Caricnoma of the anus mainly develops in the anal canal (anal canal cancer), which connects the anus to the rectum.
Now, the anus is a part of our gastrointestinal tract and is the outlet from which excreta goes out of the body. For any reason, if an abnormal mass of cells gets formed near the anal, it leads to the formation of a tumor.
This anal tumor can be cancerous or not, depending on whether it is malignant. A malignant tumor gets converted into cancer, which can then spread to other parts of the body.
Depending on the origin of these cancerous cells, anal carcinoma can be divided into different types. This classification helps doctors understand what does anal cancer feel like and adopt an effective anal cancer diagnosis.
Speaking of how common is anal cancer, it is important to note that it is a rare type of cancer, and more common among older adults. The exact reason for the lower incidence of anal carcinoma is unknown.
Despite its rare occurrence, it can be fatal if it is not diagnosed early and treated on time. Thanks to modern treatment approaches, it is possible to treat anal carcinoma with positive health outcomes, and patients are able to lead a normal life after their treatment.
Anal dysplasia can be termed a precancerous condition that leads to the formation of lesions in or around the anal canal. Though anal dysplasia is not cancerous, it can transform into cancer by converting the normal anal cells into abnormal ones, leading to an anal tumor or cancer.
Anal dysplasia initiates in the mucosa, the anal canal's inner lining, and is caused by different variants of the human papillomavirus (HPV). Now, anal dysplasia may not always cause any symptoms. However, if it does, it may include an itchy anus or even a lump in the anus. Some people may even have warts in the anus, which are usually an HPV symptom and not an anal tumor.
In most cases, carcinoma of the anus is diagnosed in individuals aged between 55 and 64. The risk of anal carcinoma is low in those aged below 35.
Carcinoma of the anus is common among those with chronic HPV infection. In addition to this, compromised immunity also contributes to increased anal carcinoma risk.
If we talk to experts about who gets anal cancer, they say that those with unhealthy lifestyle habits and unusual sexual practices, such as anal intercourse, are more susceptible to anal malignancies.
Anal carcinoma originates from cells in the mucosa, the anal canal's inner lining. Essential ducts and glands can be found under the mucosa. In simple words, it can be said that this cancer starts either just inside or around the anal opening.
The anus, the most significant part of the digestive tract, is positioned at the end of the rectum. The perianal skin and the anal canal together form the anus. The following are the different parts of anus, where cancer can form:
The anal margin can be explained as a circle formed by skin tissues with a radius of 5 cm starting from the anal verge. In rare cases, anal carcinoma can form in the anal margin, which makes it one of the less common anal cancer types.
The anal canal is a 4-cm-long tube that is responsible for connecting the anus to the rectum. The link between the anal canal and rectum is known as the anorectal line. The anal sphincter, or ring-like muscles, surrounds it. In fact, anal canal cancer is the most common type of anal cancer type.
The transitional zone refers to the anal canal lying just above the pectinate line and extending from 1 to 2 cm. Rarely, anal carcinoma can also form in the transitional zone.
Carcinoma of the anus is classified into two major groups based on the region where it forms. These include anal canal cancer, i.e., cancer in the area lying above the anal verge, and cancer of the anal margin or perianal skin, i.e., the region lying below the anal verge.
The treatment for these anal cancer types depends on their location. However, in many cases, especially in cases of stage 4 anal cancer, the cancer may quickly spread from one area to another. This can make it a little difficult for doctors to determine the area where the cancer started.
Thus, depending on the anal cancer pain and the stage, doctors often recommend anal cancer treatment. The following are the different anal cancer types:
Carcinoma in situ refers to precancerous cells or early cancer cells. This anal tumor arises from the cells present on the anal canal's surface and can also be known as Bowen's disease.
As the name suggests, this type of anal carcinoma initiates in the squamous cells. These cells are present mainly in the anal canal and the anal margin. When these cells become cancerous, it can lead to anal canal cancer. This is one of the most common anal cancer types.
A small group of anal tumors are referred to as adenocarcinomas, and they form in the cells lining the anus' upper part. In addition, adenocarcinomas can also start in the glands lying under the anal mucosa, which are responsible for releasing secretions in the anus.
Skin cancer refers to cancerous growth in the cells comprising the skin of the anus. These can be divided into two types: basal cell carcinoma and melanoma.
As the name suggests, gastrointestinal stromal tumors are more common in the small intestine or stomach. It is, again, quite rare to find it in the anal region.
Basal cell carcinoma refers to a kind of skin cancer that can initiate and develop in the perianal skin. Usually, this kind of cancer develops mainly in the skin, which is highly exposed to the sun, and this makes basal cell carcinoma of the anus rare.
Melanoma refers to a type of cancer that forms in the cells present in the anus skin or anal lining, which is responsible for creating the brown pigment called melanin. Anal melanomas are rare.
Poorly differentiated neuroendocrine tumors are pretty uncommon in the anal area. It is difficult to distinguish these cells from healthy ones, as they look identical. These tumors are divided into two types: large-cell and small-cell. This differentiation is based on how these cells look under the microscope.
Anal lymphomas are uncommon. Lymphomas refer to cancers of the disease-fighting system of the human body.
It is highly recommended to see a doctor for any of the symptoms of anal canal cancer. These symptoms may include a lump in the anus, itching, pain in the anal region (which is referred to as anal cancer pain), or bleeding from the anus.
Even if the symptoms are mild, you should visit a doctor who will refer you to a surgeon to check for any anal cancer lumps or other signs.
Anal cancer symptoms are pretty similar to those of hemorrhoids, such as anal bleeding. This is why many people tend to ignore it until things get out of hand. Thus, doctors often advise patients to get themselves checked as soon as possible.
In some cases, patients do not experience any symptoms at all. However, with time, they start getting symptoms, such as itching in and around the rectum, abnormal discharge from the anus, swollen lymph nodes present in the groin or anal region, rectum bleeding, and pain in the anal area.
Though having one or more of these signs does not mean one has anal cancer, it can get a little uncomfortable to talk about these issues. But it is always better to seek help from a healthcare provider if these symptoms worsen or do not go away even after medication.
If these signs of anal cancer are recognized and reported at an early stage, it can lead to positive health outcomes and improve survival rates. Also, since an anal cancer lump is often present at a location the doctors can easily reach, the diagnosis becomes easy.
Here are the common signs and symptoms of anal carcinoma
Bleeding is one of the first and foremost anal tumor symptoms. Initially, this bleeding is mild and does not cause too much trouble. However, with time, the patient starts experiencing pain along with bleeding. Also, bleeding from the rectum may cause the stool to look black or dark brown in color.
Other symptoms of anal cancer include pain in the anal area along with bleeding. This pain comes whenever the patient tries to go through bowel movements. In most cases, there is a burning sensation of pain followed by blood in the stool.
Many patients also experience a mass or growth in the anal cavity as one of the early signs of anal cancer. This mass may appear at the end of the anus and can be felt by the patient.
Anal itching is also included in the early symptoms of anal cancer. Though it is a common condition, if the problem does not improve or the itching increases even after medication, one should get it checked. In some cases, anal itching is also followed by bleeding and pain.
Another symptom of anal cancer is feeling a lump near the anus. However, this symptom is common with hemorrhoids as well, but there is a common difference between the two lumps. The anal cancer lump feels like a piece of flesh but is harder than the lump of hemorrhoids.
Patients suffering from cancer of the anal canal may feel burning pain or pressure in the area around their anus. Again, pain is accompanied by bleeding from the rectum in all anal cancer types.
A change in bowel movements could also be one of the anal tumor symptoms. It implies having fewer or more bowel movements than usual or experiencing straining during bowel movements.
One of the symptoms of anal cancer, which is common in hemorrhoids, is a narrowing of the stools. This anal tumor symptom is accompanied by a change in bowel movements in the case of anal carcinoma.
Squamous cell cancer presents itself as a nonhealing ulcer around the anus. These ulcers, along with an anal cancer lump, are one of the early symptoms of anal cancer.
Another common sign of anal carcinoma is a feeling of pain, fullness, or discomfort in the rectum. As one of the early signs of anal cancer, this uneasiness in the rectum, when combined with other common symptoms, can raise the alarm for the physician.
Now, the question arises: what are the causes of anal cancer? Carcinoma of the anus is normally caused by a sexually transmitted infection known as the human papillomavirus (HPV).
One of the common reasons for anal cancer (squamous cell type) is a sexually transmitted HPV infection. Other risk factors for squamous cell cancer include smoking, HIV, smoking, anal receptive intercourse, and immunosuppression.
Though the real cause of anal tumors is unknown, there are some risk factors. One of the reasons for anal cancer, or anal adenocarcinoma, is HPV, lowered immunity, and smoking.
HPV is one of the primary causes of anal cancer. HPV is one of the most common types of sexually transmitted diseases. Though people infected with HPV do not exhibit any symptoms, they can indeed affect others.
Those who have received treatment for cervical, vaginal, or vulvar cancer in the past are at a higher risk of developing anal cancer. The possible reasons behind this include HPV infection, compromised immunity, and inflammation caused by previous cancer treatments.
Smoking is also one of the major causes of anal cancer, as it is not only one of the major risk factors but can also lead to its recurrence. Doctors put it at the top of the list of what causes anal cancer.
Many case studies have reflected on the possibility of patients with sexually transmitted diseases such as AIDS or HIV and a history of anal warts getting diagnosed with anal cancer. The reason behind this is that patients with chlamydia, anal warts, and AIDS/HIV have a compromised immune system, which leads to the easy growth of cancerous cells in the body.
The right time to see a doctor is when you start experiencing any of the symptoms of anal cancer. Though these symptoms may seem minor and you may not feel comfortable talking about them, it is always better to be cautious. Also, since these symptoms are similar to those of hemorrhoids, they can create confusion and lead to an unnecessary delay in diagnosis.
The diagnosis of any type of cancer starts with a series of tests conducted by the doctor. The same goes for an anal cancer diagnosis. These tests help the physician learn about the stage of cancer and the extent to which it has metastasized.
Also, these tests help a doctor determine the area where the cancer has started, which plays a major role in deciding the treatment line. Doctors perform various tests for the diagnosis of anal carcinoma.
The tests conducted for anal cancer diagnosis depend on some essential factors. These factors are the patient's symptoms, the patient's age and complete health overview, the kind of cancer suspected in a patient, and the results of some medical tests.
Here are some crucial tests healthcare providers conduct to check whether a patient is suffering from the said cancer and anal cancer types.
If the patient suffers from any of the symptoms of anal carcinoma, a quick assessment of the patient’s medical history and physical examination are recommended as part of the initial anal cancer diagnosis.
The medical history assessment involves looking for risk factors, hints about the patient's immune system, and signs of any other health problems.
After recording the medical history, the physicians move on to conducting a physical exam to check for any signs of cancer. These physical exams include a rectal exam, a pelvic exam, and a pap test (in women).
These tests indicate whether there are any lumps or lymph nodes in the body in addition to other symptoms. If these basic tests show some issues, the doctors then perform elaborate tests to confirm the anal cancer diagnosis and disease staging.
Here are some of the detailed tests conducted for anal cancer staging:
Anoscopy refers to the examination of the anus and rectum with the help of an anoscope. An anoscope is a 3- to 4-inch-long tube that is 1-inch in diameter and is firm to touch. The anoscope gets coated with a gel, which the doctor gently pushes into the anus as well as the lower rectum.
An anoscopy enables the doctor to see the linings of the anus and rectal. If the doctor sees anything abnormal, he can take a sample for a biopsy during the anoscopy procedure only.
During the anoscopy, the patient is awake and is asked to lie on his side. Patients may find the procedure uncomfortable; however, it should not be painful. If the patient feels any pain during the procedure, they should be encouraged to inform their doctor.
Rigid protosigmoidoscopy is another technique used to localize anal tumors. It is similar to an anoscope but is longer than the former. With the help of rigid proctosigmoidoscopy, the doctor is able to look into the rectum, anus, and sigmoid colon's lower part.
Endoscopy is another test conducted for anal cancer diagnosis, during which the physician inserts a thin and long tube inside the person's anus. The tube has a camera fixed at its end, which helps the physicians have a detailed look inside the anus.
Endoscopy is employed to collect tissue samples from inside the rectum and anal canal in the case of a biopsy. The test takes 15 minutes to 1 hour, and the patient is administered local anesthesia, which assists in making the patient comfortable. Again, if the patient feels any kind of pain during the test, they should inform the presiding doctor.
Another essential anal cancer test is a rectal biopsy, which the doctor uses to confirm the diagnosis of anal carcinoma. The test includes collecting a small swab of tissue from the rectum and anal canal, which a pathologist uses to make a proper diagnosis.
If the pathologist finds cancer in the tissues, he sends a report, including information on anal cancer staging, cell types, and other aspects of cancer. During the test, local anesthesia is administered, and if the cancer has spread to lymph nodes, they may remove a nearby lymph node and conduct a biopsy on it.
When the question arises of how to detect anal cancer, blood tests do come up on the list. Blood tests are carried out to look for specific tumor markers.
Blood tests are also conducted to check for any kind of sexually transmitted disease, such as HIV. If the blood tests confirm HIV or any other disease, the patient is advised to go for its treatment first.
Another effective test for anal cancer diagnosis is an imaging test. Imaging tests are also necessary for anal cancer staging. As the name suggests, these tests for imaging of anal cancer are used to get a clear picture of the internal organs of the human body. The imaging tests are helpful in learning about the extent of cancer spread, judging the efficiency of anus cancer treatment, and determining if there has been any recurrence of cancer of the anus even after the treatment.
Ultrasound uses sound waves to create a proper image of the anus to help the doctor know the depth of cancer growth. The ultrasound of the anus is conducted to get a clear view of the squamous-cell cancer's penetration in the anal canal and rectum.
A computed tomography (CT) scan is an anal cancer test conducted to gauge the size of the tumor in the anus. The test uses X-rays and a computer screen to create 3-D images of the internal organs of the human body.
Magnetic resonance imaging (MRI) is another commonly recommended anal cancer test that uses radio waves and magnetic fields to create pictures of the insides of a human body from all angles. MRI is very helpful in getting a clear picture of the soft tissues and is thus often given preference for cancer staging. These images help the physician judge whether the cancer has spread to different body parts, such as the liver, kidney, spinal cord, etc.
Physicians often conduct a normal chest X-ray to check whether the cancer cells have spread to the lungs. However, if the CT scan of the chest has already been done, the doctors may surpass this test.
A positron emission tomography (PET) scan is used for cancer detection and judging the efficiency of cancer treatment. The PET scan uses radioactive sugar, which accumulates in different quantities in various cells, defending against the cancer's spread.
A PET scan helps in anal cancer staging, planning treatment for anal cancer, and treatment monitoring.
Treatment for anal cancer depends upon the stage of the cancer, the patient's immune health, lifestyle changes, and the causes of anal cancer. Here are the most commonly recommended treatment options for anal cancer:
Anal cancer surgery for early-stage cancer involves removing small anal tumors at an early stage. The doctor removes these tumors along with a small portion of healthy tissue surrounding them to stop the recurrence of the cancerous cells. This is often done during stage 1 anal cancer.
Depending on the extent of the spread, the physicians may suggest further treatments, such as chemotherapy, for the patients.
If the cancerous cells are not getting damaged even after chemotherapy or radiation for anal cancer, the physician may recommend a more elaborate surgery known as abdominoperineal resection. During this extensive surgical oncology procedure, the doctor practically removes a significant part of the anal canal, a part of the colon, and the patient's rectum.
Abdominal resection is a major surgical treatment for anal cancer that involves the removal of a major part of the patient's affected rectum, anal canal, and colon.
After the removal, the physician then attaches the left out part of the colon to the patient's stoma, an opening in the abdomen. Through the stoma, the human waste leaves the body and collects in a colostomy bag attached to the abdomen. This is an effective solution for recurrent cancer of the anus.
In some cases, the doctor combines both radiation and chemotherapy treatments to destroy the cancerous cells. This combination is called chemoradiation. This line of treatment is adopted when the healthcare team finds that the anal tumor is located too near the anal sphincter and cannot be removed with the help of local resection.
Chemotherapy for anal cancer involves administering powerful drugs that destroy cancer cells throughout the body. Radiation for anal cancer, on the other hand, involves using high-intensity radiation beams to kill cancer cells.
Immunotherapy refers to using drugs to assist the patient's immune system in locating and killing cancerous cells. Physicians often recommend immune checkpoint inhibitors for treating carcinoma of the anus.
Most of the time, the patient's immune system does not fight the cancerous cells, as these cells produce a protein that makes them unrecognizable. Immunotherapy is a procedure to fight this very process of producing undetectable proteins.
Radiosensitizers are a course adopted as a cure for anal cancer that makes the cancerous cells sensitive to radiation therapy. These sensitizers include signal transduction inhibitors, cell cycle modulators, and DNA-damaging agents.
Palliative care refers to a professional team of medical experts who work together to offer pain relief and comfort from other symptoms to patients. This team consists of doctors, nurses, and trained professionals who focus on improving the patient's quality of life.
Here are the different treatments adopted as per the stages of cancer of the anus:
During Stage 1, the cancer has usually spread to the wall of the anal canal but has not spread to the other nearby organs. During this stage, the physicians recommend going for an early-stage surgery that involves removing the minor tumors, which are less than 2 centimeters in diameter. Often, surgery alone is considered a cure for anal cancer that is in its early stages.
Stage 2 treatment is similar to the former stage and involves local resection of the anal tumors, which are small in size. The doctor also recommends a combination of chemotherapy and radiation for this stage. The physician may recommend abdominoperineal resection in cases where the tumor is not responding to treatment and there are chances of recurrence.
During stage 3, the cancerous cells have invaded other nearby organs and lymph nodes, thus requiring more extensive treatments. The treatment for anal cancer at this stage includes radiation therapy, chemotherapy, and abdominoperitoneal resection.
Stage 4 implies that cancer has metastasized to other distant organs, usually the liver, lungs, lymph nodes, and bones. Thus, the treatment for anal cancer that is in stage 4 may involve immunotherapy, chemotherapy, radiation therapy, or palliative care.
The patients may have to change their eating habits after the treatment. Here are the dietary recommendations after the treatment.
The diet depends on the line of treatment you have received for the cancer. If the patient has undergone surgery for the removal of the anal canal, rectum, and colon, he may not be allowed to eat immediately after the operation. The doctor would advise you to eat nothing of the sort that can upset your stomach, as it can affect your bowel movements.
Eating more proteins is recommended for patients after the treatment as it helps the body regain its energy levels.
Eat foods that are rich in fiber and fats, such as vegetables, fruits, cabbage, onions, etc., as this helps regulate your bowel movements after the surgery.
Seeing a dietitian is a must after cancer treatment so that you do not eat anything that can mess up the already fragile immune system of your body.
Eating small meals in small portions would ensure that the body is getting enough vitamins, energy, and proteins and that bowel movements are not altered. Eating small portions also helps with after-surgery symptoms, such as nausea.
Eat more food items that have soluble fiber, such as oatmeal, bananas, pears, etc. Also, the patients are recommended to have more liquids and proteins to get the energy they need to fight against any side effects of radiation therapy.
Following chemotherapy for cancer of the anal canal, the patients are recommended to have a rich-fiber diet, which includes vegetables, fruits, and dried beans. Also, the patient is recommended to have 25 grams of dietary fiber per day, along with proteins.
The first line of preparation is making an appointment with your doctor in case of any symptoms. If the doctor finds the symptoms to be related to anal carcinoma, he would further recommend you see a specialist.
Before going for the appointment, it is advised to talk to the doctor or his assistant to find out anything that you need to do before the appointment. This may include going through any dietary restrictions before the appointment.
It is always advisable to make a detailed list of the symptoms you are facing. This would help your physician get a clear picture of your health system.
Getting information about what medications you are taking, such as vitamins or any other medicine, can help your physician understand what line of treatment to pick and what related illnesses to check for.
To get the most out of your appointment and to ensure you don’t forget anything, it is always better to have a list of questions you want to ask him regarding your illness.
HCG has an assembly of specially trained professionals and doctors for diagnosing and training anal cancer. In addition, HCG's extensive experience in handling patients of all stages of anal tumors and cancer makes them stand apart from the crowd
Here are some of the risk factors that can increase a patient's chances of developing anal cancer:
As per different studies conducted, increasing age is one of the important anal cancer risk factors. Also, this cancer develops commonly among the age group of people above 50, but younger people who suffer from different sexually transmitted diseases are also at risk.
People who often get involved in unprotected anal sexual intercourse are at a high risk of getting anal carcinoma. The reason is that such sexual relations could lead to an increase in HPV infections, one of the main anal cancer causes.
Getting infected with HPV is one of the main anal cancer risk factors. HPV, or human papillomavirus, is a group of 150 viruses that can cause different kinds of cancer. Most squamous cell anal cancers are related to HPV infections.
Chronic local inflammation, which is caused by chronic wounds in the anus, infections, and metabolic disorders, is one of crucial anal cancer risk factors. Also, there are some other signs, such as redness in the anus, soreness, and swelling in the anal region, that can again increase the chances of getting cancer.
As per experts, though the direct role of immunosuppression in causing anal carcinoma is not clear, it can still be counted as a risk factor. Immunosuppression is known as the quelling of the human body's ability to fight different infections and diseases. Doctors believe that immunosuppression makes it difficult for the body to fight infections, such as HPV or HIV, eventually leading to anal carcinoma.
Smoking is not only of the anal cancer risk factors but it also increases the chances of its recurrence.
Anal cancer prevention is not completely possible, but with the help of some preventive measures, your risk may definitely be reduced. These measures also help with preventive oncology, an effective line of cancer treatment.
According to experts, quitting smoking or chewing tobacco can definitely reduce the chances of developing an anal tumor. There have been various studies that have shown that smokers face a higher risk of getting cancer compared to people who have quit. Thus,as an effective anal cancer prevention measure, quitting smoking definitely reduces the chances of anal cancer in women and men.
Another anal cancer prevention measure is to avoid getting involved in unprotected anal intercourse. Having many sexual partners or having receptive anal intercourse increases the patient's chances of getting HPV, one of the main causes of anal tumors.
Using condoms definitely decreases the chances of getting sexually transmitted diseases such as HIV, thus working as a preventive measure for anal cancer in women as well as men. However, there have not been sufficient studies to prove that condoms can prevent HPV.
