Cancer Support Group

Saturday, May 15th

Last update:06:42:40 AM GMT

Anal Cancer

Anal cancer, an uncommon cancer, is a disease in which cancer cells are found in the anus. The anus is the opening at the end of the rectum (the end part of the large intestine) through which body waste passes. Cancer in the outer part of the anus is more likely to occur in men, cancer of the inner part of the rectum (anal canal) is more likely to occur in women. If the anus is often red, swollen, and sore, there is a greater chance of getting anal cancer. Tumors found in the area of skin with hair on it just outside the anus are skin tumors, not anal cancer.

Being infected with the human papilloma virus (HPV) can affect the risk of developing anal cancer. Anal cancers frequently begin as anal dysplasia. Anal dysplasia is made up of cells of the anus that have abnormal changes, but do not show evidence of invasion into the surrounding tissue. The most severe form of anal dysplasia is called carcinoma in situ. In the case of carcinoma in situ, cells have become cancerous, but have not begun to invade normal tissue yet. Over time, anal dysplasia changes to the point where cells become invasive and gain the ability to metastasize, or break way to other parts of the body. Anal dysplasia is sometimes referred to as anal intraepithelial neoplasia (AIN), or a “Pre–cancer”. When anal cancer does spread, it most commonly spreads through direct invasion into the surrounding tissue or through the lymphatic system. Spread of anal cancer through the blood is less common, although it can occur.

Signs & Symptoms of Anal Cancer
  1. Bleeding from the anus or rectum.
  2. Pain or pressure in the area around the anus.
  3. Itching or discharge from the anus.
  4. A lump near the anus.
  5. A change in bowel habits.
Diagnosis of Anal Cancer
When anal cancer is suspected, the physician should perform a thorough history and physical examination. The physical exam should consist of a digital rectal examination (DRE) as well as visualization of the anal canal using an anoscope or bronchoscope (a long, thin instrument that is inserted into the anus to allow the physician to see the inside of the anus and rectum). Ultimately, anal cancer can only be diagnosed with a biopsy. To perform a biopsy, the physician uses a needle or a small pair of scissors or clamps to remove a piece of the tumor. It is common for there to be some mild bleeding after a biopsy is taken, and this bleeding can last for a few days after the procedure. The tissue is then sent to a pathologist who looks at the tissue underneath a microscope to determine whether the tumor is cancerous or not. Because a number of benign tumors and lesions can resemble anal cancer on physical examination, a biopsy should always be performed before initiating treatment for anal cancer.

Risk Factors of Anal Cancer
  1. Being over 50 years old.
  2. Being infected with human papilloma virus (HPV).
  3. Having many sexual partners.
  4. Having anal intercourse (anal sex)
  5. Frequent anal redness, swelling, and soreness.
  6. Smoking cigarettes.
Prevention of Anal Cancer
Anal Cancer Prevention Tips:
  • HPV is a virus transmitted through sexual contact which leads to Anal Cancer. So it is always safe to use a condom. Wearing a condom may provide protection against HPV.
  • When a person has multiple sexual partners, they are at an increased risk for both HPV and anal cancer. So avoid sexual contacts with more than one partner.
  • Avoid anal intercourse. Anal intercourse increases the risk factor for anal cancer for both men and women.
  • Quit smoking. Smokers are 4 times more likely to develop anal cancer than non–smokers.
Treatment of Anal Cancer
There are treatments for all patients with anal cancer.
1) Surgery.
2) Radiation therapy (using high–dose x–rays or other high–energy rays to kill cancer cells).
3) Chemotherapy (using drugs to kill cancer cells).

Radiation Therapy
Radiation Therapy is used to treat Anal Cancer. The radiation comes in the form of high energy x–rays that are delivered to the patient only in the areas at highest risk for cancer. The high energy of x–rays in radiation therapy results in damage to the DNA of cells. Cancer cells divide faster than healthy cells, and so their DNA is more likely to be damaged than that of normal cells. Additionally, cancer cells are generally less able to repair damaged DNA than normal cells are, so cancer cells are killed more easily by radiation than normal cells are.

Chemotherapy travels throughout the bloodstream and throughout the body to kill cancer cells. This is one of the big advantages of chemotherapy. If cancer cells have broken off from the tumor and are somewhere else inside the body, chemotherapy has the chance killing them, while radiation does not. In the setting of anal cancer, chemotherapy is most commonly given at the same time as radiation. Chemotherapy is used in different situations to treat anal cancer. If the cancer is localized to the anus and pelvic lymph nodes, it may be used in combination with radiation therapy to achieve the best chance of killing all of the cancer cells. In this setting, radiation may be used separately to relieve certain symptoms, such as pain, from cancer in other parts of the body. Unfortunately, if cancer is present in organs distant from the anus, chemotherapy is generally not very successful at controlling it.

There are several situations in which surgery should be considered for anal cancer. Thus patient can avoid the potential side effects of chemoradiotherapy. Alternatively, extensive anal cancers that have destroyed the anal sphincter, such that the patient cannot control bowel movements, are often treated with surgery. In these cases, patients have already lost their sphincter function, and require a colostomy to handle bowel movements. Because patients in this situation usually have very large tumors, they may require surgical removal of the tumor, which will usually be followed by radiation, with or without chemotherapy, after the operation. Surgery can also be performed in patients who cannot otherwise tolerate radiation therapy, or who do not want radiation therapy. Finally, surgery is often performed if cancer recurs in the anus following previous treatment with radiation therapy if additional chemotherapy and radiation cannot be given.


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