Volume 2024, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426


Introduction: Anal carcinoma is a relatively uncommon tumor that accounts for less than 2% of large bowel malignancies and approximately 1-6% of anorectal tumors. Most anal cancers originate in the mucosa between the anorectal junction and the anal verge. Risk factors for anal carcinoma include human papillomavirus (HPV), immunosuppression, older age, female gender, and smoking. Approximately 85% of anal cancers are squamous cell carcinoma, and the pathophysiology is believed to be linked to HPV-related inflammation, leading to dysplasia and progression to cancer.

Case Presentation: We present the case of a 65-year-old woman who sought medical attention at the emergency department (ED) due to rectal pain and concurrent rectal lesions persisting for the past three months. Before admission, she reported abdominal discomfort and constipation for 2-3 months, during which she took laxatives for relief. Laboratory findings in the ED were significant for anemia and leukocytosis, with all other values within normal limits. Blood tests, including antibodies for HPV and human immunodeficiency virus, were negative. A computed tomography scan of the abdomen and pelvis was largely unremarkable.

On physical examination, perianal lesions with heaped-up edges were observed. A punch biopsy was subsequently performed, revealing squamous cell carcinoma (SCC). About three weeks following discharge, after one week of admission to the general medicine ward, the patient started chemoradiation therapy and reported some improvement in her symptoms. Seven weeks later, she was in remission.

Discussion: Squamous cell carcinoma (SCC) of the anus, a rare disease entity, is often a slow and progressive malignancy. The length of time for patients to become symptomatic, in combination with its mimicking clinical presentation to common gastrointestinal tract diseases and its rarity, makes diagnosis challenging. Additionally, a patient lacking traditional risk factors for anal cancer, such as HPV and smoking, may further complicate diagnosis, treatment, and quality of life.

Conclusion: This case report emphasizes the pathogenesis and the similarities in clinical presentation of anal cancer to mild diseases, which may lead to a delay in diagnosis. Patients with anal carcinoma often delay seeking medical care, which is anecdotal in relation to the considerable overlap in symptoms of benign diseases such as hemorrhoids. Therefore, patients with “hemorrhoid” complaints, rectal bleeding, or rectal mass should warrant further physical examination and prompt referral to a gastroenterologist or a colorectal surgeon for additional evaluation.


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  1. Gondal TA, Chaudhary N, Bajwa H, Rauf A, Le D, Ahmed S. Anal Cancer: The Past, Present and Future. Curr Oncol. 2023 Mar 11; 30:(3):3232-3250. doi: [Crossref].
    https://doi.org/10.3390/curroncol30030246 [Google Scholar]
  2. SEER*Explorer: An interactive website for SEER cancer statistics [Internet] . Surveillance Research Program, National Cancer Institute; 2023 Apr 19. [updated: 2023 Nov 16; cited 2024 Jan 4]. Available from: https://seer.cancer.gov/statistics-network/explorer/. Data source(s): SEER Incidence Data, November 2022 Submission (1975-2020), SEER 22 registries.
    [Google Scholar]
  3. Golia Pernicka JS, Sheedy SP, Ernst RD, Minsky BD, Ganeshan D, Rauch GM. MR staging of anal cancer: what the radiologist needs to know. Abdom Radiol (NY). 2019 Nov; 44:(11):3726-3739. doi: [Crossref].
    https://doi.org/10.1007/s00261-019-02020-4 [Google Scholar]
  4. Albuquerque A. Cytology in Anal Cancer Screening: Practical Review for Clinicians. Acta Cytol. 2020; 64:(4):281-287. doi: [Crossref].
    https://doi.org/10.1159/000502881 [Google Scholar]
  5. Young AN, Jacob E, Willauer P, Smucker L, Monzon R, Oceguera L. Anal Cancer. Surg Clin North Am. 2020 Jun; 100:(3):629-634. doi: [Crossref].
    https://doi.org/10.1016/j.suc.2020.02.007 [Google Scholar]
  6. Pessia B, Romano L, Giuliani A, Lazzarin G, Carlei F, Schietroma M. Squamous cell anal cancer: Management and therapeutic options. Ann Med Surg (Lond). 2020 May 12; 55::36-46. doi: [Crossref].
    https://doi.org/10.1016/j.amsu.2020.04.016 [Google Scholar]
  7. Barbeiro S, Atalaia-Martins C, Marcos P, Gonçalves C, Cotrim I, Vasconcelos H. A Case Series of Anal Carcinoma Misdiagnosed as Idiopathic Chronic Anal Fissure. GE Port J Gastroenterol. 2017 Sep; 24:(5):227-231. doi: [Crossref].
    https://doi.org/10.1159/000452869 [Google Scholar]
  8. Morton M, Melnitchouk N, Bleday R. Squamous cell carcinoma of the anal canal. Curr Probl Cancer. 2018 Sep; 42:(5):486-492. doi: [Crossref].
    https://doi.org/10.1016/j.currproblcancer.2018.11.001 [Google Scholar]
  9. Silva Dalla Libera L, Almeida de Carvalho KP, Enocencio Porto Ramos J, Oliveira Cabral LA, de Cassia Goncalves de Alencar R, Villa LL, Alves RRF, et al.. Human Papillomavirus and Anal Cancer: Prevalence, Genotype Distribution, and Prognosis Aspects from Midwestern Region of Brazil. J Oncol. 2019 Sep 18; 2019::6018269. doi: [Crossref].
    https://doi.org/10.1155/2019/6018269 [Google Scholar]
  10. Lin C, Franceschi S, Clifford GM. Human papillomavirus types from infection to cancer in the anus, according to sex and HIV status: a systematic review and meta-analysis. Lancet Infect Dis. 2018 Feb; 18:(2):198-206. doi: [Crossref].
    https://doi.org/10.1016/S1473-3099(17)30653-9 [Google Scholar]
  11. Tyros G, Mastraftsi S, Gregoriou S, Nicolaidou E. Incidence of anogenital warts: epidemiological risk factors and real-life impact of human papillomavirus vaccination. Int J STD AIDS. 2021 Jan; 32:(1):4-13. doi: [Crossref].
    https://doi.org/10.1177/0956462420958577 [Google Scholar]
  12. Muršić I, Včev A, Kotrulja L, Kuric I, Milavić T, Šustić N, et al.. TREATMENT OF VERRUCA VULGARIS IN TRADITIONAL MEDICINE. Acta Clin Croat. 2020 Dec; 59:(4):745-750. doi: [Crossref].
    https://doi.org/10.20471/acc.2020.59.04.22 [Google Scholar]
  13. Huang J, Lok V, Zhang L, et al. IDDF2022-ABS-0273 Global incidence of anal cancer by histological subtypes. Gut. 2022; 71:(Suppl 2):A179-A180. doi: [Crossref].
    https://doi.org/10.1136/gutjnl-2022-IDDF.251 [Google Scholar]
  14. Shridhar R, Shibata D, Chan E, Thomas CR. Anal cancer: current standards in care and recent changes in practice. CA Cancer J Clin. 2015 Mar; 65:(2):139-62. doi: [Crossref].
    https://doi.org/10.3322/caac.21259 [Google Scholar]
  15. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al.. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017 Mar; 67:(2):93-99. doi: [Crossref].
    https://doi.org/10.3322/caac.21388 [Google Scholar]
  16. Shenoy MA, Winnicka L, Mirsadraei L, Marks D. Anal Cancer with Mediastinal Lymph Node Metastasis. Gastrointest Tumors. 2021 Jun; 8:(3):134-137. doi: [Crossref].
    https://doi.org/10.1159/000514112 [Google Scholar]
  17. Salati SA, Al Kadi A. Anal cancer - a review. Int J Health Sci (Qassim). 2012 Jun; 6:(2):206-30. doi: [Crossref].
    https://doi.org/10.12816/0006000 [Google Scholar]
  18. Chiu S, Joseph K, Ghosh S, Cornand RM, Schiller D. Reasons for delays in diagnosis of anal cancer and the effect on patient satisfaction. Can Fam Physician. 2015 Nov; 61:(11):e509-16.
    [Google Scholar]
  19. Nyitray AG, D’Souza G, Stier EA, Clifford G, Chiao EY. The Utility of Digital Anal Rectal Examinations in a Public Health Screening Program for Anal Cancer. J Low Genit Tract Dis. 2020 Apr; 24:(2):192-196. doi: [Crossref].
    https://doi.org/10.1097/LGT.0000000000000508 [Google Scholar]
  20. Wieland U, Kreuter A. Anal cancer risk: HPV-based cervical screening programmes. Lancet Infect Dis. 2019 Aug; 19:(8):799-800. doi: [Crossref].
    https://doi.org/10.1016/S1473-3099(1or9)30296-8 [Google Scholar]
  21. Barroso LF, Stier EA, Hillman R, Palefsky J. Anal Cancer Screening and Prevention: Summary of Evidence Reviewed for the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infection Guidelines. Clin Infect Dis. 2022 Apr 13; 74:(Suppl_2):S179-S192. doi: [Crossref].
    https://doi.org/10.1093/cid/ciac044 [Google Scholar]

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  • Article Type: Research Article
Keyword(s): adenocarcinomaanal canalAnal cancerhuman papillomavirus and squamous cell cancer
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