Anal cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Cet article présente les recommandations de trois sociétés savantes européennes sur le diagnostic et le traitement d'un cancer anal ainsi que le suivi des patients
These Guidelines were developed by the European Society for Medical Oncology (ESMO), the European Society of Surgical Oncology (ESSO) and the European Society of Radiotherapy and Oncology (ESTRO) and are published jointly in the Annals of Oncology, the European Journal of Surgical Oncology and Radiotherapy & Oncology. The three societies nominated authors to write the guidelines as well as reviewers to comment on them. aetiology : Squamous cell carcinoma of the anus (SCCA) is strongly associated with human papillomavirus (HPV) infection which represents the causative agent in 80%–85% of patients (usually from HPV16 or HPV18 subtypes in Europe) as is its precursor lesion anal intra-epithelial neoplasia (AIN) 3. Factors increasing the risk of HPV infection and/or modulating host response and the persistence of this infection appear to affect the epidemiology of this tumour. Anal intercourse and a high lifetime number of sexual partners increase the risk of persistent HPV infection in men and women, leading eventually to malignancy. Other important risk factors include human immunodeficiency virus (HIV), immune suppression in transplant recipients, use of immunosuppressants such as long-term corticosteroids, a history of other HPV-related cancers, autoimmune disorders, social deprivation and cigarette smoking. Cigarette smoking may also be important in the modulation/persistence of HPV infection and, hence, outcomes from treatment. Herpes simplex virus may play a secondary role in disease progression. Dietary habits, chronic inflammatory diseases and the presence of haemorrhoids do not appear to predispose to epidermoid anal cancer. Among men who have sex with men (MSM), the incidence of anal cancer is in the region of 35 per 100 000. In men who are HIV seropositive, the incidence increases to 75–135 per 100 000. The incidence is also higher among HIV seropositive women.
Annals of Oncology 2014