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Review
. 2021 Mar 22;13(6):1445.
doi: 10.3390/cancers13061445.

Fistula-Related Cancer in Crohn's Disease: A Systematic Review

Andromachi Kotsafti  1 , Melania Scarpa  1 , Imerio Angriman  2 , Ignazio Castagliuolo  3 , Antonino Caruso  4
Affiliations
Review

Fistula-Related Cancer in Crohn's Disease: A Systematic Review

Andromachi Kotsafti et al. Cancers (Basel). .

Abstract

Perianal fistulizing Crohn's disease is a very disabling condition with poor quality of life. Patients with perianal fistulizing Crohn's disease are also at risk of perianal fistula-related squamous cell carcinoma (SCC). Cancer arising at the site of a chronic perianal fistula is rare in patients with Crohn's disease and there is a paucity of data regarding its incidence, diagnosis and management. A systematic review of the literature was undertaken using Medline, Embase, Pubmed, Cochrane and Web of Science. Several small series have described sporadic cases with perianal cancer in Crohn's disease. The incidence rate of SCC related to perianal fistula was very low (<1%). Prognosis was poor. Colorectal disease, chronic perianal disease and HPV infection were possible risk factors. Fistula-related carcinoma in CD (Chron's disease) can be very difficult to diagnose. Examination may be limited by pain, strictures and induration of the perianal tissues. HPV is an important risk factor with a particular carcinogenesis mechanism. MRI can help clinicians in diagnosis. Examination under anesthesia is highly recommended when findings, a change in symptoms, or simply long-standing disease in the perineum are present. Future studies are needed to understand the role of HPV vaccination in preventing fistula-related cancer.

Keywords: Crohn’s disease; anal fistula-related cancers; perianal fistulas; squamous cell carcinoma.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1
Prisma flowchart of study selection.
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References

    1. Steinhart A.H., Panaccione R., Targownik L., Bressler B., Khanna R., Marshall J.K., Afif W., Bernstein C.N., Bitton A., Borgaonkar M., et al. Clinical Practice Guideline for the Medical Management of Perianal Fistulizing Crohn’s Disease: The Toronto Consensus. J. Can. Assoc. Gastroenterol. 2018;1:141–154. doi: 10.1093/jcag/gwy047. - DOI - PMC - PubMed
    1. Schwartz D.A., Loftus E.V., Tremaine W.J., Panaccione R., Harmsen W.S., Zinsmeister A.R., Sandborn W.J. The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology. 2002;122:875–880. doi: 10.1053/gast.2002.32362. - DOI - PubMed
    1. Scharl M., Rogler G., Biedermann L. Fistulizing Crohn’s Disease. Clin. Transl. Gastroenterol. 2017;8 doi: 10.1038/ctg.2017.33. - DOI - PMC - PubMed
    1. Panés J., Rimola J. Perianal fistulizing Crohn’s disease: Pathogenesis, diagnosis and therapy. Nat. Rev. Gastroenterol. Hepatol. 2017;14:652–664. doi: 10.1038/nrgastro.2017.104. - DOI - PubMed
    1. Winkler R., Wittmer A., Heusermann U. Das karzinom beim m. Crohn. Zeitschrift für Gastroenterologie. 2002;40:569–576. doi: 10.1055/s-2002-33417. - DOI - PubMed

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