Treatment Options for Anal Dysplasia
Back to Anal Dysplasia Chapter
| Biopsy Findings | Treatment Options |
|---|
| Low-grade lesions (AIN 1) | - Monitor via HRA every 6 months until normal twice in succession, then annual Pap smear.
- Topical treatment (see below) may be indicated for symptoms such as bleeding, itching, or burning; or for discrete lesions.
|
| High-grade lesions (AIN 2 or 3) | Topical therapy
For small lesions (<1 cm2 at the base):
- Local application of bichloroacetic acid or 80-90% trichloroacetic acid (well-tolerated but occasionally painful)
- Liquid nitrogen
Other topical, self-applied options studied in small cohorts include:
- Topical imiquimod applied for 6-10 hours then washed off, TIW for 16 weeks
- Topical 5% 5-fluorouracil applied BID for 16 weeks
- These sometimes are used to treat diffuse lesions
Infrared coagulation (office based)
- For lesions too large for topical therapy
- Followed by debridement of destroyed tissue using biopsy forceps
- Note: this treatment is not yet FDA approved
Surgery and CO2 laser ablation- For large (>1 cm2) or extensive lesions, or for patients unable to receive infrared coagulation
- Surgical excision with a scalpel for discrete lesions with or without laser ablation
- Large lesions may require multiple, staged procedures to reduce risk of bleeding, anal stenosis, sphincter compromise, and infection
- Referrals should be made to surgical centers with experience in treating anal dysplasia
Follow-up HRA should be done every 6 months |
| SCCA | Full discussion of anal cancer is beyond the scope of this chapter, but special points are noted below:
- Clinical staging consists of physical examination and biopsy of the primary tumor, palpation of the groin, CT of the chest, and CT or MRI of the abdomen and pelvis
- Staging is based on size of tumor (T1-4) and node positivity (N0-3 for nodal metastases) and correlates with 5-year survival rate
- First-line treatment consists of chemoradiotherapy rather than surgery
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From Anal Dysplasia
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009
