Anal Squamous Cell Carcinoma Incidentally Found At Hemorrhoidectomy: More Common Than You Would Think!
*Stephen J O'Brien1, *C Tyler Ellis1, *Jaclyn McDowell2, Susan Galandiuk1, Hiram C Polk, Jr.1
1University of Louisville, Louisville, KY;2Markey Cancer Control Program, Kentucky Cancer Registry, Lexington, KY
OBJECTIVE(S): The incidence of anal Squamous cell carcinoma(SCCA) is increasing nationally and even more so, in Kentucky. SCCA unexpectedly identified at pathology evaluation of hemorrhoidectomy specimens is not uncommon. We hypothesize that this is occurring more frequently and sought to evaluate its impact on outcomes.
METHODS: The Kentucky Cancer Registry, a premier population database, yielded 1,698 SCCA from 1995-2016. Fourteen percent(264) of SCCA were initially identified within hemorrhoidectomy specimens. Patient demographics, tumor details, clinical treatments and outcomes were analyzed. Risk factors associated with tumor persistence, disease-specific and overall survival were evaluated with logistic regression and Cox proportional hazards models.
RESULTS: Demographics were similar between individuals with SCCA identified within hemorrhoid(H) vs. non-hemorrhoid tissue(NH). Stage I/II disease was more common in the hemorrhoid- compared to the non-hemorrhoid group(76% vs. 46%, p<0.01, Figure 1a). In Stage I/II patients, chemoradiation was more likely used for definitive treatment in the hemorrhoid- vs. non-hemorrhoid group, (83% vs. 70%, p<0.01, Figure 1b) likely due to the presence of perianal SCC in the non-hemorrhoid group and unclear tumor location in the hemorrhoid group. Both groups(H & NH) had similar rates of disease persistence, recurrence, and survival. Subgroup analysis of stage I patients, showed that local excision was NOT associated with worse recurrence free or overall survival, compared to surgery+chemoradiation(both p>0.1).
CONCLUSIONS: SCCA within hemorrhoid tissue comprises 14% of our population-based cohort. When SCCA was diagnosed in hemorrhoidectomy specimens, patients were more likely to receive chemoradiation vs. local excision, without improved clinical outcomes. Although the reasons for this are unclear, we hypothesize that the exact cancer location is often ill-defined due to lack of precise labelling of hemorrhoid location. We advocate accurate labelling and separate submission of hemorrhoid specimens to permit the therapy associated with the least morbidity in the event of incidental SCC diagnosis.
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