Anal Cancer in Systemic Lupus Erythematosus Patients is a Neglected Condition

Abstract

Patients with systemic lupus erythematosus have a higher incidence of neoplasms associated with human papillomavirus infections, such as those that affect the vulva, the vagina, and the cervix; however, little is known about the frequency of anal cancer among these patients. Although there are recommendations for screening for this cancer in immunosuppressed individuals, it is possible that this procedure is not strictly followed. We describe the case of a 47-year-old woman with systemic lupus erythematosus who was treated with immunosuppressants and developed advanced anal squamous cell carcinoma after adequate treatment and healing of a high-grade cervical squamous intraepithelial lesion. Five years after the completion of the anal cancer treatment, the patient presented with cystic hepatic lesions that were histopathologically confirmed to be metastatic squamous cell carcinoma. This report aimed to highlight the need for anal cancer screening in patients with lupus, particularly if there was a history of cervical cytopathological alterations.

Resumo

Pacientes com lúpus eritematoso sistêmico apresentam maior incidência de neoplasias associadas a infecções por HPV, como aquelas que acometem a vulva, a vagina e o colo do útero, mas pouco se sabe sobre a frequência de câncer anal entre essas pacientes. Embora existam recomendações para o rastreamento desse câncer em indivíduos imunossuprimidos, é possível que esse procedimento não esteja sendo rigorosamente seguido. Descrevemos uma mulher de 47 anos com lúpus eritematoso sistêmico, tratada com imunossupressores, que desenvolveu um carcinoma escamocelular anal avançado após tratamento adequado e cicatrização de lesão intraepitelial escamosa cervical de alto grau. Cinco anos após o término do tratamento do câncer anal, a paciente apresentou lesões císticas hepáticas cujo resultado citopatológico confirmou ser carcinoma escamocelular metastático. O presente relato teve como objetivo chamar atenção para a necessidade do rastreamento do câncer anal em pacientes com lúpus, principalmente se houver história prévia de alterações citopatológicas cervicais.

Keywords

anal canal - anus neoplasms - anal cancer - squamous cell carcinoma - systemic lupus erythematosus - human papillomavirus infection

Palavras-chave

canal anal - neoplasias do ânus - câncer anal - carcinoma de células escamosas - lúpus eritematoso sistêmico - infecção por papilomavírus humano

This manuscript belongs to the Department of Rheumatology at the State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil.

Publikationsverlauf

Eingereicht: 21. Juli 2022

Angenommen: 18. November 2022

Artikel online veröffentlicht:
22. März 2023

• References

• 1 Bernatsky S, Boivin JF, Joseph L. et al. An international cohort study of cancer in systemic lupus erythematosus. Arthritis Rheum 2005; 52 (05) 1481-1490
• 2 Klumb EM, Pinto AC, Jesus GR. et al. Are women with lupus at higher risk of HPV infection?. Lupus 2010; 19 (13) 1485-1491
• 3 Song L, Wang Y, Zhang J, Song N, Xu X, Lu Y. The risks of cancer development in systemic lupus erythematosus (SLE) patients: a systematic review and meta-analysis. Arthritis Res Ther 2018; 20 (01) 270
• 4 Zard E, Arnaud L, Mathian A. et al. Increased risk of high grade cervical squamous intraepithelial lesions in systemic lupus erythematosus: A meta-analysis of the literature. Autoimmun Rev 2014; 13 (07) 730-735
• 5 Howlader N, Noone A, Krapcho M. et al. SEER Cancer Statistics Review, 1975-2018 [Internet]. National Cancer Institute. Bethesda, MD. 2021. Available at: https://seer.cancer.gov/statfacts/html/anus.html
• 6 Nelson VM, Benson III AB. Epidemiology of Anal Canal Cancer. Surg Oncol Clin N Am 2017; 26 (01) 9-15
• 7 Alemany L, Saunier M, Alvarado-Cabrero I. et al; HPV VVAP Study Group. Human papillomavirus DNA prevalence and type distribution in anal carcinomas worldwide. Int J Cancer 2015; 136 (01) 98-107
• 8 Lin C, Franceschi S, Clifford GM. Human papillomavirus types from infection to cancer in the anus, according to sex and HIV status: a systematic review and meta-analysis. Lancet Infect Dis 2018; 18 (02) 198-206
• 9 Clifford GM, Georges D, Shiels MS. et al. A meta-analysis of anal cancer incidence by risk group: Toward a unified anal cancer risk scale. Int J Cancer 2021; 148 (01) 38-47
• 10 Daling JR, Madeleine MM, Johnson LG. et al. Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer. Cancer 2004; 101 (02) 270-280
• 11 International Agency for Research on Cancer. Human papillomaviruses: this publication represents the views and expert opinions of an IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, which met in Lyon, 15 - 22 February 2005. Lyon: IARC; 2007. 670 p. (IARC monographs on the evaluation of carcinogenic risks to humans)
• 12 Artaza-Irigaray C, Flores-Miramontes MG, Olszewski D. et al. Genetic variability in E6, E7 and L1 genes of Human Papillomavirus 62 and its prevalence in Mexico. Infect Agent Cancer 2017; 12: 15
• 13 Nasioutziki M, Chatzistamatiou K, Loufopoulos PD. et al. Cervical, anal and oral HPV detection and HPV type concordance among women referred for colposcopy. Infect Agent Cancer 2020; 15: 22
• 14 Patel HS, Silver ARJ, Northover JMA. Anal cancer in renal transplant patients. Int J Colorectal Dis 2007; 22 (01) 1-5
• 15 Klumb EM, Araújo Jr ML, Jesus GR. et al. Is higher prevalence of cervical intraepithelial neoplasia in women with lupus due to immunosuppression?. J Clin Rheumatol 2010; 16 (04) 153-157
• 16 Joura EA, Giuliano AR, Iversen OE. et al; Broad Spectrum HPV Vaccine Study. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med 2015; 372 (08) 711-723
• 17 Palefsky JM. Practising high-resolution anoscopy. Sex Health 2012; 9 (06) 580-586