Date of Award

2023

Degree Name

Master of Medicine / Surgery (Thesis)

Schools and Centres

Medicine

First Supervisor

Professor Reginald Lord

Second Supervisor

Professor Richard Hillman

Abstract

Purpose

Anal cancer is an uncommon condition, occurring at higher rates in specific subpopulations. Clinical experience is limited and substantial changes have recently occurred in our understanding of this condition. We therefore set out to characterise patients presenting with anal cancer and investigate whether there had been any changes over the past 20 years.

Methodology

A retrospective audit of cases identified from pathology databases during the period 1 January 2000 to 31 December 2019.

Results

224 patients, comprising 162 (72%) males and 62 (28%) females were identified, with a mean age of 54 years (range 30-85) for males and 61 (range 31-92) for females. People living with HIV presented at aged 51.7 years, compared to 61.7 years for those without HIV. 216 (96%) patients had anal squamous cell carcinomas. 46% of cases were classified as intra-anal, 28% perianal and 26% both. 54% were > 2cm at diagnosis. At presentation, intra-anal cases were larger and more advanced than perianal cases. Compared to the period 2000-2009, anal cancers presented more commonly in 2010-2019 (148 versus 76), were more likely to occur in HIV negative people and to be diagnosed at an earlier stage.

Conclusion

The number of anal cancer cases almost doubled over the study period and people living with HIV presented 10 years younger than others. Perianal cases presented earlier than those originating in intra-anal locations. This, together with the large size at diagnosis, suggests the potential value of screening those at high risk.

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