Abstract
Fistula-associated anal cancer in Crohn's disease (CD) can be challenging to diagnose
and treat. Patients with longstanding fistulas in the setting of CD who present with
a sudden change in their symptoms should undergo biopsy under anesthesia with extensive
sampling, followed by staging imaging. Pelvic magnetic resonance imaging (MRI) can
be helpful in identifying the extent of the disease locally. Patients often present
in the later stages due to the challenges associated with diagnosing these patients.
Two subtypes of this disease include squamous cell carcinoma and adenocarcinoma, and
treatment depends on diagnosis. Small sample size and lack of uniform data on treatments
make it difficult to say which treatment modalities are optimal, but aggressive combined
therapy is likely the best approach for survival. This will include chemotherapy and
radiation and often radical resection as well. Despite this, survival is poor, although
more recent data suggest that outcomes are improving.
Keywords
fistula-associate anal cancer - squamous cell carcinoma - adenocarcinoma - Crohn's
disease - perianal disease
