Smernice za obravnavo bolnikov s skvamoznoceličnim karcinomom analnega kanala in kože perinealno (analnega roba)
Guidelines for the management of patients with squamous cell carcinoma of the anal canal and perianal skin (anal margin)
Abstract (Eng)Cancer of the anal canal and anal margin is a rare disease. In Slovenia, on average 20 patients are diagnosed with this disease each year, more women than men. However, the incidence has increased in the last year, mainly in young, homosexual men, most probably due to infections with the sexually-transmitted human papillomavirus (HPV) and human immunodeficiency virus (HIV), which are known causal agents of this disease. Cancer of the anal canal and anal margin is primarily a locoregional disease, as distant metastases are found in less than 10% of the patients. Radical radiochemotherapy plays the central role in the treatment of anal canal and anal margin carcinomas with no distant metastases, except in well-differentiated anal margin carcinomas smaller than 2 cm, where local excision is advised. Radical radiochemotherapy provides a complete response in as many as 80-90%, which is reflected also in an excellent treatment outcome with 5-year survival of 80%. Patients clinically staged as cT1-2 stand a 6.5% chance of developing inguinal lymph node metastases, while the likelihood in patients staged as cT3-4 is 16%. Surgery, namely abdominoperineal excision, has a role in the treatment of residual disease after radical radiochemotherapy. In the future, HPV vaccines hold great promise for the prevention of this virus-induced disease.
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