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Selimagic A, Dozic A, Husic-Selimovic A, Tucakovic N, Cehajic A, Subo A, Spahic A, Vanis N. The Role of Inflammation in Anal Cancer. Diseases 2022; 10:diseases10020027. [PMID: 35645248 PMCID: PMC9149845 DOI: 10.3390/diseases10020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this article was to present a summary of the current resources available in the literature regarding the role of inflammation in anal cancer development. Anal cancer is relatively uncommon, accounting for about 2.7% of all reported gastrointestinal cancers in the United States. However, the importance of understanding the pathogenesis and risk factors for anal cancer has been recognized over the last several decades due to a noticed increase in incidence worldwide. Infections, autoimmune diseases, and inflammatory diseases of unknown etiology cause chronic inflammation that promotes tumorigenesis. The association between chronic inflammation and cancer development is widely accepted. It is based on different pathophysiological mechanisms that lead to cellular transformation and changes in immunological response, allowing tumor cells to avoid apoptosis and immune surveillance. However, there are still many molecular and cellular mechanisms that remain largely unexplored. Further studies on this topic could be of tremendous significance in elucidating anal cancer pathogenesis and developing immunotherapeutic approaches for its treatment.
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Affiliation(s)
- Amir Selimagic
- Department of Gastroenterohepatology, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.H.-S.); (N.T.); (A.C.)
- Correspondence: ; Tel.: +387-33-285-100
| | - Ada Dozic
- Department of Internal Medicine, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.D.); (A.S.); (A.S.); (N.V.)
| | - Azra Husic-Selimovic
- Department of Gastroenterohepatology, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.H.-S.); (N.T.); (A.C.)
| | - Nijaz Tucakovic
- Department of Gastroenterohepatology, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.H.-S.); (N.T.); (A.C.)
| | - Amir Cehajic
- Department of Gastroenterohepatology, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.H.-S.); (N.T.); (A.C.)
| | - Anela Subo
- Department of Internal Medicine, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.D.); (A.S.); (A.S.); (N.V.)
| | - Azra Spahic
- Department of Internal Medicine, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.D.); (A.S.); (A.S.); (N.V.)
| | - Nedim Vanis
- Department of Internal Medicine, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.D.); (A.S.); (A.S.); (N.V.)
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Méndez-Martínez R, Maldonado-Frías S, Vázquez-Vega S, Caro-Vega Y, Rendón-Maldonado JG, Guido-Jiménez M, Crabtree-Ramírez B, Sierra-Madero JG, García-Carrancá A. High prevalent human papillomavirus infections of the oral cavity of asymptomatic HIV-positive men. BMC Infect Dis 2020; 20:27. [PMID: 31924186 PMCID: PMC6954555 DOI: 10.1186/s12879-019-4677-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/29/2019] [Indexed: 12/24/2022] Open
Abstract
Background Incidence of anal and oral infections with Human Papillomavirus (HPV) is increasing, particularly among Human Immunodeficiency Virus-positive (HIV+) men. HPV type 16 has exhibited the highest incidence and only limited data is available on other prevalent types, variants of HPV16, as well as associated factors. We were interested in identifying prevalent HPV types, variants of type 16, as well as factors associated with HPV16 infections in the oral cavity of HIV+ men who have sex with men (MSM). Methods A cross-sectional study of oral cavity samples from HIV+ MSM, that in a previous study were identified as positive for HPV16 in the anal canal. Cells from the oral cavity (102 samples, paired with 102 from the anal canal of same patient) were used to extract DNA and detect HPV infections using INNO-LiPA HPV Genotyping Extra II, and PCR. From these, 80 samples (paired, 40 anal and 40 oral) were used to identify variants of type 16 by sequencing. Statistical differences were estimated by the X2 test, and p values equal to or less than 0.05 were considered significant. SPSS ver. Twenty-four statistical software (IBM Corp) was used. Results We found a high prevalence of High-Risk HPV (HR-HPV) and Low-Risk HPV (LR-HPV). Patients were positive in the oral cavity for HR types; 16, 39 and 18 (80.4, 61.8 and 52.9% respectively) and LR types 11 and 6 (53.9 and 34.3% respectively). Surprisingly, only European variants of type 16 were found in the oral cavity, although American Asian (22.5%) and African (2.5%) variants were identified in the anal canal. The analysis showed that CD4 counts could be the most important risk factor associated with HR-HPV infections in the oral cavity, anal canal or both anatomical regions. The risk of infection of the oral cavity with type 18 increased in men diagnosed with HIV for more than 6 years. Conclusions Prevalence of both HR and LR HPV’s in the oral cavity of Mexican HIV+ MSM is very high. The fact that only European variants of HPV16 were found in the oral cavity suggest a possible tropism not previously described.
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Affiliation(s)
- Rocío Méndez-Martínez
- División de Investigación Básica, Instituto Nacional de Cancerología, Av. San Fernando #22, Tlalpan, 2do piso, Torre de Investigación Básica, 14080, CDMX, México City, Mexico.,Doctorado en Biotecnología & Doctorado en Ciencias Biomédicas, Facultad de Ciencias Químico-Biológicas, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, Mexico
| | - Silvia Maldonado-Frías
- División de Estudios de Posgrado e Investigación, Facultad de Odontología, Universidad Nacional Autónoma de México, Universidad 3000, Coyoacán, Copilco Universidad, 04360 Ciudad de México, CDMX, México City, Mexico
| | - Salvador Vázquez-Vega
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Doctores 330, Cuauhtemoc, 06720, Ciudad de México, CDMX, Mexico
| | - Yanink Caro-Vega
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" (INCMNSZ), Secretaría de Salud, México City, Mexico
| | - José Guadalupe Rendón-Maldonado
- Facultad de Ciencias Químico-Biológicas- UAS, Universidad Autónoma de Sinaloa, Calz. de las Américas Norte 2771, Burócrata, 80030, Culiacán, Sinaloa, Mexico
| | - Miriam Guido-Jiménez
- Unidad de Investigación Biomédica en Cáncer, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México & Instituto Nacional de Cancerología, Av. San Fernando #22, Tlalpan, 2do piso, Torre de Investigación Básica, 14080, CDMX, México City, Mexico
| | - Brenda Crabtree-Ramírez
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" (INCMNSZ), Secretaría de Salud, México City, Mexico
| | - Juan G Sierra-Madero
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" (INCMNSZ), Secretaría de Salud, México City, Mexico
| | - Alejandro García-Carrancá
- Unidad de Investigación Biomédica en Cáncer, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México & Instituto Nacional de Cancerología, Av. San Fernando #22, Tlalpan, 2do piso, Torre de Investigación Básica, 14080, CDMX, México City, Mexico.
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Shahjehan F, Kamatham S, Ritter A, Kasi PM. Dramatic response to modified docetaxel, cisplatin, and fluorouracil chemotherapy after immunotherapy in a patient with refractory metastatic anal cancer. Clin Case Rep 2019; 7:1729-1734. [PMID: 31534737 PMCID: PMC6745381 DOI: 10.1002/ccr3.2333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/17/2019] [Accepted: 06/26/2019] [Indexed: 12/23/2022] Open
Abstract
Doublet chemotherapies are the mainstay in the management of metastatic anal cancer. Immunotherapy has been incorporated into guidelines in a refractory setting. Treatment options remain limited with tumor progression beyond immunotherapy. Modified docetaxel, cisplatin, and fluorouracil (mDCF) chemotherapy, after progression postimmunotherapy, has shown a near-complete response in our patient with metastatic anal cancer. This likely is secondary to the sequence of immunotherapy followed by chemotherapy that is yielding greater than historical responses.
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Affiliation(s)
| | | | - Ashton Ritter
- Division of Hematology and OncologyMayo ClinicJacksonvilleFLUSA
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Patil DT, Yang B. Utility of Human Papillomavirus Capsid Protein L1 and p16 in the Assessment and Accurate Classification of Anal Squamous Intraepithelial Lesions. Am J Clin Pathol 2015; 144:113-21. [PMID: 26071469 DOI: 10.1309/ajcpd8u4fqexxizs] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Morphologic evaluation of anal dysplasia remains problematic, especially in cases with limited biopsy samples or obscuring inflammation. Studies in cervical neoplasia have shown that human papillomavirus (HPV) L1 capsid production is highest in low-grade squamous intraepithelial lesions (LSILs) and progressively decreases in high-grade squamous intraepithelial lesions (HSILs). The combined utility of HPV L1 and p16 expression in assessing anal squamous intraepithelial lesions (SILs) has never been analyzed and forms the basis of this study. METHODS In total, 145 anal lesions were reviewed and immunohistochemically stained for HPV L1 and p16. p16 expression was recorded as negative, patchy/focal, or diffuse. For analytical purposes, condylomas were evaluated separately from rest of the LSILs. RESULTS There were 34 (23%) condylomas, 64 (44%) LSILs, and 47 (32%) HSILs. HPV L1 was significantly associated with condylomas (68%) and LSILs (52%) compared with HSILs (9%; P < .0001). Diffuse p16 staining was present only in HSILs (P < .0001), whereas a patchy/focal p16 staining pattern was observed in both LSILs and condylomas. CONCLUSIONS HPV L1 and diffuse p16 expression is mutually exclusive in most anal SILs and helps separate LSIL and HSIL cases. Application of both HPV L1 and p16 can not only facilitate accurate grading but also contribute to risk assessment in anal neoplasia.
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Gami B, Kubba F, Ziprin P. Human papilloma virus and squamous cell carcinoma of the anus. Clin Med Insights Oncol 2014; 8:113-9. [PMID: 25288893 PMCID: PMC4179600 DOI: 10.4137/cmo.s13241] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 06/16/2014] [Accepted: 06/17/2014] [Indexed: 12/26/2022] Open
Abstract
The incidence of anal cancer is increasing. In the UK, the incidence is estimated at approximately 1.5 per 100,000. Most of this increase is attributed to certain at-risk populations. Persons who are human immunodeficiency virus (HIV)-positive and men who have sex with men (MSM), Organ transplant recipients, women with a history of cervical cancer, human papilloma virus (HPV), or cervical intraepithelial neoplasia (CIN) are known to have a greater risk for anal cancer. This paper will focus on HPV as a risk factor for anal intraepithelial neoplasia (AIN) and discusses the etiology, anatomy, pathogenesis, management of squamous cell carcinoma (SCC) of the anus.
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Affiliation(s)
- Bhavna Gami
- Department of Bio Surgery and Surgical Technology, St Mary’s Hospital, London, UK
| | - Faris Kubba
- Histopathology Department. Ealing Hospital UK
| | - Paul Ziprin
- Department of Bio Surgery and Surgical Technology, St Mary’s Hospital, London, UK
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Schwartz LM, Castle PE, Follansbee S, Borgonovo S, Fetterman B, Tokugawa D, Lorey TS, Sahasrabuddhe VV, Luhn P, Gage JC, Darragh TM, Wentzensen N. Risk factors for anal HPV infection and anal precancer in HIV-infected men who have sex with men. J Infect Dis 2013; 208:1768-75. [PMID: 23908478 DOI: 10.1093/infdis/jit374] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Carcinogenic human papillomaviruses (HPVs) cause a large proportion of anal cancers. Human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) are at increased risk of HPV infection and anal cancer compared with HIV-negative men. We evaluated risk factors for HPV infection and anal precancer in a population of HIV-infected MSM. METHODS Our study included 305 MSM at an HIV/AIDS clinic in the Kaiser Permanente Northern California Health Maintenance Organization. Logistic regression was used to estimate associations of risk factors comparing men without anal HPV infection; men with anal HPV infection, but no precancer; and men with anal precancer. RESULTS Low CD4 count (<350 cells/mm(3)) and previous chlamydia infection were associated with an increased risk of carcinogenic HPV infection (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.28-10.40 and OR, 4.24; 95% CI, 1.16-15.51, respectively). History of smoking (OR, 2.71 95% CI, 1.43-5.14), duration, recency, and dose of smoking increased the risk of anal precancer among carcinogenic HPV-positive men but had no association with HPV infection. CONCLUSIONS We found distinct risk factors for anal HPV infection and anal precancer. Risk factors for HPV infection and anal precancer are similar to established risk factors for cervical cancer progression.
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Affiliation(s)
- Lauren M Schwartz
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville
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D'Souza G, Rajan SD, Bhatia R, Cranston RD, Plankey MW, Silvestre A, Ostrow DG, Wiley D, Shah N, Brewer NT. Uptake and predictors of anal cancer screening in men who have sex with men. Am J Public Health 2013; 103:e88-95. [PMID: 23865658 DOI: 10.2105/ajph.2013.301237] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We investigated attitudes about and acceptance of anal Papanicolaou (Pap) screening among men who have sex with men (MSM). METHODS Free anal Pap screening (cytology) was offered to 1742 MSM in the Multicenter AIDS Cohort Study, who reported history of, attitudes about, and experience with screening. We explored predictors of declining screening with multivariate logistic regression. RESULTS A history of anal Pap screening was uncommon among non-HIV-infected MSM, but more common among HIV-infected MSM (10% vs 39%; P < .001). Most participants expressed moderate or strong interest in screening (86%), no anxiety about screening (66%), and a strong belief in the utility of screening (65%). Acceptance of screening during this study was high (85%) across all 4 US sites. Among those screened, most reported it was "not a big deal" or "not as bad as expected," and 3% reported that it was "scary." Declining to have screening was associated with Black race, anxiety about screening, and low interest, but not age or HIV status. CONCLUSIONS This study demonstrated high acceptance of anal Pap screening among both HIV-infected and non-HIV-infected MSM across 4 US sites.
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Affiliation(s)
- Gypsyamber D'Souza
- Johns Hopkins Bloomberg School of Public Health Department of Epidemiology, Baltimore, MD 21205, USA.
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Abstract
Anal cancer accounts for only 1.5% of gastrointestinal malignancies but this disease has shown a steady increase in incidence particularly in HIV positive males. The understanding of pathophysiology and treatment of anal cancer has changed radically over last thirty years. Risk factors have been identified and organ preservation by chemoradiotherapy has become a standard. This article aims to review the clinical presentation, diagnostic evaluation, and treatment options for anal cancer in the light of current literature.
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Affiliation(s)
- Sajad Ahmad Salati
- Department of Surgery, College of Medicine, Qassim University, Qassim, Kingdom of Saudi Arabia
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