Anal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

Anal cancer is strongly associated with human papilloma virus (HPV) infection. Using polymerase chain reaction (PCR), the presence of the HPV genome has been identified in 80%–85% of cases. Other important risk factors include human immunodeficiency virus (HIV), immune suppression in transplant recipients and cigarette smoking. Herpes simplex virus (HSV)may play a secondary role in disease progression.Dietaryhabits, chronic inflammatory diseases and the presence of haemorrhoids do not appear to predispose to epidermoid anal cancer. Previous (gynaecological, lymphoma or leukemia) or subsequent (e.g. lung, bladder, vulva, vagina or breast) malignancy is more likely in anal cancer patients. This observation may reflect a genetic predisposition in some individuals, while in others synchronous or metachronous multicentric epidermoid tumours are related to HPV infection. pathology and biology