The incidence of anal cancer is higher among women compared to men. This is usually a disease of the older population, and 80 percent of all anal cancers occur in people over the age of 60.
The anus is where stool leaves your body. It is made up of your outer layers of skin and the end of your large intestine. Anal cancer is a disease in which cancer cells form in the tissues of the anus.
Anal Cancer Risk Factors
smoking cigarettes
infection of HPV virus
receiving anal intercourse
abnormal openings in or around the anus (fistulas)
having multiple sexual partners
being over 50 years of age
anal swelling, redness or soreness that occurs frequently
Symptoms of Anal Cancer
The commonest symptoms of anal cancer are bleeding, pain and a feeling of fullness. Most often these symptoms of anal cancer are attributed some other problems like hemorrhoids or anal fissures with a subsequent result of delay in the diagnosis.
Possible signs of anal cancer include bleeding from the anus or rectum or a lump near the anus.
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.
How is anal cancer diagnosed ?
Anal cancer is found as a mass on rectal examination, or endoscopic examination. An incision biopsy will usually lead to the diagnosis of anal cancer. A CT scan may be ordered to evaluate for pelvic nodes. If the inguinal nodes are enlarged this should be evaluated for metastatic disease.
The following tests and procedures may be used for anal cancer : -
Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
Digital rectal examination (DRE): An exam of the anus and rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual.
Anoscopy: An exam of the anus and lower rectum using a short, lighted tube called an anoscope.
Proctoscopy: An exam of the rectum using a short, lighted tube called a proctoscope.
Endo-anal or endorectal ultrasound: A procedure in which an ultrasound transducer (probe) is inserted into the anus or rectum and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If an abnormal area is seen during the anoscopy, a biopsy may be done at that time.
Treatment of anal cancer
The 3 main methods of treatment for anal cancer are surgery, radiation therapy, and chemotherapy. Often the best approach combines 2 or more of these strategies. In the past, surgery was the only treatment for anal cancer, but doctors have found that most anal cancers can be successfully treated with radiation and chemotherapy combined and without the need for surgery. This treatment approach, called chemo radiotherapy, is now the most widely used approach for anal cancer.
Surgery for Anal Cancer
Surgery may be done if the anal cancer is detected at an early stage, but this is not the preferred mode of therapy. Currently surgery for anal cancer is indicated only in those patients who have failed to combination of chemotherapy and radiation therapy.
This mode of treatment was used in Europe for early anal cancer lesions, but is associated with higher complication rates compared to combination of chemotherapy and radiation therapy, which is the preferred treatment in anal cancer.
This is the preferred mode of treatment for most patients with anal cancer. About 80 to 90 percent of patients usually experience complete remission (complete disappearance of tumor) with this mode of treatment and most of these patients are cured of anal cancer. Most commonly used chemotherapy combination is 5-FU plus mitomycin. The anal cancer can continue to regress for 3 to 4 months following chemo-radiation. Those patients who do not experience a complete remission following chemo-radiation should undergo surgical treatment.
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