Diagnosis and therapy for anal carcinoma

Of all carcinomas in the anal canal, 75-80% are squamous cell carcinomas-the remaining 25% being adenocarcinomas. Carcinomas of the anal margin are to be differentiated from basal cell carcinomas and Paget's and Bowen's diseases. More than 80% of anal carcinomas show high-risk HP viruses. Every suspicious lesion in the anal canal and margins must be examined histologically. Primary radiochemotherapy is the first treatment option for epidermoid carcinomas of the anal canal and anal margin. Overall 5-year survival is reported at up to 90%. Surgery is reserved for the primary biopsy or excision of small tumors and for salvage abdominoperineal resection in patients with tumor persistence or local recurrence after radiochemotherapy. Systematic inguinal lymphadenectomy is not indicated. The first follow-up examination should be done 6 weeks after the end of radiochemotherapy. A biopsy is necessary after 3 months.