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anal cancer?
Nov 1, 2003

Dr. Pierone,

It seems that hiv patients still get alot of cases of anal and colorectal cancer? What is being done to prevent these occurences from occuring? And are better drugs being put in for treatment?

Lyle

Response from Dr. Pierone

I think that there are more cases of anal cancer since people are living much longer with HIV and we need to do more to make an early diagnosis. Most cases of anal cancer are related to papilloma virus infections. These viral infections most often produce genital and anal warts. Warts can be removed surgically, with lazars, by freezing, and through heat cauterization. Precancerous changes of the skin in the anal region may also occur, and if so needs to be treated and monitored by a doctor with expertise in this area. Squamous cell cancer of the anus may occur and this requires aggressive management by a cancer specialist. With contemporary treatment, the prognosis of anal squamous cell cancer is actually quite good. Notwithstanding that fact, it is always better to prevent cancer. To this point, anal pap smears may be worthwhile. Although not a standard of care, they may be in the future. Ongoing studies may prove their value as a screening test and if so, this will be another routine aspect of HIV primary care.

Anyone with HIV and ongoing anal symptoms should be seen by a clinician with experience in anoscopy and knowledge of HIV specific issues.

Also, since people are living longer, we will be seeing more colon cancer in the future. This is a very preventable cancer and colon cancer screening with colonoscopy should be performed for anyone older then 50 and then periodically thereafter. The optimal timing of follow up colon testing has not been determined precisely, every 5-10 years is the current range for those with negative exams. Persons with a family history of colon cancer should start screening earlier and have more intensive follow up testing.


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