms; Brazil; COVID-19; Colorectal Neoplasms; Cross-Sectional Studies; Early Detection of Cancer; Female; Health Services Accessibility; Humans; Male; Medically Uninsured; Middle Aged; Neoplasm Staging; Referral and Consultation
PubMed: 33711133
DOI: 10.1093/bjs/znaa124 -
Cancer Medicine Jul 2022Anal canal cancer (ACC) has been reported to be an uncommon cancer in Japan, as in the USA, Europe, and Australia. This retrospective multi-institutional study was...
Anal canal cancer (ACC) has been reported to be an uncommon cancer in Japan, as in the USA, Europe, and Australia. This retrospective multi-institutional study was conducted to clarify the characteristics of ACC in Japan. First, the histological ACC type cases treated between 1991 and 2015 were collected. A detailed analysis of the characteristics of anal canal squamous cell carcinoma (SCC) cases was then conducted. The results of the histological types revealed that of the 1781 ACC cases, 435 cases (24.4%) including seven cases of adenosquamous cell carcinomas were SCC and 1260 cases (70.7%) were adenocarcinoma. However, the most common histological type reported in the USA, Europe, and Australia is SCC. Most ACC cases are adenocarcinomas and there is a low incidence of SCC in Japan which is different from the above-mentioned countries. Moreover, we reclassified T4 into the following two groups based on tumor size: T4a (tumor diameter of 5 cm or less) and T4b (tumor diameter of more than 5 cm). The results of the TNM classification of SCC revealed that the hazard ratio (HR) to T1 of T2, T3, T4a, and T4b was 2.45, 2.28, 2.89, and 4.97, respectively. As T4b cases had a worse prognosis than T4a cases, we propose that T4 for anal canal SCC in Japan be subclassified into T4a and T4b.
Topics: Adenocarcinoma; Anal Canal; Anus Neoplasms; Carcinoma, Squamous Cell; Humans; Japan; Retrospective Studies
PubMed: 35274487
DOI: 10.1002/cam4.4631 -
International Journal of Cancer Feb 2023Squamous cell carcinoma of the anus (SCCA) is caused by HPV, and is elevated in persons living with HIV (PLWHIV). We aimed to estimate sex- and HIV-stratified SCCA...
Squamous cell carcinoma of the anus (SCCA) is caused by HPV, and is elevated in persons living with HIV (PLWHIV). We aimed to estimate sex- and HIV-stratified SCCA burden at a country, regional and global level. Using anal cancer incidence estimates from 185 countries available through GLOBOCAN 2020, and region/country-specific proportions of SCCA vs non-SCCA from the Cancer Incidence in Five Continents (CI5) Volume XI database, we estimated country- and sex-specific SCCA incidence. Proportions of SCCA diagnosed in PLWHIV, and attributable to HIV, were calculated using estimates of HIV prevalence (UNAIDS 2019) and relative risk applied to SCCA incidence. Of 30 416 SCCA estimated globally in 2020, two-thirds occurred in women (19 792) and one-third among men (10 624). Fifty-three percent of male SCCA and 65% of female SCCA occurred in countries with a very high Human Development Index (HDI). Twenty-one percent of the global male SCCA burden occurred in PLWHIV (n = 2203), largely concentrated in North America, Europe and Africa. While, only 3% of global female SCCA burden (n = 561) occurred in PLWHIV, mainly in Africa. The global age-standardized incidence rate of HIV-negative SCCA was higher in women (0.55 cases per 100 000) than men (0.28), whereas HIV-positive SCCA was higher in men (0.07) than women (0.02). HIV prevalence reached >40% in 22 countries for male SCCA and in 10 countries for female SCCA, mostly in Africa. Understanding global SCCA burden by HIV status can inform SCCA prevention programs (through HPV vaccination, screening and HIV control) and help raise awareness to combat the disease.
Topics: Female; Humans; Male; Anus Neoplasms; Carcinoma, Squamous Cell; HIV Infections; Incidence; Papillomavirus Infections; Global Health; Sex Distribution
PubMed: 36054026
DOI: 10.1002/ijc.34269 -
World Journal of Gastroenterology Sep 2014Anal cancer represents less than 1% of all new cancers diagnosed annually in the United States. Yet, despite the relative paucity of cases, the incidence of anal cancer... (Review)
Review
Anal cancer represents less than 1% of all new cancers diagnosed annually in the United States. Yet, despite the relative paucity of cases, the incidence of anal cancer has seen a steady about 2% rise each year over the last decade. As such, all healthcare providers need to be cognizant of the evaluation and treatment of anal squamous cell carcinoma. While chemoradiation remains the mainstay of therapy for most patients with anal cancer, surgery may still be required in recurrent, recalcitrant and palliative disease. In this manuscript, we will explore the diagnosis and management of squamous cell carcinoma of the anus.
Topics: Anus Neoplasms; Carcinoma, Squamous Cell; Early Detection of Cancer; Humans; Neoplasm Recurrence, Local; Neoplasm Staging; Predictive Value of Tests; Treatment Outcome
PubMed: 25278699
DOI: 10.3748/wjg.v20.i36.13052 -
The British Journal of Surgery Dec 2017Progression from anorectal abscess to fistula is poorly described and it remains unclear which patients develop a fistula following an abscess. The aim was to assess the...
BACKGROUND
Progression from anorectal abscess to fistula is poorly described and it remains unclear which patients develop a fistula following an abscess. The aim was to assess the burden of anorectal abscess and to identify risk factors for subsequent fistula formation.
METHODS
The Hospital Episode Statistics database was used to identify all patients presenting with new anorectal abscesses. Cox regression analysis was undertaken to identify factors predictive of fistula formation.
RESULTS
A total of 165 536 patients were identified in the database as having attended a hospital in England with an abscess for the first time between 1997 and 2012. Of these, 158 713 (95·9 per cent) had complete data for all variables and were included in this study, the remaining 6823 (4·1 per cent) with incomplete data were excluded from the study. The overall incidence rate of abscess was 20·2 per 100 000. The rate of subsequent fistula formation following an abscess was 15·5 per cent (23 012 of 148 286) in idiopathic cases and 41·6 per cent (4337 of 10 427 in patients with inflammatory bowel disease (IBD) (26·7 per cent coded concurrently as ulcerative colitis; 47·2 per cent coded as Crohn's disease). Of all patients who developed a fistula, 67·5 per cent did so within the first year. Independent predictors of fistula formation were: IBD, in particular Crohn's disease (hazard ratio (HR) 3·51; P < 0·001), ulcerative colitis (HR 1·82; P < 0·001), female sex (HR 1·18; P < 0·001), age at time of first abscess 41-60 years (HR 1·85 versus less than 20 years; P < 0·001), and intersphincteric (HR 1·53; P < 0·001) or ischiorectal (HR 1·48; P < 0·001) abscess location compared with perianal. Some 2·9 per cent of all patients presenting with a new abscess were subsequently diagnosed with Crohn's disease; the median time to diagnosis was 14 months.
CONCLUSION
The burden of anorectal sepsis is high, with subsequent fistula formation nearly three times more common in Crohn's disease than idiopathic disease, and female sex is an independent predictor of fistula formation following abscess drainage. Most fistulas form within the first year of presentation with an abscess.
Topics: Abscess; Adult; Age Factors; Anus Diseases; Datasets as Topic; England; Female; Humans; Incidence; Inflammatory Bowel Diseases; Male; Middle Aged; Rectal Fistula; Risk Factors; Sex Factors; Young Adult
PubMed: 28857130
DOI: 10.1002/bjs.10614 -
World Journal of Surgical Oncology Jan 2023Perianal Paget's disease (PPD) is an intraepithelial invasion of the perianal skin and is frequently associated with underlying anorectal carcinoma. The relatively rare... (Review)
Review
BACKGROUND
Perianal Paget's disease (PPD) is an intraepithelial invasion of the perianal skin and is frequently associated with underlying anorectal carcinoma. The relatively rare nature of this disease has made it difficult to develop treatment recommendations. This study aims to analyze the clinical and pathological features of perianal Paget's disease (PPD) and to explore rational treatment options and follow-up for this disease.
METHODS
The National Cancer Center Hospital database was searched for all cases of perianal Paget's disease diagnosed between 2006 and 2021. In the 14 patients identified, we reviewed the diagnosis, management, and outcomes of adenocarcinoma with pagetoid spread, including suspected or recurrent cases.
RESULTS
All 14 cases met the inclusion criteria. The median follow-up period after diagnosis was 4.5 (range, 0.1-13.0) years. Pagetoid spread before initial treatment was suspected in 12 cases (85.7%). Underlying rectal cancer was identified in 6 cases, and no primary tumor was detected in the other 6 cases. Seven patients had recurrent disease, with the median time to recurrence of 34.6 (range, 19.2-81.7) months. The time to the first relapse was 3 months, and that to the second relapse was 6 months. The overall 5-year survival rate was 90.0%.
CONCLUSIONS
Endoscopic and radiologic evaluation, as well as immunohistologic examination, should be performed. is to differentiate PPD with and without underlying anorectal carcinoma. The time to first recurrence varies widely, and long-term and regular follow-up for more than 5 years is considered necessary for local recurrence and distant metastasis.
Topics: Humans; Rectal Neoplasms; Anus Neoplasms; Paget Disease, Extramammary; Neoplasm Recurrence, Local; Adenocarcinoma
PubMed: 36658590
DOI: 10.1186/s12957-022-02872-z -
Canadian Journal of Rural Medicine :... 2021
Topics: Abscess; Anus Diseases; Clinical Competence; Drainage; Humans; Practice Patterns, Physicians'; Rural Health Services; Rural Population
PubMed: 33380604
DOI: 10.4103/CJRM.CJRM_16_20 -
La Clinica Terapeutica 2023Crypts are small anatomical structures situated between the anal papillae, which do not cause any symptoms unless they become inflamed. Cryptitis is a localized...
INTRODUCTION
Crypts are small anatomical structures situated between the anal papillae, which do not cause any symptoms unless they become inflamed. Cryptitis is a localized infection of one or more of the anal crypts.
CASE PRESENTATION
A 42-year-old woman presented to our practice, complaining intermittently of anal pain and pruritus ani over a span of 1 year. She was referred multiple times to various surgeons, and she was treated conservatively for anal fissure without any evident improvement. The referred symptoms were increased often after defecation. Under general anesthesia, a hooked fistula probe was introduced into the inflamed anal crypt and the whole length of the crypt was layed open.
CONCLUSION
Anal cryptitis is a misdiagnosed condition. The un-specific symptomatology of the disease can easily mislead. The clinical suspicion is fundamental for the diagnosis. Patient's history, digital ex-amination, and anoscopy are essential for the diagnosis of anal cryptitis.
Topics: Female; Humans; Adult; Anal Canal; Fissure in Ano; Diagnostic Errors
PubMed: 37199352
DOI: 10.7417/CT.2023.2522 -
Frontiers in Immunology 2023Human papillomavirus (HPV), a common sexually transmitted virus infecting mucosal or cutaneous stratified epithelia, is implicated in the rising of associated cancers... (Review)
Review
Human papillomavirus (HPV), a common sexually transmitted virus infecting mucosal or cutaneous stratified epithelia, is implicated in the rising of associated cancers worldwide. While HPV infection can be cleared by an adequate immune response, immunocompromised individuals can develop persistent, treatment-refractory, and progressive disease. Primary immunodeficiencies (PIDs) associated with HPV-related disease include inborn errors of GATA, EVER1/2, and CXCR4 mutations, resulting in defective cellular function. People living with secondary immunodeficiency (e.g. solid-organ transplants recipients of immunosuppression) and acquired immunodeficiency (e.g. concurrent human immunodeficiency virus (HIV) infection) are also at significant risk of HPV-related disease. Immunocompromised people are highly susceptible to the development of cutaneous and mucosal warts, and cervical, anogenital and oropharyngeal carcinomas. The specific mechanisms underlying high-risk HPV-driven cancer development in immunocompromised hosts are not well understood. Current treatments for HPV-related cancers include surgery with adjuvant chemotherapy and/or radiotherapy, with clinical trials underway to investigate the use of anti-PD-1 therapy. In the setting of HIV co-infection, persistent high-grade anal intraepithelial neoplasia can occur despite suppressive antiretroviral therapy, resulting in an ongoing risk for transformation to overt malignancy. Although therapeutic vaccines against HPV are under development, the efficacy of these in the setting of PID, secondary- or acquired- immunodeficiencies remains unclear. RNA-based therapeutic targeting of the HPV genome or mRNA transcript has become a promising next-generation therapeutic avenue. In this review, we summarise the current understanding of HPV pathogenesis, immune evasion, and malignant transformation, with a focus on key PIDs, secondary immunodeficiencies, and HIV infection. Current management and vaccine regimes are outlined in relation to HPV-driven cancer, and specifically, the need for more effective therapeutic strategies for immunocompromised hosts. The recent advances in RNA-based gene targeting including CRISPR and short interfering RNA (siRNA), and the potential application to HPV infection are of great interest. An increased understanding of both the dysregulated immune responses in immunocompromised hosts and of viral persistence is essential for the design of next-generation therapies to eliminate HPV persistence and cancer development in the most at-risk populations.
Topics: Humans; Papillomavirus Infections; Human Papillomavirus Viruses; HIV Infections; Warts; Anus Neoplasms
PubMed: 36960048
DOI: 10.3389/fimmu.2023.1112513 -
Human Vaccines & Immunotherapeutics Jun 2016Human papillomavirus (HPV), the most common sexually transmitted infection in the US and worldwide, can cause cancers, anogenital warts (AGW), and recurrent respiratory... (Review)
Review
Human papillomavirus (HPV), the most common sexually transmitted infection in the US and worldwide, can cause cancers, anogenital warts (AGW), and recurrent respiratory papillomatosis (RRP) in men, women, and children. Global incidence of AGW ranges from 160-289 cases per 100,000 person-years and peaks in young men and women in the third decade of life. RRP has an estimated incidence of 3 per 1 million person-years in children. Pre-licensure trial efficacy, modeling and time-trend ecological studies have shown a significant short-term impact of 4vHPV vaccine. In girls aged 15-19 years, a previously published meta-analysis indicated that genital warts decreased significantly by 31%; stratified analysis revealed more substantial reductions in populations with high (≥50 %) vs. low (<50 % ) vaccination coverage (61% vs. 14%). Longer-term monitoring will reveal whether this impact continues under 9vHPV programs, and whether current declines in AGW are mirrored by declines in RRP.
Topics: Age Factors; Anus Diseases; Condylomata Acuminata; Female; Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; Humans; Incidence; Male; Papillomavirus Infections; Respiratory Tract Infections; Treatment Outcome; Vaccination
PubMed: 27217191
DOI: 10.1080/21645515.2016.1172754