Anal cancer is rare, accounting for less 5% of large-bowel tumours. Over 80% of anal cancers are squamous cell in origin, however, malignant melanoma may occur in the anal canal. The recognition of a high incidence of squamous cell carcinoma of the anus amongst some homosexual men led to the search for an infective aetiological agent. Risk factors for anal cancer include a history of genital warts and evidence now suggests an association between human papilloma virus types 16, 18, 30, 31 and 33, and anal cancer. It is believed that anal cancer may occur due to progression of anal intraepithelial neoplasia in a manner analogous to intraepithelial carcinoma of the cervix, vulva or vagina.
Anal cancer typically presents with pain and bleeding, and these symptoms are often initially disregarded or misdiagnosed. Clinicians must be most suspicious of a patient with an indolent anal ulcer or rectal bleeding who complains of persistent or severe pain.
Treatment is usually by combination chemo and radiation therapy using 5-FU and mitomycin C combined with highdose external beam irradiation. Surgery is reserved for those who relapse despite oncological therapy; however, small lesions at the anal margin may still be treated by local excision only.
Anal cancer spreads to inguinal lymph nodes which should always be assessed by the clinician. Typically, inguinal nodes are included in the radiation field.
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