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Anus and perianal area



Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 16 April 2013, last major update April 2005
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.


● Incidence increasing in males and females; more common in women (2-4:1)
● 4000 new cases and 620 deaths annually from anal cancer in US
● Associated with HPV in 75-85% of cases, usually HPV 16 (Mod Pathol 1996;9:614, Mod Pathol 1989;2:439)
● HPV negative tumors occur in older patients, often no dysplasia; most rectal adenocarcinomas are HPV negative
● May arise from mucosa (called anal canal cancers) or skin / distal to squamous mucocutaneous junction (called perianal cancers)
Symptoms: bleeding, pain, mass, itching, none (25%)
Risk factors: Crohn’s disease, lymphogranuloma venereum, condyloma acuminatum or other sexually transmitted diseases, cervical cancer, receptive anal intercourse in homosexuals, heavy smoking, immunosuppression
Metastases: rectal and inguinal lymph nodes, liver, lungs
WHO classification of anal carcinomas: squamous cell, adenocarcinoma (rectal type, of anal glands, or within anorectal fistulae), mucinous adenocarcinoma, small cell, undifferentiated

Prognostic factors

Poor prognostic factors:
● High stage (based on large size, increased depth of invasion, nodal involvement, metastases)
● Recurrence
● Possibly poorly differentiated (basaloid) tumors
● Possibly aneuploidy

5 year survival: 50-70%; 100% if less than 2 cm, confined to mucosa or submucosa and well differentiated


● Local excision for small tumors
● Larger tumors get radiation therapy or chemotherapy, rarely abdominoperineal resection

Gross description

● Usually near dentate (pectinate) line growing upward into rectum or outward towards perianal tissues
● If proximal to pectinate line, often cannot distinguish grossly from rectal adenocarcinoma
● Perianal skin involvement varies from none, surface ulceration or ulcerated tumor with rolled edges

Positive stains

● CEA, cytokeratin, EMA, p53

Negative stains

● ER, PR

End of Anus and perianal area > Carcinoma > Carcinoma-general

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