Anal Cancer

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Cancer is a disease caused by abnormal growth of cells in a person’s body. There are several types of cancer. Cancer can affect any part of the human body. Anal cancer is a malignant tumor which begins in a person’s anus. The anus is the opening at the lower ends of the intestines. This cancer occurs in a person’s anal canal. The anal canal is a short tube which is located at the end of rectum. This tube is through which stool passes from the body. This type of cancer is very rare and uncommon. There are not too many cases reported about anal cancer. The causes, symptoms, treatment and risks of anal cancer will be mentioned in detail below.

Anal cancer

Causes of Anal Cancer

The causes of anal cancer have still not been determined exactly. Even though the exact cause has not been determined, there are still various factors which can increase in the likelihood of developing this condition in anyone [1]. Such factors include the following:

  • Infection with HPV which is the human papilloma virus. This is a very common yet usually harmless group of viruses. These viruses spread through sexual contacts. They can affect the membrane linings of the person’s body which are very moist.
  • The risk of HPV increases if a person has multiple sexual partners. People who practice anal sex are also more vulnerable to being infected with HPV.
  • Smoking may also be a factor contributing to anal cancer.
  • People who have histories of having cervical, vaginal and vulvul cancer are also prone to be affected with anal cancer in later years of their life. This might happen if the cancer cells don’t completely die with the treatments and later spread out in the body infecting other areas of the body.
  • People who have weak immune systems are also more likely to get anal cancer. Weak immune system can be caused by drugs or certain conditions which suppress the immune system. People who have received organ transplants some time in their life also have high chances of anal cancer.

Most of the cases that have been diagnosed with anal cancer have been of people aged 65 years and above. Also, according to studies, the condition is more common among the women than it is than man. The risks of anal cancer are therefore much more as a person gets older. Also, it has been noted more in the men who are single than in men who are married.

Signs and Symptoms of Anal Cancer

There are many signs and symptoms of anal cancer. The signs of anal cancer include [2]:

  • Sudden bleeding from the anus or the rectum
  • Feelings of pain and pressure in areas around the anus.
  • Itching and discharge experienced from the anus
  • A lump felt somewhere near the anus.
  • Sudden change in bowel habits.

Diagnosing Anal Cancer

If someone experiences any odd and unusual symptoms, they should consult a general physician as soon as they can. The general physician can then guide them as to what those symptoms mean. If these are symptoms being experienced by the person do resemble anal cancer, the patient would then be asked and examined for certain tests. The physician might feel patient’s abdomen. He could also carry out a thorough rectal examination. A rectal exam would make the doctor insert a finger in patient’s bottom. The gloved finger would help the patient to figure out any abnormalities.

If according to the doctor further exams would still be necessary, the patient will be then referred to a hospital. Many different tests will be done at the hospital to check the patient for anal cancer. Since the symptoms could even mean other conditions sometimes, a thorough test and diagnosis will be needed. Some of the tests that could be done include the following:

  • Sigmoidoscopy: in this test, the doctors insert a thin and flexible tube in the patient’s bottom with a small camera attached. The camera has a light so it makes it easy for the doctors to check for any possible abnormalities.
  • Proctoscopy: in this test, a hollow tube instrument is used to check the inside of patient’s rectum. The instrument has a tube at the end of it.
  • Biopsy: in biopsy, a small sample of tissues is removed by the doctors from the patient’s anus during the process of sigmoidoscopy or proctoscopy. The tissue will then be examined by the doctors in the laboratory.

After the patient has been tested for anal cancer through one or more of the above mentioned methods, he would be required to wait for his results. After the results, if his condition and the symptoms that he had been experiencing do indeed suggest that the patient has anal cancer, the doctor may carry out scans in order to check if the cancer has spread. After these have been completed, the doctors will then be able to determine the stage of cancer the patient is suffering from. The stage of cancer basically refers to determining how large it is and how far it has spread. The higher the score that will be given to this stage, the more dangerous the disease will be for the patient. The lower the score on the other hand, the earlier the stage would be. Treating cancer and curing it while it’s still at an early stage is easier and have higher possibilities.

Treatment of Anal Cancer

After the patient has been unfortunately treated with anal cancer, he would then be given care by the multidisciplinary team. This is basically a team which consists of different specialists. These specialists work together and figure out the best possible treatment option for the patient suffering from anal cancer. The different doctors in the team have different specialized skills and opinions of each of them would contribute to making a plan for treating the patient with the best possible options.

There are two main treatments that are used for anal cancer – Chemoradiation and Surgery.

Chemoradiation for Anal Cancer

As the name suggests, this treatment is a combination of two different cancer treatment therapies. These are a combination of chemotherapy and radiation therapy. In chemotherapy, treatment is done by killing cancer cells through medicines and chemical drugs that kill and destroy cancer cells. Radiotherapy on the other hand uses high energy doses of radiation to kill cancer cells. The combination of both of these therapies is currently the most commonly used treatment to cure anal cancer. It has turned out to give positive results in treating cancer patients and is very effective.

For anal cancer, chemotherapy is given to the patients in two different sessions. The sessions would last from Monday to Friday. The sessions would have a gap of four weeks between them. The patient will not be required to stay at the hospital where they are given treatments, during the weeks.

Chemotherapy is given to the patients through a small tube. The tube is inserted into the central catheter of PICC in the arm of the patient. The tube stays in patient’s arm during the time of entire treatment. By inserting the tube inside, the patient can avoid staying at the hospital and being admitted there for over the two sessions. The patient will be given a tiny pump made of plastic which he will be asked to get attached to. The patient will be required to take the pump to his home. There are a few hospitals now which offer tablet chemotherapy for treating anal cancer in a patient. This enables the patient to avoid the need for having a pump and PICC.

Radiotherapy on the other hand is given to the patient in shorter sessions. It is given to them once every day from Monday to Friday. The patient is given a break at the weekends. This is done for a period of five to six weeks. The patient wouldn’t be required to stay and get admitted in the hospital for these appointments. Additional scans will be required to prepare the patient for radiotherapy.

Both chemotherapies and radiation therapies have the same side effects on the patient. These side effects include the following:

  • Fatigue and feeling of constant tiredness
  • The skin around the patient’s anus might become sore.
  • The skin around men’s penis and scrotum and the skin around women’s vulva may become very sore and swollen.
  • Loss of hair from the head and pubic areas. The hair in pubic area completely disappears.
  • The patient might feel sick. He may experience nausea and vomiting
  • Bowel movements may get affected. Some patients experience severe diarrhea while some experience constipation.
  • The patient might lose his appetite and might not be able to take regular meals. He may also experience significant weight loss.
  • Skin problems might occur and skin may become very sensitive to certain kinds of soaps and washes. Too much chemical might hurt the skin. Special skin doctors should be contacted for recommendations and suggestions about possible soaps that the patient might be able to use.

These side effects are mostly temporary. There is however other side effects such as infertility, erectile dysfunction, bleeding from sexual organs and vaginal pain during intercourse that is more troublesome and long term. The doctor should be consulted for these problems so that the issues are properly investigated and treated.

Surgery for Anal Cancer

The other method used for treating anal cancer is surgery. Surgery is less commonly used for anal cancer than chemo radiation. Only if the tumor is small enough to be able to be removed through surgery, only then surgery can be used as an option. Another instance when surgery is done is when chemo radiation has been ineffective and has failed.

A very small tumor which has been very clearly defined may be cut out from the patient’s body by using the method of local excision. This process is relatively simple and is carried out under the general anesthetics.  This procedure requires the patient to stay in hospital only for a few days.

In cases where chemoradiation isn’t successful, an abdominipereal resection will be performed in which the patient’s tissues from anus and rectum will be removed which will reduce the risk of cancer from returning. Patient will be required to stay in hospital for 10 days.

A permanent colostomy will be also performed during the surgery to allow the patient to pass stools. Life after colostomy may get difficult. Adjusting to the life after colostomy may be a challenge but people get used to it over time.

If the cancer is successfully treated with chemo radiation, need for having colostomy will decrease. This method has a survival rate of 70%. Surgery is only for people who fail with this therapy [3].

Coping with Anal Cancer

Being diagnosed with cancer can be extremely overwhelming and frightening. This can be a very hard time for the patient and his family. To help the patient and his family cope, they can take an active role in their health care [4].

  • The patient should learn about anal cancer so they can take good care of themselves. The patient may become confident about anal cancer if he knows about the diseases enough so he can make his own decisions.
  • Family and friends should always stay very close to the patient. They can become a great support for the patient in their time of absolute need. By helping them with their responsibilities while they are sick will be a great deal for the patients since they will be able to feel less stressed as their responsibilities are being met while they are at the hospital.
  • The patient should find someone to talk to and find a good listener who will listen to their hopes and fears. This could be a friend or family close to the patient or a professional counselor as well.