Anal cancer: Etiopathogenesis, diagnostics and therapy [Analkarzinome: Ätiopathogenese, diagnostik und therapie]

Anal cancer is a malignant tumor which can be divided into cancer of the anal canal and cancer of the anal margin and is frequently associated with human papillomavirus (HPV) infections. Clinical assessment of the anus and the anal canal as well as proctorectoscopy is seminal and will guide further investigations. After histopathological confirmation of squamous cell cancer of the anus further diagnostic modalities, such as endoanal ultrasound and computed tomography (CT) scan of the chest, abdomen and pelvis have to be initiated to provide adequate staging and to rule out distant metastases. A colonoscopy to rule out synchronous bowel cancer is indispensable; however, multiple other proctological findings, such as chronic fissures and perianal eczema, have to be considered for the differential diagnosis as the manifestation and appearance of anal cancer can be variable. The standard of care is combined radiochemotherapy with a total dose of up to 60 Gy in addition to 5-fluorouracil (5-FU) and mytomycin C. Surgery plays a role in gaining histological confirmation by excisional biopsy or complete excision for limited tumors. Furthermore, abdominoperineal resection is the treatment of choice for persistent tumors after radiochemotherapy or local recurrent disease. © Springer-Verlag 2014.