title: Presenting symptoms predict local staging of anal cancer: a retrospective analysis of 86 patients.
abstract: BACKGROUND
  Incidence of anal carcinoma (AC) is increasing and timely diagnosis is critical for efficient therapy. However, there is a paucity of recent studies addressing clinical symptoms and physical findings of anal carcinoma.
  
  
  METHODS
  We performed a retrospective study reviewing history, symptoms and physical findings from 86 patients with newly diagnosed AC. We analyzed frequency of symptoms and physical findings according to T and TNM stage and their predictive value regarding tumor stage.
  
  
  RESULTS
  Most patients presented with T2 (37 %) or T3 (29 %) cancer. 85 of 86 patients were symptomatic with anal bleeding (78 %), anal/perianal pain (63 %), weight loss (31 %) and foreign body sensation (22 %). 95 % of patients had ≥1 finding on physical examination including a visible tumor, palpable resistance and pain/blood during digital rectal examination. Patients with locally advanced disease (T3/T4) presented with more symptoms (p < 0.01) and more physical findings (p = 0.04) than patients with T1/T2 disease. On multivariate regression analysis perianal pain, painful defecation and weight loss were significantly associated with T3/T4 disease.
  
  
  CONCLUSIONS
  Clinical symptoms and physical findings are present in nearly all AC patients. Pain referred to the perianal region, painful defecation and weight loss have predictive value for locally advanced disease.
authors.affiliation: Department of Medicine and Specialities, Triemli Hospital, Zurich, Switzerland.|Division of Gastroenterology and Hepatology, University Hospital Zurich, Rämistr 100, 8091, Zürich, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Sauter
authors.affiliation: Division of Radiation-Oncology, Triemli Hospital, Zürich, Switzerland.
authors.forename: Georg
authors.initials: G
authors.lastname: Keilholz
authors.affiliation: Division of Radiation-Oncology, Triemli Hospital, Zürich, Switzerland.
authors.forename: Helmut
authors.initials: H
authors.lastname: Kranzbühler
authors.affiliation: Division of Radiation-Oncology, Triemli Hospital, Zürich, Switzerland.
authors.forename: Norbert
authors.initials: N
authors.lastname: Lombriser
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, Rämistr 100, 8091, Zürich, Switzerland.
authors.forename: Meher
authors.initials: M
authors.lastname: Prakash
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, Rämistr 100, 8091, Zürich, Switzerland.|Department of Medicine and Specialities, Division of Gastroenterology, Triemli Hospital, Zurich, Switzerland.
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Vavricka
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, Rämistr 100, 8091, Zürich, Switzerland. benjamin.misselwitz@usz.ch.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Misselwitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D003672:Defecation; D051517:Digital Rectal Examination; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006119:Groin; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010146:Pain / Q000209:etiology; D010388:Pelvis; D010808:Physical Examination; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D015431:Weight Loss
keywords: Anal carcinoma; Physical examination; Symptoms; Tumor staging