HEMORRHOIDS AGAIN?

Abstract Introduction Anal cancer represents 4% of digestive tract tumors, although its incidence is increasing due to the growing number of patients with HPV infection, who are immunosuppressed or who practice anal sex. The most common histological type is carcinoma and the usual standard treatment is the combination of radiotherapy with chemotherapy. Survival at 5 years exceeds 50% even in patients with nodal disease. Clinical case We present the case of a 54-year-old man, with a history of anal intercourse, referred to General Surgery for hemorrhoids. During the examination in consultation, an ulcerated excrescent anal lesion was observed. A rectal swab was taken for sexually transmitted diseases and a biopsy of the lesion was HPV+, genotype 16. In the pathology study, anal squamous cell carcinoma was diagnosed. An extension study was performed, objectifying bilateral inguinal lymphadenopathies (N1a) and treatment with radiochemotherapy was started after a decision made by the multidisciplinary tumor committee. Discussion Anal squamous cell carcinoma is the most frequent histological variety of malignant tumors of the anus. The first-line treatment is radiotherapy (which must be to the inguinal region) associated with chemotherapy (5-FU and mitomycin C). A clinical follow-up should be carried out in all cases at 8–12 weeks and, in addition, an annual extension radiological study in locally advanced cases. Rescue surgery will be reserved for those patients with confirmed locoregional recurrence, with abdominoperineal amputation being the indicated technique in most cases.