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Clinical Colorectal Cancer Sep 2020The standard treatment for localized squamous-cell carcinoma of the anal canal is definitive chemoradiotherapy. A meta-analysis of published studies conducted by our... (Comparative Study)
Comparative Study
BACKGROUND
The standard treatment for localized squamous-cell carcinoma of the anal canal is definitive chemoradiotherapy. A meta-analysis of published studies conducted by our group showed significantly lower rates of disease-free survival (DFS) and overall survival at 3 years among HIV-positive patients. We aimed to compare detailed treatment outcomes between the groups of HIV-positive and -negative patients.
PATIENTS AND METHODS
We performed a retrospective multicenter study of a comparative cohort of consecutive patients with histologic diagnosis of localized squamous-cell carcinoma of the anal canal who received definitive chemoradiotherapy. Patients' characteristics and outcomes were compared according to HIV status. The primary end points were time to complete response (CR) and DFS time.
RESULTS
From June 2001 to September 2018, a total of 185 patients were included; 43 (30.2%) were HIV positive and 142 (69.8%) were HIV negative. The overall CR rates were 67.4% and 91.5% for HIV-positive and -negative patients, respectively (P < .001). The median follow-up was 47.8 months and the median time to experience CR was 7.8 months (95% confidence interval [CI], 5.7-10.5) for HIV-positive versus 4.89 months (95% CI, 4.54-5.25) for HIV-negative (P < .001) patients. The median DFS times were 79.7 months (95% CI, 56.8-102.6) and 127.9 months (95% CI, 112.6-143.2) for HIV-positive and -negative patients, respectively (P = .02). There was a trend toward greater grade 3/4 toxicity in the HIV-positive group.
CONCLUSION
HIV-positive patients take longer to experience CR and present worse DFS. These findings have clinical implications because waiting longer to define CR among these patients may prevent unnecessary anorectal amputations.
Topics: Adult; Aged; Aged, 80 and over; Anal Canal; Anus Neoplasms; Argentina; Brazil; Carcinoma, Squamous Cell; Chemoradiotherapy; Disease-Free Survival; Female; Follow-Up Studies; HIV Infections; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Progression-Free Survival; Retrospective Studies; Risk Factors; Time Factors
PubMed: 32389596
DOI: 10.1016/j.clcc.2020.03.006 -
Missouri Medicine 2020Anorectal conditions are one of the most common problems evaluated by primary care physicians. Most patients present with rectal pain, rectal bleeding, or purulent... (Review)
Review
Anorectal conditions are one of the most common problems evaluated by primary care physicians. Most patients present with rectal pain, rectal bleeding, or purulent drainage per rectum. Colorectal conditions have overlapping symptoms. Thorough history and careful anorectal examination can differentiate common anorectal conditions like hemorrhoids, anorectal abscesses, anal fistula, anal fissure, and anal condyloma. Most of these conditions can be diagnosed and treated without imaging.
Topics: Anus Diseases; Colorectal Surgery; Diagnosis, Differential; Fissure in Ano; Hemorrhoids; Humans; Primary Health Care
PubMed: 32308242
DOI: No ID Found -
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 Epidemiology, Biomarkers &... Aug 2022Previous studies show an association between smoking and anal cancer. The objective of this study was to assess the association between smoking and anal HPV (human...
BACKGROUND
Previous studies show an association between smoking and anal cancer. The objective of this study was to assess the association between smoking and anal HPV (human papillomavirus) prevalence, incidence, and persistence in men.
METHODS
The HPV Infection in Men (HIM) Study is a multinational study that enrolled HIV-negative men. At baseline and follow-up visits, anal specimens were collected. HPV genotyping was assessed by linear array. Prevalence ratios (PR) were used to assess the association between smoking and anal HPV prevalence. Odds ratios (OR) were used to assess the association between smoking and anal HPV incidence and ≥12-months persistence.
RESULTS
Current smokers have a higher prevalence [adjusted PR (aPR), 1.36; 95% confidence interval (CI), 1.06-1.73) and incidence [adjusted OR (aOR), 1.74; 95% CI, 1.26-2.39] and ≥12-months persistence (aOR, 1.67; 95% CI, 1.19-2.33) of any anal HPV compared with never smokers. There were no differences in the prevalence, incidence, or persistence of anal HPV between former and never smokers. Smoking status was not associated with the prevalence or persistence of anal HPV among men who have sex with men but was associated with higher incidence of HR-HPV. Among men that have sex with women (MSW), current smokers had an increased prevalence and incidence of LR-HPV compared with never smokers.
CONCLUSIONS
Current smokers had a higher prevalence, persistence, and incidence of HPV compared with never smokers. Further research is needed to assess the role smoking in anal HPV persistence and progression to disease.
IMPACT
Prevention initiatives should raise awareness about smoking and the risk factor of anal HPV infection and anal cancer.
Topics: Alphapapillomavirus; Anal Canal; Anus Diseases; Anus Neoplasms; Female; HIV Infections; Homosexuality, Male; Humans; Male; Papillomaviridae; Papillomavirus Infections; Prevalence; Risk Factors; Sexual and Gender Minorities; Smoking
PubMed: 35653709
DOI: 10.1158/1055-9965.EPI-21-1373 -
Journal of the American Society of... 2022There are substantial disparities in cancer screening for sexual minorities and gender non-conforming patients. In additional to patients having trauma due to negative... (Review)
Review
There are substantial disparities in cancer screening for sexual minorities and gender non-conforming patients. In additional to patients having trauma due to negative experiences with the healthcare system, disparities may be heightened due to heteronormative and cisnormative design of screening programs and electronic medical record systems. Furthermore, there are morphologic challenges specific to certain specimen types from the LGBT + population, such as anal cytology samples, cervical cytology from transgender men taking testosterone, and neovaginal cytology samples. Men who have sex with men are at increased risk for anal cancer compared with the general population. While early detection of anal dysplasia decreases the risk of invasive carcinoma, screening programs are not widespread. Cervical cancer screening may be psychologically and physically challenging for transgender men and non-binary patients. The use of exogenous testosterone therapy causes atrophic changes in cervical cytology samples which mimic high-grade dysplasia. The rate of unsatisfactory samples are also increased in this population. Although HPV driven cancers have been reported in patients with neovaginas, there are currently no guidelines about appropriate screening for transgender women and intersex patients who have neovaginas. Cytopathologists can optimize the health of LGBT + patients in many ways including advocating for inclusive screening guidelines, validating self-collection for HPV and cytology samples, updating requisition forms to better capture the spectrum of gender expression, and recognizing the morphologic changes in cytology samples due to exogenous hormone use.
Topics: Anus Neoplasms; Early Detection of Cancer; Female; Homosexuality, Male; Humans; Male; Papillomavirus Infections; Sexual and Gender Minorities; Testosterone; Uterine Cervical Neoplasms
PubMed: 35840516
DOI: 10.1016/j.jasc.2022.06.003 -
Revista Brasileira de Ginecologia E... Mar 2022The purpose of this study was to compare the frequency of the occurrence of high-risk human papillomavirus (HPV) and abnormal anal cytology in immunocompetent women... (Observational Study)
Observational Study
OBJECTIVE
The purpose of this study was to compare the frequency of the occurrence of high-risk human papillomavirus (HPV) and abnormal anal cytology in immunocompetent women with and without HPV-induced genital lesions.
METHODS
This analytical cross-sectional, observational study was conducted between July 2017 and December 2018 in a specialized outpatient clinic of a tertiary hospital in Fortaleza, CE. Fifty-seven immunocompetent women with and without genital intraepithelial lesions were assessed; they were divided into two groups: group 1 was comprised of women with HPV-associated genital lesions ( = 26), and group 2 was comprised of those without HPV-associated genital lesions ( = 31). Samples for liquid-based cytology and high-risk DNA-HPV polymerase chain reaction real-time tests were collected from the cervix and anus. All cases were evaluated using high-resolution anoscopy; biopsies were performed when required. The Fisher exact and chi-squared tests were applied for consolidated data in the contingency table, and the Student -test and Mann-Whitney U-test for independent variables.
RESULTS
Anal high-risk HPV infections were more frequent in group 1 (odds ratio [OR], 4.95; 95% confidence interval [CI], 1.34-18.3; = 0.012), along with concomitant high-risk HPV infections in the uterine cervix and the anus (OR 18.8; 95% CI, 2.20-160; < 0.001). The incidence of high-risk cervical HPV infection was associated with high-risk anal HPV infection (OR, 4.95; 95% CI, 1.34-18.3; = 0.012). There was no statistical difference concerning abnormal anal cytology or anoscopy between the groups, and no anal intraepithelial lesion was found in either group.
CONCLUSION
Immunocompetent women with HPV-associated genital lesions and high-risk cervical HPV were more likely to have high-risk anal HPV.
Topics: Anal Canal; Anus Diseases; Brazil; Cervix Uteri; Cross-Sectional Studies; Female; Humans; Papillomaviridae; Papillomavirus Infections
PubMed: 35139570
DOI: 10.1055/s-0042-1742405 -
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 -
The Oncologist Mar 2023Anal squamous cell carcinoma (SCCA) is an uncommon malignancy with a rising incidence that has a high cure rate in its early stages. There is an unmet need for a...
BACKGROUND
Anal squamous cell carcinoma (SCCA) is an uncommon malignancy with a rising incidence that has a high cure rate in its early stages. There is an unmet need for a reliable method to monitor response to treatment and assist in surveillance. Circulating tumor DNA (ctDNA) testing has shown great promise in other solid tumors for monitoring disease progression and detecting relapse in real time. This study aimed to determine the feasibility and use of personalized and tumor-informed ctDNA testing in SCCA.
PATIENTS AND METHODS
We analyzed real-world data from 251 patients (817 plasma samples) with stages I-IV SCCA, collected between 11/5/19 and 5/31/22. The tumor genomic landscape and feasibility of ctDNA testing was examined for all patients. The prognostic value of longitudinal ctDNA testing was assessed in patients with clinical follow-up (N = 37).
RESULTS
Whole-exome sequencing analysis revealed PIK3CA as the most commonly mutated gene, and no associations between mutations and stage. Anytime ctDNA positivity and higher ctDNA levels (MTM/mL) were associated with metastatic disease (P = .004). For 37 patients with clinical follow-up, median follow-up time was 21.0 months (range: 4.1-67.3) post-diagnosis. For patients with stages I-III disease, anytime ctDNA-positivity after definitive treatment was associated with reduced DFS (HR: 28.0; P = .005).
CONCLUSIONS
Our study demonstrates the feasibility of personalized and tumor-informed ctDNA testing as an adjunctive tool in patients with SCCA as well as potential use for detection of molecular/minuteimal residual disease, and relapse during surveillance. Prospective studies are needed to better evaluate the use of ctDNA testing in this indication.
Topics: Humans; Circulating Tumor DNA; Cell-Free Nucleic Acids; Biomarkers, Tumor; Neoplasm Recurrence, Local; Carcinoma, Squamous Cell; DNA, Neoplasm; Anus Neoplasms; Mutation
PubMed: 36562592
DOI: 10.1093/oncolo/oyac249 -
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