In 2012, the Department of Visceral Surgery of the Lausanne University Hospital CHUV implemented a dedicated high-resolution anoscopy (HRA) outpatient clinic for surveillance and follow-up purposes. This 10-year longitudinal study analyzed 537 patients (2214 visits) using a structured screening protocol. Dysplastic lesions were detected in 49% of patients, predominantly low-grade squamous intraepithelial lesions (LSILs, 74%). Among LSIL cases, 6% progressed to high-grade squamous intraepithelial lesions (HSILs) within 24 months, reaching 25% cumulative progression at 36 months. Of HSIL patients, 3% developed carcinoma in situ after 48 months. Notably, no invasive carcinoma was observed during the follow-up. Four patients diagnosed with squamous cell carcinoma at initial screening were treated with chemoradiotherapy, and one required salvage surgery. Independent risk factors for the presence of higher-stage precancerous lesions (≥HSILs) were the presence of high-risk HPV genotypes (OR 14.5, 95% CI 5–42.2, p < 0.001), detectable HIV viral load (OR 5.4, 95% CI 1.8–16.7, p = 0.003), and symptoms at the first screening visit (OR 3.2, 95% CI 1.1–9.9, p = 0.04). HIV-positive status was associated with a trend towards an increased risk of progression (OR 2.79, p = 0.073). These findings highlight the importance of systematic follow-up and early intervention in high-risk populations to prevent anal cancer progression.

Background: This study represents a follow-up analysis of the AnusGynecology (ANGY) study. Methods: This prospective, cross-sectional, single-center study recruited women for concomitant cervical and anal screening of HPV genotypes and cytology during a single appointment. All women with findings of either HPV or any type of dysplastic lesions on anal smears were offered follow-up in a specialized high-resolution anoscopy (HRA) outpatient clinic, representing the study cohort for this follow-up study. Results: Overall, 275 patients (mean age 42 ± 12) were included. Among them, 102 (37%) had cervical high-risk (HR) HPV. In total, HPV was (incidentally) revealed in 91 patients (33%) on anal smears, while any degree of anal squamous intraepithelial lesion (SIL) was found in 30 patients (11%), 6 if which were high-grade SIL (H-SIL). Furthermore, 10 out of 19 biopsies were positive (3 H-SIL lesions). Only half (48/91, 53%) of the women agreed to undergo the recommended specialized follow-up evaluation. Of them, 18 (38%) were diagnosed with dysplastic lesions (9 low grade (L-SIL) and 9 H-SIL, respectively) on biopsies, while the remaining visits revealed no abnormalities. Multivariable analysis revealed cervical HR-HPV infection (OR 4, 95% CI 2.2–7.5) and anal intercourse (OR 3.1, 95% CI 1.7–5.9) as independent risk factors for anal HR-HPV infection. Conclusions: Close follow-up of these women is hence strongly recommended.

Despite recent progress in different treatment modalities, colorectal cancer remains a leading cause of cancer-related death, highlighting the need to further develop novel treatment strategies. In this context, over recent decades, several experimental studies have demonstrated that high doses of vitamin C provide anti-cancer benefits in various colorectal cancer models. Intravenous administrations of vitamin C are necessary to reach these high concentrations in tumors. Tumors harboring KRAS or BRAF mutations or driven by the HIF1α signaling pathway are particularly sensitive to high-dose vitamin C. In addition, high doses of vitamin C increase the efficacy of other treatments when used in combination, including chemotherapies, targeted therapies, and immunotherapies. Whilst results of experimental studies were promising, their translation into clinical protocols has been disappointing. So far, very few clinical data support the anti-cancer benefits of vitamin C in colorectal cancer patients. This lack of success highlights the need to ameliorate the selection of patients based on biomarkers and to refine treatment protocols to achieve high-dose vitamin C in tumors. In this review, we analyze in vitro and in vivo studies that investigated the effect of vitamin C in colorectal cancer cells and point out the anti-cancer mechanisms of vitamin C. We further examine clinical trials that tested vitamin C in colorectal cancer patients and address several points that still need to be investigated in order to fully define the role of vitamin C in the treatment of colorectal cancer.