WHAT IS ANAL CANCER?
Anal cancer arises from the cells around the anal opening (anal verge) or within the anal canal (1-2 inches inside the anus).
Most anal cancers are Squamous Cell Carcinomas. Cells that are becoming malignant, but have not invaded below the surface are called ‘pre-cancerous’ (carcinoma-in-situ) or Bowen’s disease.
HOW COMMON IS ANAL CANCER?
Anal cancer is fairly uncommon, 1-2% of GI cancers. However, the numbers of cases are increasing at a very rapid rate.
WHO IS AT RISK?
Age-most people with anal cancer are over the age of 50, except specific groups.
Anal warts-infection with Human Papilloma Virus (HPV) have an increased risk of anal cancer.
Anal sex-both males and females who have anal receptive intercourse are at increased risk.
HIV infection-even if normal counts.
Smoking-increases the risk of most cancers.
Chronic inflammation-people with long standing inflammation or fistulas are at slightly higher risk.
Pelvic radiation-radiation for rectal, prostate, bladder, or cervical cancer are at higher risk.
CAN ANAL CANCER BE PREVENTED?
Few cancers can be totally prevented, but there things to reduce risk. Regular check ups. Using condoms and avoid skin to skin contact when having anal receptive intercourse (this reduces risk, but does not eliminate it). Avoid sexual contact when your partner has anal warts.
WHAT ARE THE SYMPTOMS OF ANAL CANCER?
Bleeding from the anus or rectum. Feeling a lump or mass by the anal opening. Pain in the anal area. Persistent itching. Change in bowel habits. Narrowing of stools. Discharge (mucous) with bowel movements. Swollen glands or lymph nodes in the groin/inguinal area.
HOW IS ANAL CANCER DIAGNOSED?
Finding anal cancers early is the key to a cure. Rectal exam and routine anoscopy help in the diagnosis. Anal pap smears, similar to cervical pap smears, allows examination of cells in the anal canal. If anal pap smear is not normal, then High Resolution Anoscopy (HRA) is done. HRA (done in the office or under a light anesthetic) allows a better view of the anal area and anal canal. Biopsies are then diagnostic.
HOW ARE ANAL CANCERS TREATED?
For small early anal cancers-excision removes the cancer.
For larger, more advanced cancers- a combination of chemotherapy and radiation treatments are indicated.
WILL I NEED A COLOSTOMY?
For early cancers, or cancers that respond to chemotherapy and radiation treatments, a colostomy is usually not needed. For more advanced cancer, or recurrent cancer, removal of the entire anal area, and a permanent colostomy, may be needed.
CONCLUSION
Finding anal cancer early is the key.
Screening for high risk groups, especially people who have anal receptive intercourse, anal warts, or HIV positive patients is recommended.