Anal Carcinoma Surveillance Counterpoint: Canada

Abstract

Anal dysplasia and intraepithelial neoplasia are part of a continuum of anal cancer that is typically treated with curative intent. Surveillance after treatment in our practice includes high-resolution anoscopy. This is similar to colposcopy in cervical cancer screening and treatment programs. It allows for the visualization of the anal canal, with biopsy of suspicious looking lesions [1]. In Canada, high-resolution anoscopy is performed in a few outpatient settings, and constitutes part of a screening program for individuals who are at high risk for anal dysplasia due to human papillomavirus (e.g., men who have sex with men and HIV-positive individuals). These high-risk individuals are usually screened with an anal Pap smear, and referred for high-resolution anoscopy if the cytology result is abnormal. Following high-resolution anoscopy, biopsy may be indicated. If the biopsy shows high-grade dysplasia (anal intraepithelial neoplasia II/III, carcinoma in situ), lesions are treated with either 80 % trichloroacetic acid or infrared coagulation. Recent data on infrared coagulation show that it is a safe and effective office-based procedure, and that repeated treatments lead to resolution of the high-grade dysplasia [2].