Pt presented with h/o mass per rectum for quite few.months.. H/o severe pain since few days..



Squamous cell carcinoma (SCC) of the anus typically presents as a bleeding mass with pain or tenesmus. These lesions are large and typically have central ulceration, which can be present for several years prior to presentation. A form of perianal SCC known as Bowen's disease (high-grade intraepithelial SCC)

The incidence of anal cancer in the general population has increased over the last 30 years. A higher incidence has been associated with female gender, infection with human papillomavirus (HPV), lifetime number of sexual partners, genital warts, cigarette smoking, receptive anal intercourse, and infection with human immunodeficiency virus (HIV) [2]. From an etiologic standpoint, anal cancer is more similar to genital malignancies than it is to other gastrointestinal tract cancers.

Four distinct categories of tumors arise in the anal region: ●Tumors that develop from any of the three types of mucosa are termed anal canal cancers. Tumors arising in the transitional or squamous mucosa are squamous cell cancers (SCCs) and appear to behave similarly, despite their sometimes variable morphologic appearance. By convention, most series that report outcomes of "anal cancer" refer exclusively to these tumors. The term "anal cancer" by common definition refers to SCCs arising within the mucosa of the anus, and the two terms will be used interchangeably throughout this review. Basaloid (also termed junctional or cloacogenic) carcinoma is a variant of SCC that arises from epithelial transitional zone. However, these terms have largely been abandoned because these tumors are now recognized as nonkeratinizing types of SCC. Tumors arising within the anal canal above the dentate line are termed nonkeratinizing SCCs, while those arising within the anal canal distal to the pectinate (dentate) line are termed keratinizing SCCs. ●Adenocarcinomas arising from glandular elements within the anal canal are rare, but appear to share a similar natural history to rectal adenocarcinomas and are treated similarly.

●Tumors arising within the hair-bearing skin at or distal to the squamous mucocutaneous junction have been referred to as anal margin cancers. However, the preferred term is perianal skin cancers. With the exception of melanomas, tumors arising on the perianal skin behave biologically like skin cancers. They are staged and classified as skin cancers

Tumors originating above the dentate line, similar to rectal cancers, drain to the perirectal and paravertebral nodes. In contrast, tumors arising below the dentate line drain to the inguinal and femoral nodes, areas that are rarely involved by rectal cancer. In the AJCC/IUCC staging system, perirectal nodes are N1 nodes; metastases in the unilateral internal iliac or superficial inguinal nodes are scored as N2 disease, and N3 nodal disease refers to metastases in both perirectal and inguinal nodes, or bilateral internal iliac or inguinal nodes

A case of prolapsed thrombosed piles with secondary infection and ulceration. It could be one of the presentation of Ca rectum leading to prolapse of already existing secondary haemorrhoids. After reduction of pile mass in theare proctoscopy to be done or sigmoidoscopy to rule out cause of secondary piles .If nothing found haemorrhoidsectomy to be done

Among patients with anal squamous cell carcinoma (SCC), a history of anorectal condyloma is present in about 50 percent of homosexual men and less than 30 percent of women and heterosexual men;

Pretreatment clinical staging consists of physical examination and biopsy of the primary tumor, palpation of the groin, computed tomography (CT) of the chest, CT or magnetic resonance imaging (MRI) of the abdomen and pelvis, and an integrated positron emission tomography (PET)/CT scan.

Historically, both the staging and treatment of anal cancer was surgical and consisted of abdominoperineal resection and inguinal lymph node dissection. However, combined chemoradiotherapy has emerged as the preferred method of treatment, with radiation therapy (RT) administered to the sites of primary disease and lymphatic spread, usually with prophylactic irradiation of clinically negative groins. This strategy has significantly reduced the rates of locoregional recurrence and led to markedly improved control of gross nodal disease.

What is the appropriate workup/treatment of perianal squamous cell carcinoma? What are the types of closure useful for these types of lesions

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