Anal Carcinoma: A Series of Cases with a Literature Review - - - Analni karcinom: prikaz mini-serije bolesnika i pregled literature
Journal Title: Acta Facultatis Medicae Naissensis - Year 2016, Vol 33, Issue 4
Abstract
The aim of this study was to analyze the cases of five patients with squamous cell carcinoma (SCC) and to draw attention to the dilemma in the treatment of incontinence on admission of these patients and to present, through a literature review, locations of the surgical treatment. The anal carcinoma is a rare disease which involves different histopathological (HP) types of cancer. They account for about 2.5% of all digestive cancers. The treatment of the disease is multimodal. There are dilemmas about screening of precancerous lesions and treatment of diagnosed incontinence. There is a high similarity between HPV infection and SCC. Our methods and results were compared with the data from the literature. In the period of three years (from 2013 to 2015), five cases of the anal carcinoma were diagnosed and treated in the regional hospital. In all of our cases, the disease was histopathologically confirmed as SCC of the anal and perianal areas. It excluded the cases of anal adenocarcinoma (AAC). Nearly half of the patients (40%) were incontinent and the rectum excision was one of the possible solutions. Distinction in histopathological structure created the confusion in the treatment of these patients. The dilemma we had was whether to do an amputation of the rectum in patients with incontinence before the standardized Chemoradiation therapy (CRT). The review of the literature sums up certain conclu-sions. The diagnosis of SCC includes the perianal "ulcer" that does not heal, as well as atypical ano-perianal growths. Surgical treatment of SCC is indicated when the diameter of lesion is small (2 cm), or the disease is persistent or recurrent. In the case of anal incontinence because of the tumor changes, the abdominoperineal resection of the rectum (APR) is an alternative to performing bipolar colostomy and CRT. The review of the literature using MEDLINE/PubMed databases did not find the case with restoring anal continence after this treatment. Testing a larger number of patients with incontinence on admission would provide a more clear answer to the question of the treatment of these patients. - - - Povod za pisanje rada je prikaz naših bolesnika. Cilj rada bio je da se skrene pažnja na analni karcinom i njegove različite histološke potkategorije i da se prikažu standardni i novi stavovi iz literature. U radu je prikazana naša serija slučajeva i mesto hirurškog tretmana, posebno kod inkontinentnih bolesnika. Analni karcinom je retko oboljenje koje čine više patohistoloških (PH) različitih tipova karcinoma, oko 2,5% svih digestivnih karcinoma. Tretman oboljenja je multimodalitetni. Još uvek ima nepoznanica u etiologiji, klasifikaciji, dijagnostici ovog oboljenja. Postoje dileme oko skrininga prekanceroznih lezija i tretmana dijagnostikovane inkontinencije. Složena anatomija i histologija analne regije je razlog nedoumica. Koincidencija sa virusnom infekcijom i razvojem prekanceroza je visoka. U poslednje tri godine (2013 – 2015) u regionalnoj bolnici, koja zdravstveno obezbeđuje oko 300.000 stanovnika, dijagnostikovano je i lečeno pet slučajeva analnog karcinoma. Ovome je pridodat jedan slučaj od ranije, ukupno šest prikazanih u retrospektivnom radu. Primenjeno lečenje je upoređeno sa stavovima iz literature. Bolest je u pet slučajeva patohistološki potvrđena kao analni i perianalni skvamozno-celularni kancer (SCC, squamous-cellular carcinoma), a kod jednog bolesnika analni adenokarcinom (AAC). Troje bolesnika je bilo inkontinentno na prijemu i amputacija rektuma je jedno od primenjenih rešenja. Preporuke iz literature nisu jasno određene za ove bolesnike. Opredelili smo se za amputaciju rektuma. Pregledom literature prikazujemo sve moguće opcije. Razlika u histološkoj strukturi dovodi do konfuzije u lečenju. Polovina od ukupnog broja naših bolesnika bila je inkontinentna na prijemu, te ističemo dilemu tretmana ovih bolesnika za koje liteteraturne preporuke nisu decidirane. Potreban je individualan pristup. Mi smo radili amputaciju rektuma pre nego li standardizovano hemio-radioterapijsko lečenje. Osvrtom na literaturu prikazujemo sve moguće opcije.
Authors and Affiliations
Momčilo Stošić, Igor Stojanović, Svetlana Mihajlović, Kosta Zdravković
Keywords
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- EP ID EP347388
- DOI 10.1515/afmnai-2016-0031
- Views 68
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