Overview of the anal cancer
When malignant (cancer) cells form in the tissues of the anus, a condition termed as anal cancer is said to have happened. The anus is the end of the large intestine, below the rectum, through which stool (solid waste) leaves the body and anal cancer implies cancer of anus. The anus is formed partly from the outer skin layers of the body and partly from the intestine. To control the opening and closing of anus for stool passing, two ring-like muscles, called sphincter muscles, are located at the opening of the anus. The anal canal, the part of the anus between the rectum and the anal opening, is about 1½ inches long. The skin around the outside of the anus is called the perianal area. Tumors in this area are skin tumors, not anal cancer.
Anal cancer may be categorized into the following stages:
Stage 0: (Carcinoma in Situ) In stage 0, cancer is found only in the innermost lining of the anus. Stage 0 cancer is also called carcinoma in situ, where in situ means in place.
Depending on the size of tumor stage I, II and III and IV are defined as:
Stage I: Tumor is 2 centimeters or smaller.
Stage II: Tumor is larger than 2 centimeters.
Stage IIIA: Tumor may be any size and has spread to either lymph nodes near the rectum; or nearby organs, such as the vagina, urethra, and bladder.
Stage IIIB: The tumor may be any size and has spread:
to nearby organs and to lymph nodes near the rectum; or
to lymph nodes on one side of the pelvis and/or groin, and may have spread to nearby organs; or
to lymph nodes near the rectum and in the groin, and/or to lymph nodes on both sides of the pelvis and/or groin, and may have spread to nearby organs.
Stage IV: In stage IV, the tumor may be any size and cancer may have spread to distant parts of the body.
Recurrent Anal Cancer: If cancer has recurred (come back) after it has been treated then it’s called recurrent anal cancer. The cancer may come back in the anus or in other parts of the body.
Causes/risk factors of anal cancer
Risk factors include the following:
Being over 50 years old
Human Papillomavirus (HPV) infection
Frequent anal redness, swelling, and soreness
Having anal fistulas (abnormal openings)
Having many sexual partners and having receptive anal intercourse (anal sex)
Smoking cigarettes
These risk factors suggest that there maybe a possibility of anal cancer, however there’s a possibility that a person may not get anal cancer despite being exposed to the risk factors mentioned above.
Symptoms of anal cancer
The symptoms that may suggest the existence of anal cancer are:
Pain or pressure in the area around the anus
Itching or discharge from the anus
Bleeding from the anus or rectum
Lump near the anus.
A lump near the anus
A change in bowel habits
Other conditions may cause the similar symptoms that may not be anal cancer, therefore an opinion from the doctor/physician is of utmost importance
Diagnosis of anal cancer
The following tests and procedures may be used to diagnose anal cancer:
Physical exam and history: To check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual a general physical exam is conducted by a physician. Patient’s health, habits, past illnesses and treatments will also be taken into account to check any possibility of anal cancer.
Anoscopy
Biopsy
Digital rectal examination (DRE)
Endo-anal or endorectal ultrasound
Proctoscopy
CT/CAT scan
Chest X-ray
Treatment of anal cancer
On diagnosis of anal cancer there are three basic types of standard treatment options:
Surgery
Local resection: it is a surgical procedure in which the tumor is cut from the anus along with some of the healthy tissue around it. If the tumor is small and cancer has not spread local resection may be used. This procedure saves the sphincter muscles and the patient still has the control over bowel movements. Tumors in the lower part of the anus can be removed with local resection.
Abdominoperineal resection: In this surgical procedure the anus, the rectum, and part of the sigmoid colon are removed through an incision made in the abdomen. End of the intestine is then sewn by the doctor 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.
Radiation therapy
Chemotherapy
Various factors that influence the decision of choosing a treatment option are:
The prognosis (chance of recovery) depends on the following:
Where the tumor is in the anus
Whether the cancer has spread to the lymph nodes
The stage of the cancer
Where the tumor is in the anus
The size of the tumor
Whether the patient has human immunodeficiency virus (HIV) because already weakened immune system can then not be put under a lot of strain by heavy doses of chemotherapy or radiation therapy.
Whether cancer remains after initial treatment or has recurred.
Other types of treatment are being tested in clinical trials. These include the following:
Radiosensitizers: Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.
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