Anal Kanserler
Özet
Anal kanserler, tüm gastrointestinal malignitelerin yaklaşık %3’ünü oluşturan nadir tümörlerdir ve insidansı son 30 yılda artış göstermiştir. En önemli risk faktörleri arasında kronik insan papilloma virüsü (HPV) ve HIV enfeksiyonları, anal ilişki ve sigara kullanımı yer almaktadır. Histolojik olarak primer anal kanal kanserlerinin %80'ini skuamöz hücreli karsinomlar (SCC) oluştururken, adenokarsinom, melanom ve bazal hücreli karsinom gibi daha nadir türler de görülmektedir. Hastalığın tanısında dijital rektal muayene, anoskopi ve biyopsi temel yöntemlerdir. Evrelemede tümör boyutu (T) ve lenf nodu tutulumu (N) en kritik prognostik faktörler olarak öne çıkmaktadır. Metastatik olmayan anal SCC'nin birincil tedavisinde, sfinkter fonksiyonunu korumak amacıyla cerrahi yerine eş zamanlı kemoradyoterapi (5-FU ve mitomisin kombinasyonu) standart protokol olarak uygulanmaktadır. Kemoradyoterapiye yanıt vermeyen veya nükseden lokal ileri vakalarda abdominoperineal rezeksiyon (APR) gibi radikal cerrahi yöntemlere başvurulurken, uzak metastaz varlığında paklitaksel ve karboplatin kombinasyonu ilk basamak sistemik tedavi olarak tercih edilmektedir.
Anal cancers are rare tumors, accounting for approximately 3% of all gastrointestinal malignancies, with an increasing incidence over the past 30 years. The primary risk factors include chronic human papillomavirus (HPV) and HIV infections, receptive anal intercourse, and smoking. Histologically, squamous cell carcinoma (SCC) comprises about 80% of primary anal canal cancers, while rarer types such as adenocarcinoma, melanoma, and basal cell carcinoma also occur. Digital rectal examination, anoscopy, and biopsy are fundamental for diagnosis. In staging, tumor size (T) and lymph node status (N) stand out as the most critical prognostic factors. For the primary treatment of non-metastatic anal SCC, concurrent chemoradiotherapy (a combination of 5-FU and mitomycin) is implemented as the standard protocol instead of surgery to preserve sphincter function. Radical surgical methods such as abdominoperineal resection (APR) are considered for locally advanced cases that do not respond to chemoradiotherapy or relapse, whereas a combination of paclitaxel and carboplatin is preferred as the first-line systemic treatment in the presence of distant metastasis.
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