Other forms oftreatment, such as surgical excision, may be considered by anal cancer multidisciplinary teams (MDTs), but surgery is usually reserved for salvage. There are still some areas of uncertainty about optimum treatment, and eligible
patients should Palbociclib order be encouraged to participate in trials. Management of relapse: All patients with suspected or confirmed relapse should be discussed by the anal cancer MDT. Those with confirmed loco-regional recurrence should undergo cross-sectional imaging and all treatment options, including surgery, should be considered by the MDT. Palliative radiotherapy, chemotherapy and palliative care should be discussed with patients who have metastatic disease or who are not sufficiently fit to undergo potentially curative treatment. www.selleckchem.com/products/LBH-589.html The incidence of anal cancer in people living with HIV is up to 40 times higher compared with the general
population [3] and it occurs at a much younger age [4–7]. The highest risk is in HIV-positive men who have sex with men (MSM) who have an incidence of 70–100 per 100 000 person years (PY) compared with 35 per 100 000 PY in HIV-negative MSM [8]. Recent studies confirmed the high incidence in HIV-positive MSM, other HIV-positive men and in HIV-positive women [9,10]. Importantly, the incidence of anal cancer appears to have risen with the widespread use of HAART [7,9,11–17] and this may relate to the longer survival of people living Thiamet G with HIV allowing time for the progression from HPV infection through the phases of anal dysplasia to invasive anal cancer. It is believed that the pathogenesis of invasive anal cancer resembles that of cervical cancer with human papilloma virus
(HPV) infection leading to anal intraepithelial neoplasia (AIN) and ensuing progression from low- to high-grade dysplasia and subsequently, invasive cancer [4,18–20]. This pathogenetic model suggests a role for anal screening by a combination of cytology and high-resolution anoscopy followed by local ablative therapy of AIN. However, as noted in the 2008 BHIVA, BASHH and FFPRHC guidelines, the role of anal screening is not yet proven [1,20,21]. Whilst some centres have instituted screening pilots [22,23], the cost-effectiveness analyses have produced both positive and negative results [24–29]. The presentation of anal cancer can vary from rectal bleeding and anal pain to features of incontinence if the anal sphincters are affected, with some patients being asymptomatic [4]. Many comparative series have shown that people living with HIV who develop anal cancer are younger than HIV-negative individuals with anal cancer [5,30–36]. However, most comparisons suggest that there is no difference in tumour stage at presentation [5,30–39].