A systematic review of anal squamous cell carcinoma in inflammatory bowel disease

Abstract Aim The aim of this systematic review was to determine the incidence, aetiology and clinical characteristics of anal squamous cell carcinomas (SCC) presenting in patients with inflammatory bowel disease. Method A systematic review of the literature was undertaken using Medline, Embase, Coch...

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Bibliographic Details
Published in:Surgical oncology 2013-12, Vol.22 (4), p.230-237
Main Authors: Slesser, A.A.P, Bhangu, A, Bower, M, Goldin, R, Tekkis, P.P
Format: Article
Language:English
Subjects:
Anal cancer
Anal squamous cell carcinoma
Anus Neoplasms - pathology
Carcinoma, Squamous Cell - pathology
Crohn's disease
Hematology, Oncology and Palliative Medicine
Histology
Humans
Inflammatory bowel disease
Inflammatory Bowel Diseases - complications
Patients
Prognosis
Rodents
Statistical analysis
Studies
Surgery
Tumors
Ulcerative colitis
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Summary:Abstract Aim The aim of this systematic review was to determine the incidence, aetiology and clinical characteristics of anal squamous cell carcinomas (SCC) presenting in patients with inflammatory bowel disease. Method A systematic review of the literature was undertaken using Medline, Embase, Cochrane and Web of Science. Results A total of 33 cases of anal SCC were described, 7 in ulcerative colitis (UC) and 26 in Crohn's disease (CD). The annual incidence of anal SCCs was 0.9/100,000 and 2.0/100,000 in patients with UC and CD respectively. The gender ratio in CD was 3M:17F with a median age of 42 years, the main presenting symptom was anal pain and 85% of CD cases had peri-anal disease. No studies described anal intra-epithelial neoplasia. The human papilloma virus was found to be positive in 2 out of 5 (40%) cases. The majority of patients (73%) with CD received radical surgery as their first line treatment. The cumulative overall and disease free survival in CD was 37 per cent at five years. Conclusion The findings of this review when contrasted with the data from cancer registries suggests that there is a higher incidence of anal SCC, an earlier age of presentation and poorer outcomes in patients with Crohn's disease compared to the general population implying a more aggressive neoplastic process. This review supports the hypothesis that peri-anal disease plays a contributing role in anal SCCs and as such targeted surveillance in patients with longstanding peri-anal disease should be considered.
ISSN:0960-7404
1879-3320
DOI:10.1016/j.suronc.2013.08.002