A Brief Statistical Review of Epidermoid Carcinoma of the Anal Canal and Rectum'* RICHARD DALE, M.D. From the Department of Surgery, Southern Pacific Memorial Hospital, Salz Francisco, California DIFFERENT terms have been utilized to designate epidermoid carcinoma of the anal canal, the most common of which are transitional cloacogenic carcinoma, basaloid small-cell carcinoma, and squamous-cell carcinoma, Grade 4.5 One hundred years ago, two Frenchmen, Hermann and De- Fosses, 4 described a zone of transitional-cell epithelium bridging the upper reaches of the anal canal, and claimed that the cells were cloacal in origin. In 1950, Grinvalsky and Helwig, 3 at the Armed Forces institute of Pathology, investigated these atypical tumors and stated that they be termed transitional cloacogenic carcinoma. Dock- erty? of the Mayo Clinic, classifies them as squamous-cell carcinoma, Grade 4. He claims that squamous-cell carcinoma of the cervix and of the gallbladder occurs, and no one postulates a transitional-cell origin for it. 1 Most general surgeons refer to this tumor of the anal canal and rectum as epidermoid carcinoma. Epidermoid carcinoma of the anal canal occurs infrequently. Eight hundred con- secutive cases of carcinoma of the anus and rectum were reviewed by Sweet, 7 and only 4.7 per cent were epidermoid. At the Mayo CIinic, from 1929 to 1955, only 28 patients with epidermoid carcinoma were encoun- tered, s From 1944 to 1954, only 74 patients with epidermoid carcinoma were seen at Memorial Hospital in New York.0 SkirS * Received for publication March 27, t965, 353 believes that this tumor occurs rarely, but it may occur with chronic nonspecific in- flammation, or with lymphopathia venerea. Treatment recommended for this tumor is wide local excision, which requires an abdominoperineal resection. Pelvic lymph nodes should be removed in continuity. Most authorities recommend dissection of inguinal lymph nodes only when glands are involved. Stearns, s in 1959, reported an incidence of metastasis to pelvic lymph nodes of 47 per cent; superficial inguinal lymph nodes were involved in 46 per cent, mesenteric lymph nodes in 23 per cent, liver in 12 per cent, lung in 3 per cent, and the spine in 2 per cent. The over-all five-year rate of survival of patients suffering with epidermoid carcinoma of the anal canal and rectum is reported to vary from 30 to 40 per cent after surgical removal and from 5 to 15 per cent after irradiation. Irradiation alone is not recommended. Relief of pain after palli- ative surgery occurs in 42 per cent of the patients. With irradiation only, pain is relieved in 35 pei" cent. 6 SulTlmary A brief review of the terminology, incidence and treatment recommended for epidermoid carcinoma of the anal canal and rectum is presented. Statistical records of metastatic spread and five-year survival rates are also stated briefly.

A brief statistical review of epidermoid carcinoma of the anal canal and rectum

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A Brief Statistical Review of Epidermoid Carcinoma of the Anal Canal and Rectum'*

RICHARD DALE, M . D .

From the Department of Surgery, Southern Pacific Memorial Hospital, Salz Francisco, California

DIFFERENT terms have been utilized to designate epidermoid carcinoma of the anal canal, the most common of which are transitional cloacogenic carcinoma, basaloid small-cell carcinoma, and squamous-cell carcinoma, Grade 4.5 One hundred years ago, two Frenchmen, He rm ann and De- Fosses, 4 described a zone of transitional-cell epi thel ium bridging the upper reaches of the anal canal, and claimed that the cells were cloacal in origin. In 1950, Grinvalsky and Helwig, 3 at the Armed Forces insti tute of Pathology, investigated these atypical tumors and stated that they be termed transitional cloacogenic carcinoma. Dock- er ty? of the Mayo Clinic, classifies them as squamous-cell carcinoma, Grade 4. He claims that squamous-cell carcinoma of the cervix and of the gallbladder occurs, and no one postulates a transitional-cell origin for it. 1 Most general surgeons refer to this tumor of the anal canal and rectum as epidermoid carcinoma.

Epidermoid carcinoma of the anal canal occurs infrequently. Eight hundred con- secutive cases of carcinoma of the anus and rectum were reviewed by Sweet, 7 and only 4.7 per cent were epidermoid. At the Mayo CIinic, f rom 1929 to 1955, only 28 patients with epidermoid carcinoma were encoun- tered, s From 1944 to 1954, only 74 patients with epidermoid carcinoma were seen at Memorial Hospital in New York.0 SkirS

* Received for publication March 27, t965,

353

believes that this tumor occurs rarely, but it may occur with chronic nonspecific in- flammation, or with lymphopath ia venerea.

T rea tmen t recommended for this tumor is wide local excision, which requires an abdominoperineal resection. Pelvic lymph nodes should be removed in continuity. Most authorities recommend dissection o f inguinal lymph nodes only when glands are involved.

Stearns, s in 1959, reported an incidence of metastasis to pelvic lymph nodes of 47 per cent; superficial inguinal lymph nodes were involved in 46 per cent, mesenteric lymph nodes in 23 per cent, liver in 12 per cent, lung in 3 per cent, and the spine in 2 per cent.

T h e over-all five-year rate of survival of patients suffering with epidermoid carcinoma of the anal canal and rectum is reported to vary f rom 30 to 40 per cent after surgical removal and f rom 5 to 15 per cent after irradiation. I r radiat ion alone is not recommended. Relief of pain after palli- ative surgery occurs in 42 per cent of the patients. Wi th irradiat ion only, pain is relieved in 35 pei" cent. 6

SulTlmary

A brief review of the terminology, incidence and treatment recommended for epidermoid carcinoma of the anal canal and rectum is presented. Statistical records of metastatic spread and five-year survival rates are also stated briefly.