Understand the prognosis of anal squamous cell carcinoma in the setting of ulcerative colitis.
Adult patients with both ulcerative colitis (556.9/K51.9) and anal squamous cell carcinoma (154.3/C44.520) between January 1, 2000 to August 1, 2019.
Treatment and survival of anal squamous cell carcinoma.
Seventeen adult patients with ulcerative colitis and anal dysplasia and/or anal squamous cell carcinoma were included out of 13,499 ulcerative colitis patients treated; 6 had a diagnosis of anal squamous cell carcinoma, 8 had high grade squamous intraepithelial lesions, and 3 had low grade squamous intraepithelial lesions. There were 4 males (23%) and median age of 55 years (range, 32-69) years. At diagnosis, 6 had an ileal pouch anal anastomosis of which 5 had active pouchitis, 1 had an ileorectal anastomosis with active proctitis, 1 had a Hartman’s stump with disuse proctitis, 5 had pancolitis, and 4 had left sided colitis. Of the 6 with anal squamous cell carcinoma, all received 5-FU and mitomycin C with external beam radiation therapy. Four patients had an ileal pouch anal anastomosis, all of whom required intestinal diversion or pouch excision due to treatment intolerance. At a median follow-up of 60 months, three patients experienced mortality: one at 0 months (treatment related myocardial infarction), one at 60 months (metastatic anal squamous cell carcinoma), and one at 129 months (malignant peripheral nerve sheath tumor); the remaining had no residual disease.
Retrospective, small number of patients.
Anal squamous cell carcinoma in the setting of ulcerative colitis is extremely rare. In the setting of IPAA, diversion may be necessary to prevent radiation intolerance. Careful examination of the perianal region should be performed at the time of surveillance endoscopy. See Video Abstract at http://links.lww.com/DCR/B582.
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