Causes Of Anal Cancer
The most common cause of anal cancer is the human papilloma virus accounting for around 80% of cases.
Other factors that can increase your risk of anal cancer include:
having diseases such as chlamydia, anal warts and AIDS/HIV
women who have already had cervical, vulval or vaginal cancer or a history of abnormal cells in the cervix, vulva or vagina
people who have anal intercourse may have an increased risk of anal cancer possibly due to an increased risk of HPV infection
people with weakened immune systems
Tests to diagnose anal cancer may include:
Patients Can Enter Clinical Trials Before During Or After Starting Their Cancer Treatment
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCIs clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
How Is Anal Cancer Treated
Anal cancer treatment depends on what type of cancer it is and how far its spread. The most common treatments include surgery to remove early-stage anal cancer a combination of chemotherapy and radiation therapy for most stage two or stage three anal cancers abdominoperineal resection or chemotherapy and/or immunotherapy for those with stage four anal cancer.
Surgery for early-stage cancer
Early-stage cancer that hasnt entered your anal wall can be treated by removing the affected skin entirely. Even some smaller tumors that have grown into the anal wall can be removed surgically. These smaller tumors usually dont require further treatment with radiation or chemotherapy. This surgery is called local excision.
Chemotherapy and radiation therapy
Chemotherapy uses drugs to kill cancer cells. Some chemotherapy can be taken by mouth, while other drugs must be given through your vein or as a shot into your muscle.
Chemotherapy and radiation therapy work together for optimal effectiveness. Your healthcare provider will tailor your treatment plan according to your specific needs.
Your healthcare provider may recommend immunotherapy with or without chemotherapy to ease symptoms in those with stage four anal cancer. Immunotherapy uses medications to boost your own immune system so it can fight cancer cells more effectively.
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Anal Cancer Causes And Risk Factors
We dont know what causes most anal cancers, but several factors may increase your risk of developing the disease.
You are more at risk of getting anal cancer if you have one or more of the following risk factors:
- The most common risk factor is Human papilloma virus , an infection which causes genital and anal warts.
- A history of cervical or vaginal cancer, or abnormal cells of the cervix, likely to be linked with HPV or smoking.
- A lowered immune response as a result of another condition or treatment for other illnesses which suppress your immune system, such as HIV, or following organ transplantation.
- Smoking tobacco has been shown to increase the risk of developing many cancers, including cancer of the anus.
- Being aged over 50, and in younger adults with HIV infection.
- Some data suggests that people with a high lifetime number of sexual partners, are at higher risk. This may be due to the increased risk of contracting HPV.
Bowel Cancer Risk Factors
The causes of bowel cancer are not clearly understood. Regular screening is important because bowel cancer can develop without noticeable symptoms.
The risk of bowel cancer is greater if you:
- Are aged 50 and over .
- Have had an inflammatory bowel disease , particularly if you have had it for more than 8 years.
- Have previously had special types of polyps in the bowel or a large number of polyps in the bowel.
- Flexible sigmoidoscopy.
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Certain Factors Affect Prognosis And Treatment Options
The prognosis and treatment options depend on the following:
- Thestage of the cancer .
- Whether the tumor has spread into or through the bowel wall.
- Where the cancer is found in the rectum.
- Whether the bowel is blocked or has a hole in it.
- Whether all of the tumor can be removed by surgery.
- The patients general health.
- Whether the cancer has just been diagnosed or has recurred .
Normal Structure And Function Of The Anus
The anus is the opening at the lower end of the intestines. It’s where the end of the intestines connect to the outside of the body.
As food is digested, it passes from the stomach to the small intestine. It then moves from the small intestine into the main part of the large intestine . The colon absorbs water and salt from the digested food. The waste matter that’s left after going through the colon is known as feces or stool. 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.
Structures of the anus
The anus is connected to the rectum by theanal canal. The anal canal has two ring-shaped muscles that keep the anus closed and prevent stool from leaking out. The anal canal is about 1-1/2 to 2 inches long and goes from the rectum to the anal verge. The anal verge is where the canal connects to the outside skin at the anus. This skin around the anal verge is called the perianal skin .
The inner lining of the anal canal is the mucosa. Most anal cancers start from cells in the mucosa. Glands and ducts are found under the mucosa. The glands make mucus, which acts as a lubricating fluid.
The cells of the anal canal change as they go from the rectum to the anal verge:
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What Are The Signs Of Anal Cancer
The most common initial symptom of anal cancer is rectal bleeding. This occurs in about half of patients with new anal cancers. Pain or sensation of an anal mass is seen in about 30% of patients with new anal cancers. Other symptoms include:
- Anal itching.
- Change in bowel patterns.
- Tenderness with palpation.
In some patients, these symptoms may be associated with the presence of warts in the anal region. In general, these symptoms are vague and non-specific. As a result, in one-half to two-thirds of patients with anal cancer, a delay of up to 6 months occurs between the time when symptoms start and when a diagnosis is made.
Rarely, in advanced cases, anal cancers can disrupt the function of the anal muscles. This can result in the loss of control of bowel movements.
What Is Bowel Cancer
Bowel cancer is the third most common cancer affecting Australians. It is estimated around 15,500 people are diagnosed with bowel cancer every year. It is most common in people over 50, but it can occur at any age.
In its early stages, bowel cancer may have no symptoms, but if detected early, it can be successfully treated.
A lot can happen in a hurry when youre diagnosed with cancer. The guide to best cancer care for bowel cancer can help you make sense of what should happen. It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
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Facts About Anal Cancer
According to the American Cancer Society, having cancer of the anus is a fairly rare occurrence in the United States. This is especially notable when compared to colorectal cancer, a type that occurs nearby in the rectum or colon. While the two are similar, they have different risk profiles and typical treatment regimens. Yet even though anal cancer is relatively rare, the number of cases and deaths has been rising consistently over many years. Fortunately, though, the treatment options have also become more effective.
What Is The Outlook After The Treatment Of Anal Cancer
Cure rates depend on the thickness of the tumour and whether cancer has spread to other sites at the time of diagnosis. Overall, 5-year survival is 60% for males and 70% for females.
Treatment may result in faecal incontinence.
Long-term follow-up may detect the secondary spread of cancer to local lymph glands or elsewhere. These are difficult to treat. Further radiation treatment or chemotherapy may be offered.
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Cancer May Spread From Where It Began To Other Parts Of The Body
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if rectal cancer spreads to the lung, the cancer cells in the lung are actually rectal cancer cells. The disease is metastatic rectal cancer, not lung cancer.
Whats The Most Common Type Of Anal Cancer
The most common type of anal cancer is something called squamous cell carcinoma. Under the microscope, this looks similar to a common type of skin cancer, but anal cancer is different. Other types of anal cancer include adenocarcinoma.
After Rectal Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Rectum Or To Other Parts Of The Body
The process used to find out whether cancer has spread within therectum 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 and procedures may be used in the staging process:
What Causes Anal Cancer
Nearly all anal cancers are attributable to persistent infection with HPV, the cause of genital warts. Certain strains of HPV are known to be oncogenic , especially types HPV 16 and 18, and these two infections cause more than 90% of anal cancers. Rarely, subtyping of HPV has detected low-risk strains such as HPV 6 or multiple strains of HPV associated with anal cancer. The HPV infection is sexually acquired, but it is not necessary to have had anal intercourse for HPV to reach the anal canal. HPV is just as commonly detected in the anus as in the cervix, although anal cancer is not nearly as common as cervical cancer.
In Australia and New Zealand, the rates of anal cancer are increasing in association with documented increases in infection with HPV.
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Anal Cancer Risk Factors
Anything that increases your chance of getting anal cancer is a risk factor. These include:
- Age: Squamous cell carcinoma of the anus most often is found in people older than 50
- Human immunodeficiency virus or acquired immunodeficiency syndrome
- Having more than 10 sexual partners
- Anal intercourse
- Frequent anal redness, swelling and soreness
- Tobacco use
- Immunosuppression, including taking immune-suppressing drugs after an organ transplant
Not everyone with risk factors gets anal cancer. However, if you have risk factors, its a good idea to discuss them with your doctor.
Common Concerns In Malignancies Of The Anal Margin And Perianal Skin
Malignancies of the anal margin and perianal skin are relatively uncommon lesions, comprising 3 to 4% of all anorectal malignancies. Commonly included in this group of cancers are Bowen’s disease , perianal Paget’s disease , invasive squamous cell cancer, basal cell cancer, and malignant melanoma. This article will discuss all of these as well as Buschke-Lowenstein tumor or verrucous carcinoma.
Patients with these lesions often present with common perianal complaints, such as itching or burning, bleeding, pain, drainage, or a mass. Proper diagnosis requires a high index of suspicion on the part of the surgeon. Any person with persistent complaints of a local rash or chronic irritation can be considered at risk until proven otherwise. Less concerning are symptoms of relatively short duration and symmetrical rashes however, all patients should be scheduled for follow-up visit within 4 to 6 weeks. Innocent local irritations will resolve in that time with appropriate therapy those that persist must be biopsied for tissue diagnosis.
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How Is Anal Cancer Diagnosed
Anal cancer may be suspected from the appearance of the lesion, which is an irregular nodule on the skin surface or within the anal canal and bleeds easily on contact. It may be detected by digital anal examination, anoscopy , proctoscopy/sigmoidoscopy or colonoscopy .
High-risk patients may be offered anal cytology smears to detect high grade squamous intraepithelial lesions, similar to those used in cervical cancer screening. A swab is inserted into the lower rectum and rolled around the anal canal as it is withdrawn. The swab is processed in the laboratory and examined to detect abnormal cells. Suspicious smears are followed by high-resolution anoscopy.
Skin or mucosal biopsy is then performed to confirm the diagnosis by histopathology.
Imaging is usually undertaken before treatment, to determine the extent of cancer and whether it has spread to local lymphglands or elsewhere in the body. Tests may include:
- Ultrasound scan
Patients May Want To Think About Taking Part In A Clinical Trial
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
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How Common Is Anal Cancer
The American Cancer Society predicts that there will be about 9,440 new cases of anal cancer in 2022. Women will account for about 6,290 of these cases. The organization estimates deaths at 1,670, with women representing 930 of the total. The number of cases of anal cancer has been on the rise in the past several years.
Sexuality And Bowel Cancer
Having bowel cancer and treatment can change the way you feel about yourself, other people, relationships and sex. These changes can be very upsetting and hard to talk about. Doctors and nurses are very understanding and can give you support. You can ask for a referral to a counsellor or therapist who specialises in body image, sex and relationships.
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What Is Anal Dysplasia And How Does It Relate To Anal Cancer
Dysplasia refers to any kind of abnormal changes in your bodys cells. Anal dysplasia is a term used to describe conditions that develop before the onset of anal squamous cell cancer . Symptoms of anal dysplasia may include:
- Anal itching .
If you develop anal dysplasia, your healthcare provider may perform a procedure called chromoendoscopy to find and destroy any abnormal tissue. During this procedure, your healthcare provider uses an endoscope and stains or dyes that make it easier to see when tissue is abnormal.
Case Reportperianal Squamous Cell Carcinoma: A Case Report
Perianal squamous malignancies are often misdiagnosed leading to delay in treatment.
Surgical management aims to preserve sphincter function.
Chemoradiation is preferred in cases of suspected sphincter involvement.
Some superficial muscle fibers may be resected in select cases without loss of function.
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Can I Prevent Anal Cancer
There isnt a completely effective way to make sure you dont get anal cancer, but you can help protect yourself by reducing some risk factors. For example:
- Dont smoke. If you do smoke, stop.
- Practice safe sex. Make sure you use condoms if you engage in anal sex.
- Get the human papilloma virus vaccineif youre eligible for it. This vaccine not only prevents anal cancer, but also cancers of the mouth and throat, cervical cancer and penile cancer.
After A Diagnosis Of Anal Cancer
After a diagnosis of anal cancer, you may feel upset, confused, anxious or upset. These are normal reactions. Talk about your treatment options with your doctor, family and friends. See as much information as you need.
Anal cancer is rare so your specialist will probably recommend treatment in a specialist centre by a range of health professionals.
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What Are The Symptoms And Signs Of Anal Cancer
Anal cancer may present with:
- Bleeding from the anus
- A mucus or jelly-like discharge from the anus
- Constipation, bloating, diarrhoea or faecal incontinence , which can cause incontinence-associated dermatitis.
Symptoms are often thought initially to be due to haemorrhoids , polyps or skin tags.