Cancer of the epithelial coccygeal passage in surgical practice

The article presents a multifactorial analysis of literature data published in Russian and foreign scientific periodicals devoted to the problem of malignancy of the epithelial coccygeal passage. The issues of history, terminology, epidemiology, and the main pathogenetic risk factors for malignant transformation are considered, priorities in the diagnosis and treatment of patients with epithelial coccygeal cancer are outlined. It has been shown that the time interval from the moment of detection of the epithelial coccygeal passage to the development of cancer in it varies widely – 1 month to 62 years. The average time to establish the primary diagnosis of the epithelial coccygeal passage before its malignant transformation is 21.1±1.36 years. Attention is focused on the fact that one of the key pathogenetic mechanisms of malignancy of the epithelial coccygeal passage is chronic (persistent) inflammation developing in the tissue structures of the epithelial coccygeal passage. The morphological characteristics of cancer of the epithelial coccygeal passage are described and the most common histological types of tumors are identified. It has been shown that failure to conduct a pathological examination of removed surgical materials can be regarded as one of the indirect subjective risk factors for developing cancer of the epithelial coccygeal passage. From a methodological point of view, the expediency of including patients in the group with a potentially increased risk of malignancy in whom ECP is characterized by significant variability of morphostructural changes in the tissues of the sacrococcygeal region caused by a long-term ongoing (persistent) inflammatory process accompanied by follicular occlusion syndrome manifested by purulent hydradenitis is substantiated. It is postulated that the combination of these changes obviously increases the likelihood of mutation in the tissues of the sacrococcygeal region, which in turn can contribute to malignant transformation. It has been shown that sing ling out a group of patients with a known high risk of malignancy will increase oncological alertness among surgeons towards patients of this category and undoubtedly ensure early diagnosis of cancer of the epithelial coccygeal passage. The aspects of surgical treatment and the principles of oncological radicalism of surgical intervention are touched upon. The possibilities of cryosurgery in the treatment of patients in this category are highlighted.