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Treatment Options for perianal squamous cell carcinoma? (the cancer is on the outside)
Dec 23, 2001

Hi -- Great site! I just had surgery for internal anal warts (HPV condyloma)but the biopsy of the removed material revealed that a perianal (outside) 1 cm x 1 cm "skin tag" was a "invasive squamous cell carcinoma, grade 1, extending to one margin". The other, internal material was verified as condyloma with no dysplasia. I had the "skin tag" looked at 4 months ago, and that first colo-rectal surgeon told me to ignore it and treated me for an "internal hemorrhoid" before a second opinion revealed the condyloma. I haven't seen an oncologist yet, but if the carcinoma was only on the outside perianal area, will I still need 5-FU and mitomycin and radiation treatments? Are there effective alternatives without having to go through chemo or radiation? This is my first time with HPV. I also have chronically swollen groin lymph nodes, about 1.5 cm, movable, no changes in 6-8 months. Not sure if that's significant. What are my options?

Response from Dr. Dezube

You ask excellent questions with answers, which are not so straight-forward. The standard treatment for anal cancer is the combination of chemotherapy (mitomycin/fluorouracil) and radiation therapy. It is a very effective regimen, but it can be tough on the body, as well as tough on the cancer.

In your case, you may NOT even have anal cancer. It sounds like you have invasive cancer in an EXTERNAL skin tag. If this is the case, then you technically don't have anal cancer. What you may have is invasive squamous cell cancer of the SKIN. If this is the case, the treatment is surgical removal. You still have the deal with the extension to the margin, something we call in the trade "a dirty margin". This can be treated either with a reexcision or by radiation; both are treatments to the local area and are aimed at eradicating any cancer cells left behind in the dirty margins. Indeed, you may not need the chemotherapy used for anal cancer.

Whatever you decide to do, it is crucial that you have regular follow-up. You clearly have HPV related diseases. You need to be watched closely to nip any further disease in the bud. I would recommend that all your pathology slides be looked at very closely, but it does indeed seem that fixing of the dirty margins is all you need.

In terms of your lymph nodes, it may pay to have one of them biopsied. This can be done even by a fine needle aspiration. If any groin lymph nodes were to harbor cancer, then my above recommendations would be altered.

Good luck and please keep me posted. BD.


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