This chapter focuses on anal squamous cell carcinoma and its precursor lesions and summarizes the relevant epidemiology, evaluation, and management. Risk factors including human immunodeficiency virus status and sexual practices as well as the role of human papilloma virus in anal cancer pathogenesis are reviewed. Further understanding of the molecular biology of anal cancer will inform future strategies for targeted therapy, and biomarkers such as p16 and p53 may emerge as important prognostic indicators. Anal low-grade or high-grade squamous intraepithelial lesion histologies are particularly prevalent in at-risk populations, and surgical oncologists should understand the principles that underlie surveillance and management strategies. Finally, the role of chemoradiation and salvage abdominoperineal resection and the options for systemic therapy in the setting of metastatic disease are outlined.
This review contains 10 figures, 5 tables, and 77 references.
Key Words: Anal cancer, Anal HSIL, Anal LSIL, Anal margin cancer, Anal squamous cell, carcinoma, HPV, p16, Perianal cancer