肛门部鳞状细胞癌的诊断与治疗---解读美国结直肠外科医师协会实践指南

Diagnosis and treatment for anal squamous cancer— interpretation of guideline from American Society of Colon and Rectal Surgeons

肛门部鳞状细胞癌是相对罕见的恶性肿瘤。许多医生缺乏这方面的治疗经验,甚至将肛门癌与低位直肠癌混为一谈。实际上,肛门癌与直肠癌在生物学行为与临床治疗等方面存在显著差别。对于肛门癌来说,疾病特异性的病史,如乳头瘤病毒或艾滋病病毒的感染史应仔细询问。内镜检查与影像学评估非常重要。手术是直肠癌的主要治疗手段,而对于肛管癌,放化疗是首选治疗,手术仅适用于放疗抵抗或复发的肛门癌。为了进一步提高临床决策水平,美国结直肠外科医师协会出版了肛门部鳞状细胞癌的治疗参考指南。该指南重点关注肛管与肛周鳞状细胞癌的诊断、治疗前评价与临床治疗。

Squamous-cell carcinoma （SCC） of the anus remains a relatively rare malignancy. Many doctors were inexperienced in treatment of anal cancer, and a lot of people even confuse anal cancer with low rectal cancer. In fact, anal cancer is significantly different with rectal cancer from oncological behavior to clinical treatment. A disease-specific history of anal cancer should be carefully performed, such as the infection history of HPV or HIV. Endoscopic and radiologic evaluations are significant for anal cancer. In the treatment, surgery is the cornerstone for rectal cancer, while it is just indicated for the radio-resistant or recurrent disease in anal cancer. Chemoradiotherapy is well demonstrated as the primary treatment of anal cancer. With the purpose of improving clinical decisions, the American Society of Colon and Rectal Surgeons （ASCRS） published the Practice Parameters for Anal Squamous Neoplasms. This practice parameter will focus on the diagnosis, pretreatment evaluation and therapy of SCC in anus and anal margin.