Rectal tumours

They can be difficult to recognise, often taking years to diagnose, as they are difficult to distinguish from other non-malignant skin conditions and grow slowly.

Red infiltration, white plaque, white overscarring of the epidermis, skin-level prominence, scaling, resemble benign skin diseases.

– Itching, burning, discharge, a feeling of dyscomfort, the appearance of growths, also indistinguishable from other diseases.
– Recognition is made more difficult by the fact that a single disease can take many different morphological forms.
– Most are associated with high-risk HPV infection.
(Bowen disease, Bowenoid papulosis, AIN, PAIN,).
– HPV has no role in the development of others: e.g.
Extramammary Paget’s disease.
– A definitive diagnosis can only be made by taking a biopsy, which can be performed painlessly under local anaesthesia.

Rectal squamous cell carcinoma is caused by 95% of high-risk HPV.
Among sexually transmitted infections, HPV infection rates are the highest: 70-80% in the sexually active population, but only 1% of those infected will be symptomatic.
The virus lives and replicates only in the squamous epithelium, i.e. the skin around the rectum and the lower 1-3 cm of the anal canal.
The time between infection and the onset of symptoms is not known. High risk group: MSM population, immune deficient status, many sexual partners (unprotected).

A rectal swab is sent for HPV classification and biomarker testing, which helps to clarify the degree of dysplasia, i.e. whether and to what extent the virus has infiltrated the cells. Since PAIN and AIN are preventive conditions, which are superficial lesions that spread to deeper layers after a long time, they become invasive late, leaving enough time for prevention due to the slow process. It can be safely examined with a high-resolution anoscope (HRA), which provides magnification of 6-20x. Visualization can be increased by using 5% acetic acid.) targeted biopsies are taken with tiny pediatric endoscopic biopsy forceps. Close follow-up of the high risk group (HIV+ MSM) is important in the prevention of anal squamous cc.

The use of topical creams and liquids.
– Non invasive local cytostatic effect: Podopyllotoxin, 5FU, Podophyllin, Verrutop, Veregen.
– Aspecific immune stimulation: Imiquimod, Interferon, Isoprinozine tbl.

Electrocauter, laser, surgical excision, infrared coagulator, cryotherapy.
The above therapies can be combined: after local cytostatic or immunostimulation, the lesion may be reduced or high grade dysplasia may regress to low grade dysplasia.
Before starting the chosen therapy, the patient should be fully informed of the options.
The procedure should be chosen according to the patient’s condition and wishes.
Adenocarcinoma of the rectum is not linked to previous viral infection.