UCSF

Squamous intraepithelial lesions (SIL) of the anal canal are similar in etiology and pathology to SIL of the cervix. Cervical cytology screening and colposcopy examination were adapted and validated for anal canal lesions. It is hypothesized that treatment of anal high grade SIL (HSIL), considered the cancer precursor lesion in both the cervix and anus, will prevent their progression to cancer similar to the decreased incidence of cervical cancer that occurred with the advent of cervical screening programs. Anal cytology and high resolution anoscopy (i.e., colposcopy of the anal canal) are becoming the standard of care, particularly for populations considered at risk which include immunocompromised individuals and men who have sex with men (MSM). This approach has led to an increased diagnosis of HSIL, an increased demand for clinicians trained in procedures to identify and diagnosis HSIL, and an increased need for treatment. The papers in this dissertation evaluate methods to improve the detection of anal HSIL as well as in vitro and in vivo studies of a treatment of HSIL using Traditional Chinese Medicine (TCM). The results indicate that lesion characteristics and Lugol's staining patterns associated with cervical HSIL are also associated with anal HSIL. The TCM ointment, used as part of a multi-modality treatment, was cytotoxic in three cervical cancer cell lines tested. Finally, the TCM treatment that consisted of weekly acupuncture and moxibustion, and daily self-applied TCM ointment and moxibustion was safe and feasible.