RESUMO

The evidence on products for the prevention of radiodermatitis is limited. The primary objective was to analyse the effectiveness of the spray skin protectant 'non-burning barrier film' in the prevention of radiodermatitis with moist desquamation in patients with the anal canal and rectal cancer followed in nursing consultations compared to a standardised moisturiser based on Calendula officinalis and Aloe barbadensis. Single-blind randomised clinical trial. The study was performed in a hospital in Rio de Janeiro, Brazil, with 63 patients undergoing anal canal and rectal cancer treatment, randomised into one of the following two groups: an experimental group, which used a spray skin protectant and a control group, which used a moisturiser. Data were collected using an initial and subsequent evaluation form and were assessed using descriptive and inferential analyses. Participants who used the spray skin protectant had a lower chance of presenting radiodermatitis with moist desquamation and a longer time without this outcome when compared to the control group. The overall incidence of radiodermatitis was 100%, with 36.5% being severe. Furthermore, 17.5% of participants discontinued radiotherapy due to radiodermatitis. There were no differences between the groups regarding the severity of radiodermatitis and the number of patients who discontinued radiotherapy. The skin protectant was effective in preventing radiodermatitis with moist desquamation amongst patients with anal canal and rectal cancer.

Assuntos

RESUMO

Primary anorectal melanoma is a rare malignant melanocytic neoplasm; its principal manifestation is rectal bleeding. It has an ominous prognosis with a five-year survival rate of 10%. The case of a 56-year-old woman with rectal bleeding and the sensation of a rectal mass is presented. A polypoid lesion, resected transanally, was documented in the distal rectum during the colonoscopy. The histological study confirmed a primary anorectal melanoma.

El melanoma anorrectal primario es una neoplasia melanocítica maligna poco frecuente, su principal manifestación es el sangrado rectal. Tiene un pronóstico ominoso con una tasa de sobrevida del 10% a 5 años. Se presenta el caso de una mujer de 56 años con rectorragia y sensación de masa rectal. Durante la colonoscopia se documentó una lesión polipoide en el recto distal, que se resecó por vía transanal. El estudio histológico confirmó la presencia de un melanoma anorrectal primario.

RESUMO

Introducción: El melanoma anorrectal es un tumor infrecuente que se caracteriza por ser agresivo y de mal pronóstico; constituye el 1 por ciento entre los tumores malignos colorrectales. Es más frecuente en pacientes femeninas de más de 50 años y alcanza un pico máximo en la octava década de la vida. Objetivo: Presentar las características clínicas de una paciente con melanoma del canal anorrectal. Caso clínico: Se estudió a una paciente femenina de 61 años que acudió a consulta de gastroenterología, por presentar constipación de varios meses de evolución, asociada a tenesmo rectal, anorexia, astenia y pérdida de peso de forma rápida y progresiva. Se le diagnosticó un melanoma anorrectal, en estado avanzado de la enfermedad, por lo que tuvo mala evolución. Conclusiones: Con una anamnesis y exploración física minuciosa, asociado al uso de los medios diagnósticos disponibles y un elevado índice de sospecha, se consigue con la paciente, que el estudio y diagnóstico se hicieran con prontitud y con ello imponer tratamiento(AU)

Introduction: Anorectal melanoma is an infrequent tumor characterized by aggressive and poor prognosis; it constitutes 1 percent among colorectal malignancies. It is more frequent in female patients over 50 years of age and reaches a maximum peak in the eighth decade of life. Objective: To present the clinical characteristics of a patient with melanoma of the anorectal canal. Clinical case: A 61-year-old female patient was studied, who came to the gastroenterology department for constipation of several months of evolution, associated with rectal tenesmus, anorexia, asthenia and rapid and progressive weight loss. He was diagnosed with anorectal melanoma, in advanced stage of the disease, for which he had poor evolution. Conclusions: With a thorough anamnesis and physical examination, associated with the use of the available diagnostic means and a high index of suspicion, it is achieved with the patient, that the study and diagnosis were made promptly and thus impose treatment(AU)

Assuntos

RESUMO

Squamous cell carcinoma of the anal canal (SCCA) is a rare neoplasm, but with rising incidence rates in the past few decades; it is etiologically linked with the human papillomavirus (HPV) infection and is especially prevalent in immunocompromised patients, mainly those infected with HIV. Fluoropyrimidine-based chemoradiotherapy remains the cornerstone of the treatment of non-metastatic disease, but the locally advanced disease still presents high rates of disease recurrence and systemic therapy of SCCA is an unmet clinical need. Despite sharing common molecular aspects with other HPV-related malignancies, such as cervical and head and neck cancers, SCCA presents specific epigenomic, genomic, and transcriptomic abnormalities, which suggest that genome-guided personalized therapies should be specifically designed for this disease. Actionable mutations are rare in SCCA and immune checkpoint inhibition has not yet been proven useful in an unselected population of patients. Therefore, advances in systemic therapy of SCCA will only be possible with the identification of predictive biomarkers and the subsequent development of targeted therapies or immunotherapeutic approaches that consider the unique tumor microenvironment and the intra- and inter-tumoral heterogeneity. In the present review, we address the molecular characterization of SCCA and discuss potential diagnostic, predictive and prognostic biomarkers of this complex and challenging disease.

RESUMO

O câncer anal é raro, porém certas populações apresentam risco aumentado para o seu desenvolvimento, sendo o terceiro tumor maligno mais comum entre os portadores do HIV. Diferentemente da maioria das malignidades que acometem estes indivíduos, o câncer anal pode ser prevenido. O sucesso da triagem de câncer do colo do útero para a diminuição de sua incidência tem conduzido à sua utilização como critério para efetuar o seguimento do câncer anal. Entretanto, este protocolo tem sido mais empregado na pesquisa, e em apenas algumas exceções. Neste estudo é realizada a revisão sobre o câncer anal, seus fatores de risco e diagnóstico, com o objetivo de alertar a comunidade científica e os profissionais de saúde quanto à importância de efetuar seu rastreamento e acompanhamento, bem como das suas lesões precursoras em indivíduos portadores de HIV/AIDS.

Anal cancer is rare, but certain populations are at increased risk for this type of tumor, beingthe third most commonly reported malignancy among HIV positive individuals. Unlike themajority of malignancies occurring in this population, the anal cancer can be prevented. The successof cervical cancer screening in reducing its incidence has led to point this strategy as a criterionfor performing the anal cancer screening. However, this protocol has been used mostly and widelyfor conducting the scientific researches, with a few exceptions only. This study reviews the topicson anal cancer, its risk factors and its diagnosis, in order to alert the scientific community andthe health professionals about the importance of anal cancer screening and its monitoring inHIV infected patients.

Assuntos

RESUMO

Se presenta el caso de un paciente de 60 años de edad que presenta dolor y sensación de cuerpo extraño enla región anal, asociado a deposiciones con restos de sangre. Al tacto rectal se palpó una lesión indurada enla cara anterior del conducto anal. En la colonoscopía se evidenció una lesión proliferante elevada, pigmentada“negruzca”, de aproximadamente 2 cm de diámetro, compatible con neoplasia maligna de canal anal. Se procedió a una biopsia e inmunohistoquímica, que dio como resultado el S-100 positivo y HMB-45 negativo.Una tomografía helicoidal multicorte toraco-abdomino-pélvico descartó tumoraciones y adenomegalias metastásicas. El paciente fue sometido a una resección local parcial transanal de la tumoración pigmentada.El resultado histopatológico posquirúrgico confirmó el diagnóstico de melanoma maligno anal amelanótico(MMAA); el S-100 fue positivo; el Melan-A, positivo débil, y el KI-67, positivo. El paciente presentó una evolución favorable y fue dado de alta a los tres días de la cirugía.

We present the case of a 60 year old patient suffering pain and the sensation of a foreign body in the analregion associated with traces of blood in stools. Digital rectal exam (DRE) revealed a hardened lesion locatedon the wall of the anal canal. Colonoscopy revealed a raised proliferating lesion with a blackish color which was about 2 inches in diameter. This was compatible with an anal canal malignancy. We proceeded to a biopsy and immunohistochemistry study which tested positive for S-100 and negative for HMB-45. A multislicehelical chest, abdominal and pelvic CAT scan ruled out metastatic tumors and lymphadenopathy. The patient underwent local transanal excision of the partially pigmented tumor. Post- surgical histopathological results confi rmed the diagnosis of malignant anal amelanotic melanoma positive for S-100. The sample tested weakly positive for Melan-A and positive for KI-67. The favorable outcome of the procedure led to the patient’sdischarge 3 days after surgery.

Assuntos