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Anal "carcinoma-in-situ": what's the best treatment for this? Will I need my colon to be taken out?
May 3, 2003
I am HIV positive and I recently identified a small anal wart. I was diagnosed with HIV while being treated for testicular cancer with an orchiechtomy (removal of the testicle) and radiation therapy. However, the radiation treatment had a severe impact on my immune system bringing my CD4 count down as low at 117. It is now, a year later, just rebounded to about 250. My viral load is undectable.
I brought the wart to the attention of my doctor and then I had the wart surgically removed. They also did a "mapping" and biopsy of some of my skin, internal and external. They found that I am indeed infected with HPV, but also found "carcinoma in situ" at one of the biopsy locations. I am not really sure what this means. I still have to meet with the surgeon and my infectious disease doc to talk about treatment.
My questions are:
1. At what point is a colectomy recommended?
2. Can anal cancer be treated with just surgery?
3. What kind of impact will radiation/chemo have on my immune system a second time around?
4. I know that warts will likely recur, but if the cancer is removed, what's the likelihood it will return.
Thanks for your help, and sorry for so many questions.
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Response from Dr. Dezube
I'm glad to hear that your testicular cancer was successfully treated with surgery and radiation. The first thing to say is that you have "carcinoma-in-situ". This is the stage BEFORE invasive cancer. Although invasive anal cancer is typically treated with chemotherapy and radiation, carcinoma-in-situ is usually just treated with surgery. Based on what you have told me, it would be most unusual for you to need a colectomy (removal of the colon), though I know that many of my patients worry about this. Once the carcinoma-in-situ is removed, you will need to be followed up since recurrence can indeed occur. Recurrence can occur in your case for two reasons-- 1) you are HPV positive and 2) the radiation which you received for testicular cancer may predispose you to squamous cancer. What would I recommend for you? Your best bet lies in early detection and treatment, which you are already doing. Good luck.
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