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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.

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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