Summary We have presented two examples of difficulties encountered in making a diagnosis, and have shown how improper medical or surgical therapy may hinder correct treatment of cancer. Over a period of 13 years, two patients have been treated for neoplastic anal fistula. The lesson to be learned is that an early diagnosis is seldom reached and consequently correct treatment is delayed. It is emphasized that cancer should be suspected whenever a chronic fistula is surrounded by a large area of swelling and tenderness and drains blood and mucus. Biopsy is the most effective means of discovering a malignant complication, but the tissue to be examined must be removed from the deep tissues involved and not from the margins of external fistulous tracts. In addition to the reports listed in the bibliography, 131 similar reports have been found.
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Heidenreich et al. (1966) studied this question.
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