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What is Anal Cancer?
Anal cancer is an uncommon type of cancer and it starts in the anus. The anus is the opening at the lower end of the intestines. Stool is stored in the last part of the large intestine, called the rectum. From there, stool is passed out of the body through the anus as a bowel movement. Anal cancer occurs in the anal canal. The anal canal is a short tube at the end of your rectum through which stool leaves your body.
Anal cancers are often divided into 2 groups:
· Cancers of the anal canal (above the anal verge)
· Cancers of the anal margin (below the anal verge)
Sometimes anal cancers extend from one area into the other, so it’s hard to know exactly where they started.
Though many types of tumors may develop in the anus, but not all tumors are necessarily cancerous. The skin around the outside of the anus is called the perianal area. Tumors in this area are skin tumors, not anal cancer.
Causes/ Risks of Anal Cancer
Risk factors include the following:
· Being infected with human papillomavirus (HPV).
· Having many sexual partners.
· Having receptive anal intercourse (anal sex).
· Being older than 50 years.
· Frequent anal redness, swelling, and soreness.
· Having anal fistulas (abnormal openings).
· Smoking cigarettes.
Signs and Symptoms of Anal Cancer
If any of the following symptoms occurs, you should immediately visit your doctor for thorough checkups:
· Bleeding from the anus or rectum.
· Pain or pressure in the area around the anus.
· Itching or discharge from the anus.
· A lump near the anus.
· A change in bowel habits.
Diagnosing/ Tests for Anal Cancer
Your doctor may conduct the following tests to diagnose if you have anal cancer:
· Physical exam and history
· Digital rectal examination (DRE)
· Endo-anal or endorectal ultrasound
What is the chance of recovery?
The chance of recovery from Anal Cancer depends on the following:
· The size of the tumor.
· Where the tumor is in the anus.
· Whether the cancer has spread to the lymph nodes.
The treatment options depend on the following:
· The stage of the cancer.
· Where the tumor is in the anus.
· Whether the patient has human immunodeficiency virus (HIV).
· Whether cancer remains after initial treatment or has recurred.
Stages of Anal Cancer
The process used to find out if cancer has spread within the anus or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests may be used in the staging process:
· CT scan (CAT scan)
· Chest x-ray
· MRI (magnetic resonance imaging) /nuclear magnetic resonance imaging (NMRI).
· PET scan (positron emission tomography scan)
· Pelvic exam
The following stages are used for anal cancer:
· Stage 0
· Stage I
· Stage II
· Stage III
· Stage IV
Spreading of Anal Cancer
There are three ways that cancer spreads in the body.
· Tissue. The cancer spreads from where it began by growing into nearby areas.
· Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
· Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
Treatment of Anal Cancer
There are different types of treatment for patients with anal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials.
Three types of standard treatment that are used for Anal Cancer:
Radiation therapy- Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. The way the radiation therapy is given depends on the type and stage of the cancer being treated. External and internal radiation therapy are used to treat anal cancer.
Chemotherapy- Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing.
Surgery- the following procedures of surgery may be done, suitable for you:
Local resection: A surgical procedure in which the tumor is cut from the anus along with some of the healthy tissue around it. Local resection may be used if the cancer is small and has not spread.
Abdominoperineal resection: A surgical procedure in which the anus, the rectum, and part of the sigmoid colon are removed through an incision made in the abdomen. The doctor sews the end of the intestine to an opening, called a stoma, made in the surface of the abdomen so body waste can be collected in a disposable bag outside of the body. This is called a colostomy. Lymph nodes that contain cancer may also be removed during this operation.
Treatment of HIV infected patients
Cancer therapy can further damage the already weakened immune systems of patients who have the human immunodeficiency virus (HIV). For this reason, patients who have anal cancer and HIV are usually treated with lower doses of anticancer drugs and radiation than patients who do not have HIV.
Recurrent Anal Cancer
Recurrent anal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the anus or in other parts of the body.
Treatment of recurrent anal cancer may include the following:
· Radiation therapy and chemotherapy, for recurrence after surgery.
· Surgery, for recurrence after radiation therapy and/or chemotherapy.
· A clinical trial of radiation therapy with chemotherapy and/or radiosensitizers.
Source: National Cancer Institute