title: Anal Neoplasia in Inflammatory Bowel Disease: Classification Proposal, Epidemiology, Carcinogenesis, and Risk Management Perspectives.
abstract: Patients with inflammatory bowel disease [IBD] may develop, similarly to individuals from general population, rare cases of human papilloma virus [HPV]-related anal canal squamous cell carcinoma [SCC] and intra-epithelial precursor lesions, as well as very rare cases of anal canal adenocarcinoma. Patients with chronic perianal Crohn's disease [CD] are at substantial risk of developing SCC or adenocarcinoma from the fistula-lining epithelium, as well as SCC or adenocarcinoma arising from chronic anorectal ulcerations or strictures. Based on this lesion stratification, we provide in this review tailored incidence estimates and we propose an IBD-specific classification of all types of anal neoplasia that may occur in patients with IBD. After reviewing putative carcinogenesis of all types of neoplasia, we conclude that HPV vaccination could reduce the incidence of HPV-related lesions, although an anal screening programme related to these lesions is not mandatory on the sole basis of IBD. By contrast, we point out that all patients with chronic perianal CD should be explored in depth, including biopsies under anaesthesia and fistula curettage when necessary, in case of any change in anal symptoms ─in particular new, increasing, unexplained pain. Finally, we conclude that there is an urgent need for elaborating and evaluating surveillance algorithms in patients with chronic perianal CD, in order to avoid cancers with late diagnosis and poor prognosis.
authors.affiliation: Department of Gastroenterology, Hôpital Saint-Antoine, UPMC Univ Paris 06, Paris, France.|Hôpital Charles-Lemoyne and Université de Sherbrooke, Montréal, QC, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wisniewski
authors.affiliation: Department of Pathology, Hôpital Saint-Antoine,UPMC Univ Paris, France.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Fléjou
authors.affiliation: Department of Gastroenterology, CHU Pontchaillou, Univ Rennes, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Siproudhis
authors.affiliation: Department of Gastroenterology and Proctology, CHU Bichat, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Abramowitz
authors.affiliation: Department of Pathology, Hôpital Saint-Antoine,UPMC Univ Paris, France.
authors.forename: Magali
authors.initials: M
authors.lastname: Svrcek
authors.affiliation: Department of Gastroenterology, Hôpital Saint-Antoine, UPMC Univ Paris 06, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Beaugerie
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000453:epidemiology / Q000209:etiology; D001005:Anus Neoplasms / Q000145:classification / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D002294:Carcinoma, Squamous Cell / Q000145:classification / Q000453:epidemiology / Q000209:etiology; D003424:Crohn Disease / Q000145:classification / Q000150:complications; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000145:classification / Q000150:complications*; D012308:Risk Management
keywords: Anal cancer; adenocarcinoma; anal fistula-related cancers; inflammatory bowel disease; squamous cell carcinoma