Prise en charge du cancer du canal anal en 2018.

Anal canal cancer is a rare disease accounting for 3% of digestive tract tumours. However, its annual incidence has increased during the two last decades reaching 0.5/100,000 in men and 1.3/100,000 in women in 2012. Squamous carcinoma is the most common histological type, and accounts for more than 80% of anal canal malignancy. The main risk factor is human papillomavirus (HPV), in particular 16 and 18 subtypes. This virus is associated with 50% to 100% of anal canal cancers through the action of E6 and E7 oncoproteins. The decrease of natural clearance of HPV due to the multiplicity of sexual partners and human immunodeficiency virus (HIV) epidemic could partly explain the observed increase of anal cancer incidence. Since eighties and Nigro's trials management has significantly changed: a multidisciplinary strategy combining radiotherapy and concurrent chemotherapy had replaced the radical surgery. Chemoradiation offered better results considering local control and also allowed a better functional prognosis by sphincter-preservation. Overall 5-year survival varies from 70 to 80% but recurrences, which are mainly loco-regional, benefit from salvage surgery in only 30% of cases. Thus, a close clinical surveillance is justified to diagnose early recurrence. The two newest and most promising therapies are anti-EGFR and anti-PD1. Yet, more randomized trials are required to confirm their efficiency, especially in metastatic disease which is still associated with poor prognosis. [ABSTRACT FROM AUTHOR]