Cancer of the anus complicating perianal Crohn's disease.
OBJECTIVE
This study was designed to review the clinical and pathologic findings, treatment, and outcomes of patients who have a cancer that complicates perianal Crohn's disease.


METHODS
Charts of patients who had documented perianal Crohn's disease and a pathologic diagnosis of anal carcinoma were reviewed.


RESULTS
There were 14 patients (6 men; mean age, 49 years) who had evidence of perianal Crohn's disease (mean, 6.9 (range, 1-20) years) before their cancer diagnosis. The diagnosis often was delayed despite increasing pain, multiple biopsies, and imaging studies. Ten patients had preoperative diagnoses of cancer; however, none of the eight magnetic resonance imaging studies were diagnostic. There were 11 adenocarcinomas (8 mucinous or colloid subtypes) and 3 squamous-cell carcinomas. Treatment included abdominoperineal resections plus chemotherapy in 12, and radiation and a defunctioning stoma in 1 patient. Of the 12 who had an abdominoperineal resection, 3 had posterior vaginectomies and rectus flap reconstructions. At last follow-up (mean, 41 (median, 22) months), five patients were alive without disease, five were alive with disease, and four had died.


CONCLUSIONS
Physicians should have a high level of suspicion of cancer in patients with longstanding perianal Crohn's disease who have a change in symptoms. In this series, patients who were diagnosed preoperatively and treated with multimodality therapy had better outcomes.
Devon
K M
KM
Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
Brown
C J
CJ
Burnstein
M
M
McLeod
R S
RS
D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000473:pathology; D001004:Anus Diseases / Q000150:complications / Q000473:pathology; D001005:Anus Neoplasms / Q000150:complications* / Q000175:diagnosis; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000175:diagnosis; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged