John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive


Treatment of anal cancer in 2019 Volume 26, issue 8, Octobre 2019


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Hôpital Bichat, Service d’hépatogastroentérolgie et de cancérologie digestive, 46 rue Henri Huchard, 75018 Paris
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Anal cancer is a squamous cell carcinoma in the greatest majority of the cases. Human papillomavirus (HPV) infection is found in more than 90% of cases. It is a rare cancer but its frequency increases, particularly among patients infected with human immunodeficiency virus (HIV), especially men who have sex with men. The histological diagnosis relies on biopsies during clinical proctologic examination. Technological progress and improved accessibility make essential anorectal magnetic resonance imagine (MRI) for locoregional workup, on top of all body CT-scan. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is nearly always realised and anorectal ultrasonography remains interesting for small tumors. DPD (dihydropyrimidine dehydrogenase) deficiency screening became mandatory before 5-FU-based treatments. HIV status, HIV-related comorbidities, other HPV-induced cancers and anal continence assessment must be also searched. Anal cancer is localized in the great majority of the cases and the reference treatment for these forms is radiation therapy combined with chemotherapy. Systemic chemotherapy is used for metastatic or inoperable forms. Recent data allow us to propose several chemotherapy regimens in first line.

Salvage surgery is indicated in case of local progression or recurrence after chemoradiotherapy. The anti-epidermal growth factor receptor antibodies ant immunotherapy are most advanced therapeutic perspectives.

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