Fistula-associated anal carcinoma in Crohn’s disease

ABSTRACT

Introduction: Fistula-associated anal carcinoma in patients with Crohn’s disease (CD) is a rare condition. More recently, this entity has been increasingly reported likely due to increased recognition, and the incidence may be greater than once appreciated. There remains a paucity of data regarding the incidence, diagnosis, treatment, and outcome of fistula-associated anal carcinoma.

Area covered: This review evaluates the clinical features, pathology, treatment, and prognosis of fistula-associated anal carcinoma in patients with CD. A strategy for surveillance of this carcinoma is proposed by the authors based on the evidence obtained from this review.

Expert commentary: Clinicians caring for patients with CD and perianal involvement need to be aware of the rare yet extremely important association of long-standing perianal disease and fistula-associated carcinoma. Only through awareness, a high level of suspicion will be diagnosed in a timely manner. This involves a thorough history, a proper, and complete anorectal examination, along with early imaging and examination under anesthesia. Through this approach, it is hoped that early diagnose can be achieved in at-risk patients and change the significant morbidity and mortality associated with this diagnosis.

KEYWORDS:

• Crohn’s disease
• anal carcinoma
• perianal fistula
• fistula-associated anal carcinoma
• diagnosis
• treatment
• prognosis
• surveillance

Declaration of interest

P.G. Kotze has received speaking and consultancy honoraria from AbbVie, Janssen, Pfizer, Takeda and UCB. A. Spinelli has received speaker or consultant honoraria from Takeda, Tigenix, Ethicon. R. Panaccione has received research/educational support from: AbbVie, Abbott, Ferring, Janssen, Schering-Plough, Centocor, Millennium, Elan, Procter & Gamble and Bristol-Myers Squibb; served as a consultant for: AbbVie, Abbott, Amgen, Aptalis, AstraZeneca, Baxter, Eisai, Ferring, Janssen, Merck, Schering-Plough, Shire, Centocor, Elan, GlaxoSmithKline, UCB, Pfizer, Bristol-Myers Squibb, Warner Chilcott, Takeda, Cubist, Celgene, Gilead Sciences and Takeda; participated on speaker’s bureaus for AbbVie, AstraZeneca, Janssen, Schering-Plough, Shire, Ferring, Centocor, Elan, Prometheus, Warner Chilcott and Takeda; attended Advisory Boards for AbbVie, Abbott, Amgen, Aptalis, AstraZeneca, Baxter, Eisai, Ferring, Genentech, Janssen, Merck, Schering-Plough, Shire, Centocor, Elan, GlaxoSmithKline, UCB, Pfizer, Bristol-Myers Squibb, Warner Chilcott, Takeda, Cubist, Celgene and Salix. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has disclosed associtation with Abbvie, Ferring, Janssen, MSD, Pfizer, Takeda, Diasorin, Arkobiotics.

Additional information

Funding

This paper was not funded.