Endoscopic diagnostics and treatment of “early” anal cancer

Anal cancer is a rare malignancy of the distal gastrointestinal tract, often associated with human papillomavirus, the most common sexually transmitted infection worldwide. Currently available screening methods for anal intraepithelial neoplasia, a precursor for anal cancer, combine anal Papanicolaou cytology and high resolution anoscopy with biopsy of suspicious lesions. It is well known that the anal canal is an area examined by proctologists, however, with endoscopic examination, cancer of the anal canal can also be detected, including in the early stages of the tumor process. When conducting an endoscopic examination of the lower gastrointestinal tract, the most common cause of incomplete examination of the colon during colonoscopy is poor preparation, less often—the anatomical features of the colon. An endoscopist, who examined the colon often skip the changes related to the lower ampullar part of the rectum and the anal canal, because of quickly removing the endoscope and not using the technique of examining this area in retrofl exed mode. This review describes the epidemiology of anal intraepithelial neoplasia and anal cancer and carcinogenesis in the population of the Russian Federation, presents an algorithm for examining patients at risk, diagnostic and therapeutic endoscopic techniques that allow timely diagnosis of pathological conditions of the lower ampulla of the rectum and anal canal, also presents modern possibilities of endoscopic treatment of this pathology.

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