Anal Squamous Cell Cancers

Publication Date: July 1, 2018
Last Updated: March 14, 2022

Recommendations

Premalignant Neoplasms of the Anal Canal and Perianal Region

Patients at increased risk for anal squamous neoplasms should be identified by history, physical examination, and laboratory testing, noting that the risk is higher in HIV-positive individuals, men who have sex with men (MSM), and women with a history of cervical dysplasia. (1B)
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Standardized nomenclature with a 2-tiered system should be used. Biomarkers, including p16, should be used selectively to clarify equivocal high-grade lesions. (1C)
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Individuals with anal dysplasia should be followed at regular intervals with a history, physical examination, and a discussion of screening options. (2B)
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Screening with anal cytology (or anal Papanicolaou (Pap) tests) may be considered in high-risk populations as part of a comprehensive screening program, but the sensitivity and specificity of the test do not support its use for universal screening. (2B)
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HPV testing may be used as an adjunct to screening for anal cancer. (2B)
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HRA may be considered as a screening option for patients at high risk for cancer when performed by clinicians with appropriate training in the procedure. (2B)
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Topical imiquimod, fluorouracil, trichloroacetic acid and cidofovir with close long-term follow-up are each options for the treatment of LSIL or HSIL. (2B)
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Ablative treatments with conventional anoscopy or HRA are appropriate therapies for HSILs. (2B)
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  • Vaccination against HPV in men and women under age 26 years for primary prevention is typically recommended.
  • Vaccination of individuals with anal dysplasia for secondary prevention of dysplasia and cancer is not recommended.
(2A)
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Patients who have been treated for anal dysplasia may be observed without regular cytology, HPV testing, or HRA; however, treatment of visible or palpable disease should be offered. (2C)
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Overview

Title

Anal Squamous Cell Cancers

Authoring Organization

American Society of Colon and Rectal Surgeons