Seltener Tumor mit guter Prognose: das Analkarzinom – Wichtig ist die frühzeitige Diagnose

Zusammenfassung

Das Analkarzinom ist mit einem Anteil von bis zu 5 % aller Karzinome im Gastrointestinaltrakt ein relativ seltener Tumor mit in den letzten Jahren steigender Inzidenz, der häufig (80–90 %) mit dem humanen Papillomavirus (HPV) assoziiert ist. Histologisch handelt es sich meist um ein Plattenepithelkarzinom. Die Diagnose eines Analrandkarzinoms ist über eine Inspektion und eine digital-rektale Untersuchung relativ einfach zu stellen und bioptisch bzw. über eine Exzision abzusichern. Danach folgen die üblichen Staginguntersuchungen. Kleine, gut differenzierte Analrandkarzinome (pT1 und pT2) und pT1-Analkanalkarzinome, können mit einer R0-Exzision gut behandelt werden, eine engmaschige Nachsorge vorausgesetzt. Alle anderen T-Stadien bedürfen einer kombinierten Radiochemotherapie (RCT). Diese ist schon 40 Jahre etabliert, die Radiotherapie hat sich in den Jahren allerdings zu einer intensitätsmodulierten Strahlentherapie in Kombination mit einer Brachytherapie „verfeinert“. Nach wie vor Standard ist die Chemotherapie mit Mitomycin C und 5-Fluorouracil. Abhängig vom Stadium ist die Therapie also in Zusammenarbeit mit dem Strahlenonkologen zu koordinieren. Unter diesen Bedingungen ist das Analkarzinom ein Tumor, der mit einer guten Prognose und dem Erhalt der Kontinenz verbunden ist.

Summary

Anal carcinoma is a rare tumour (less than 5 % of all gastrointestinal cancers) that is often associated with the human papilloma virus (HPV). Incidence is increasing. Most anal cancers are squamous cell carcinomas. Diagnosis is easy by inspection (anal margin) or rectal examination/anoscopy (anal canal). Biopsy or excision of the tumour confirms the diagnosis. Staging includes the common staging procedures. Small, well differentiated anal margin carcinomas (pT1 and pT2) can be excised (R0), but a close follow up of the patient is necessary. Very small anal canal carcinomas (pT1) might also be treated by surgery alone. All other T-stages or tumours with unknown localization and/or resection status should be treated by combined radiochemotherapy (RCT). RCT has been the standard for the last 40 years. In this time differentiated radiotherapy treatments have been developed: three-field percutaneous therapy, RCT in combination with interstitial brachytherapy. Chemotherapy with mitomycine-C and 5-fluorouracil has remained the standard. Therefore therapy should be stage dependent and in cooperation with the oncologist/radiotherapist. Under these conditions anal carcinoma is a tumour with a good prognosis and a good quality of life after therapy (no abdominoperineal resection/no colostomy needed in most cases).

Key words

Anal carcinoma - human papilloma virus (HPV) - diagnosis - combined radiochemotherapy (RCT) - brachytherapy - rectal excision - prognosis

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