The Management and Prevention of Anal Squamous Cell Carcinoma

Am Soc Clin Oncol Educ Book. 2019 Jan:39:216-225. doi: 10.1200/EDBK_237433. Epub 2019 May 17.


Our aim is to discuss the current established management of care and associated prevention strategies of anal squamous cell carcinoma (SCCA). In general, the development of SCCA is commonly linked to a prior history of HPV. Unfortunately, HPV vaccination continues to be underutilized in the United States versus other countries. Increased acknowledgment of the importance of HPV vaccination as an anticancer vaccine should be encouraged. The present standard of care is primary chemoradiotherapy (CRT), which results in a high level of disease control for small, early-stage SCCA. More advanced cancers still fare poorly with this treatment, and the disease relapses locoregionally in the majority of cases (30%-50% of patients), resulting in an abdominoperineal resection. Current treatment recommendations are associated with substantial morbidity; alternative radiation doses and/or novel combinations of agents with CRT are needed to improve quality of life and oncologic outcomes. Cytotoxic chemotherapy remains the standard of care for treatment-naïve patients with metastatic disease, with a possible new treatment paradigm of carboplatin/weekly paclitaxel. In addition, immune checkpoint inhibition appears to have a promising role in the setting of patients with refractory disease. Several clinical trials with immunotherapeutic and vaccine approaches for locally advanced and metastatic anal cancer are ongoing, as are HPV-agnostic umbrella trials. Whenever possible, clinical trial enrollment is always encouraged for further therapeutic development in the setting of a rare cancer, given the potentially substantial global impact for other HPV-associated malignancies.

Publication types

  • Review

MeSH terms

  • Anus Neoplasms / diagnosis*
  • Anus Neoplasms / etiology
  • Anus Neoplasms / prevention & control*
  • Anus Neoplasms / therapy*
  • Carcinoma, Squamous Cell / diagnosis
  • Carcinoma, Squamous Cell / etiology
  • Carcinoma, Squamous Cell / prevention & control*
  • Carcinoma, Squamous Cell / therapy
  • Combined Modality Therapy
  • Diagnostic Imaging
  • Disease Management
  • Disease Susceptibility
  • Early Detection of Cancer
  • Humans
  • Neoplasm Staging
  • Risk Factors
  • Treatment Outcome

Supplementary concepts

  • Anal Canal Carcinoma