Abstract
BackgroundSquamocellular anal carcinoma is increasingly diagnosed in patients with risk factors.MethodsState-of-the-art imaging with magnetic resonance imaging (MRI) using phased-array coils and volumetric multidetector computed tomography (CT) provides detailed visualisation of anal disorders, identification and extent assessment of neoplastic tissue, detection and characterisation of nodal and visceral metastases. MRI has been recommended by the European Society for Medical Oncology (ESMO) as the preferred modality of choice to stage anal cancer, taking into account the maximum tumour diameter, invasion of adjacent structures and regional lymph node involvement.ResultsCross-sectional imaging techniques allow the identification of coexisting complications, and differentiation from other perineal abnormalities.ConclusionCross-sectional imaging is useful for planning radiotherapy, surgical drainage or salvage abdomino-perineal resection. After chemo-radiotherapy, MRI follow-up provides confident reassessment of therapeutic response, persistent or recurrent disease.Teaching Points • Anal carcinoma is increasingly diagnosed in patients with human immunodeficiency virus (HIV), anoreceptive intercourse, chronic inflammatory bowel disease. • An established association exists with human papillomavirus (HPV) infection and premalignant intra-epithelial dysplasia. • Phased-array MRI is recommended as the preferred imaging modality for regional staging. • Imaging allows detection of infectious complications, planning of radiotherapy or salvage surgery. • Follow-up MRI allows reliable assessment of therapeutic response after chemo-radiotherapy.
Highlights
An uncommon malignancy in the general population, squamocellular anal carcinoma (SCAC) accounts for approximately 1 % of all gastrointestinal neoplasms and less than 5 % of anorectal tumours
An established association exists with human papillomavirus (HPV) infection and premalignant intra-epithelial dysplasia
Phased-array magnetic resonance imaging (MRI) is recommended as the preferred imaging modality for regional staging
Summary
An uncommon malignancy in the general population, squamocellular anal carcinoma (SCAC) accounts for approximately 1 % of all gastrointestinal neoplasms and less than 5 % of anorectal tumours. To uterine cervix dysplastic changes, oncogenic human papillomavirus (HPV) has been detected in the vast majority (up to 90 %) of invasive SCACs, and linked to the development of low- and high-grade premalignant anal intra-epithelial neoplasms (AIN), with high-risk or multiple HPV serotypes infection [1, 2]. The incidence of SCAC is steadily increasing, in patients with risk factors such as human immunodeficiency virus (HIV) infection, history of anoreceptive intercourse, coexistent cervical dysplasia or cancer, immunosuppression, inflammatory bowel diseases (IBD) and cigarette smoking. At least half of SCACs occur in relatively young (40–60 years) HIV-positive individuals, most often men who have sex with men (MSM) [3,4,5]
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