Vulvar High-Grade Squamous Intraepithelial Lesions and Cancer as a Risk Factor for Anal Cancer: A Review

Abstract

Anal squamous cell carcinoma (ASCC) has a higher incidence described in certain groups, namely, in women with vulvar high-grade squamous intraepithelial lesions (vHSILs) and/or human papillomavirus squamous cell carcinoma (VSCC). This review describes terminology, vHSIL, and VSCC in their association with ASCC and the published recommendations for early detection of this cancer in these women. Materials and Methods:A narrative review was conducted by the authors on vHSIL and VSCC as risk factors for ASCC. Results:The ASCC and VSCC incidence are increasing. Women with vHSIL and/or VSCC can present with ASCC at diagnosis, being one of the highest-risk groups. Suspicious symptoms include rectal bleeding, pain, and a sensation of an anal mass. Digital anorectal examination can help detect early ASCC. Sensitivity of anal cytology in women with vHSIL and VSCC seems low, with the exception of immunosuppressed women with genital neoplasia (cervix, vagina, and vulva). There are still insufficient data on high-resolution anoscopy in women with vHSIL and/or VSCC as a screening method.Conclusions: Clinicians need be aware that women with vHSIL and VSCC comprise one of the highest-risk groups for ASCC. Inquiring suggestive symptoms of ASCC and a digital anorectal examination can help in the early detection of this type of cancer.

Early Diagnostics of Vulvar Intraepithelial Neoplasia

“…Studies have confirmed the elevated prevalence of anal intraepithelial neoplasia in women with HPV-related precancer and cancer [ 12 ]. If an evaluation of the anal canal is needed, the patient should be referred to a clinician with adequate training for this procedure [ 13 ].…”

HPV status and HPV16 viral load in anal cancer and its association with clinical outcome

“…9,10 Women who have or had high-grade or worse cervical lesions (CIN2/3+) and/ or vulvar high-grade lesions also have a higher risk of anal lesions and cancer. [11][12][13] Moreover, incidence of anal cancer is significantly higher in people living with HIV (PLWH). [14][15][16] The morbidity associated with anal lesion and cancer treatments can be very high.…”

“…Several factors have been linked to an increased risk of anal cancer including age (higher proportion of cases occur in people after 50 years of age), number of sexual partners, history of receptive anal sexual intercourse, smoking and immune capacity 9,10 . Women who have or had high‐grade or worse cervical lesions (CIN2/3+) and/or vulvar high‐grade lesions also have a higher risk of anal lesions and cancer 11‐13 . Moreover, incidence of anal cancer is significantly higher in people living with HIV (PLWH) 14‐16 …”

Anal Intraepithelial Neoplasia and Anal Squamous Cell Carcinoma: Updates From the Last 3 Years

“…The incidence rates of anal SCC in women with vulvar cancer and vulvar HSIL were 48 and 42 per 100,000 person-years, 6 respectively, more than 20 times that described for the general population. Thus, a high index of suspicion for anal SCC should be maintained in these women 7 …”

“…Thus, a high index of suspicion for anal SCC should be maintained in these women. 7 A meta-analysis published after the anal cancer risk scale 6 also analyzed the incidence rate of anal SCC in patients with anal condylomas. 8 The overall incidence rate of anal SCC in these patients was 7 per 100,000 person-years and was higher in men (13 per 100,000 person-years) than in women (5 per 100,000 person-years).…”