Anal Cancer Awareness Day is March 21st

by Jane Ashley

March 21st is Anal Cancer Awareness Day. The anal passage is the lower end of our gastrointestinal system. The anus is located below the rectum and is about 1 to 1 ½ inches long. Two strong muscles, called the anal sphincter muscles, open and close to allow stool to pass from our bodies.

Anal Cancer Ribbon

Anal cancer is relatively uncommon, affecting about 8,300 (2,770 men and 5,530 women) people in the U.S every year. Almost 1,300 deaths occur annually from anal cancer .

Risk Factors

HPV virus. HPV causes about 90 percent of anal cancers. Almost every sexually active person has been exposed to HPV at some point in their lives. Most people don’t know that they have HPV because it doesn’t always cause symptoms. It can also stay dormant for years.

Age. Most patients are between 50 and 80. Anal cancer seldom occurs in people under 35.

Frequent anal irritation. You may be more likely to develop anal cancer if you have a history of irritation, redness, swelling or soreness in your anal canal.

Anal fistula. If you’ve had an anal fistula (abnormal tunnel between the anal canal and the outer skin of the anus), you are at increased risk for anal cancer.

Smoking. Smokers are eight times more likely to develop anal cancer.

Lowered immunity. Immunocompromised people are more likely to develop anal cancer. This includes people who have had organ transplants or have HIV.

Symptoms

Not all of these symptoms are present. Be sure to talk to your doctor if you experience any of these symptoms.

Bleeding, pus or discharge.
Pain or pressure in the anal area.
Anal itching.
Stools that become narrow.
Change in bowel habits.
Lump or swelling near the anus.
Swollen lymph nodes in the groin, pelvis or anal area.

Anal cancer is sometimes misdiagnosed as hemorrhoids. If bleeding continues after you finish treatment for hemorrhoids, ask to be referred to a specialist.

Hpv Causes Six Kinds Of Cancer

How is Anal Cancer Diagnosed?

As with most other cancers, there are some tests and exams utilized to pinpoint a patient’s specific diagnosis.

Digital rectal exam. After a thorough case history, your doctor will do a digital rectal exam (DRE) to determine if you have any lumps or other abnormalities.

Anoscopy. An anoscope is a thin, lighted, flexible tube that is inserted into the anus so that the physician can visually look at any lump or abnormality that they felt. A patient may be sedated for this exam.

Biopsy. A small amount of tissue from the suspicious area is removed and examined under a high-powered microscope by a pathologist (a person trained in the identification of disease in cells, tissues, and organs).

Ultrasound. An ultrasound uses sound waves to create a “picture.” In the case of suspected anal cancer, a wand is inserted into the anus to create a detailed picture of the anal canal.

Imaging. X-rays, CT scans, PET scans and MRIs show details of your tumor and whether it has spread into your pelvic region or to distant parts of your body.

The diagnosis process provides your physician with the stage of your cancer and the grade. Your treatment is based on this information.

How is Anal Cancer Treated?

Treatment depends on the type, stage, the grade, your overall health and takes into account the side effects and your preferences (whenever feasible). Your medical team will consider your overall health and stamina, risk of side effects and if you want or need to continue working during treatment.

Surgery. Early-state or carcinoma in situ patients are good candidates for surgery. A colorectal surgeon or surgical oncologist will remove all abnormal cells and some healthy tissue surrounding the area (called a margin). You will be monitored and checked as a follow-up. Recurrent anal cancer may require a major surgery called abdominoperineal resection (known as APR surgery), the removal of the anus, rectum and lower colon resulting in the patient having a permanent colostomy. The surgeon will also remove adjacent lymph nodes.

Radiation. Recent studies have shown similar cure rates with radiation and chemotherapy instead of surgery. External-beam radiation is the treatment of choice for anal cancer. Treatment usually consists of radiation treatment on weekdays for 5 or 6 weeks — patients have weekend breaks from treatments.

Chemotherapy. Chemotherapy is very effective when combined with radiation. When combined with chemo, lower doses of radiation can be given. Fluorouracil (5-FU) or the oral equivalent, Xeloda, is combined with either mitomycin C or cisplatin. The chemotherapy is given on the same days as the radiation with breaks on the weekends.

Side effects include fatigue, skin irritation, upset stomach, anal irritation, loose bowel movements and discomfort during bowel movements. Most of these are temporary and resolve after treatment. Female patients who receive radiation may experience vaginal stenosis (narrowing and shortening of the vagina).

Can Anal Cancer Be Prevented?

Anal cancer can now be prevented by vaccination with the HPV vaccine Gardasil. Experts recommend that both boys and girls receive Gardasil between the ages of 11 and 13 before they become sexually active. HPV can cause cervical, vaginal, vulvar cancers, anal cancer, penile and head and neck cancer along with genital warts. Adults up to age 26 may also be vaccinated if their parents didn’t have them vaccinated when they were pre-teens.

Anal cytology is similar to a Pap smear and can detect abnormal cells in the anus before they turn into cancer or at the earliest stage of anal cancer when it is easiest to treat. Experts recommend that high-risk individuals be screened for anal cancer.

80 Percent Hpv Infection

Straight Talk about HPV

What is HPV? HPV is a family of over 150 viruses. They are the cause of genital warts and some cancers, including anal cancer.
There is no need for shame or embarrassment if you are diagnosed with anal cancer. Yet, many patients are embarrassed, just as women used to be embarrassed to tell people they had breast cancer and men were embarrassed by their prostate cancer diagnosis. Cancer strikes virtually every organ of our body.

HPV is a common virus, so common, in fact, that most men and women will contract HPV at some time in their life. HPV virus may not cause any symptoms. It can lay dormant for years so that you don’t even know when you contracted it.

According to the Cleveland Clinic, about 14 million people every year contract the HPV virus. About 79 million people in the U.S. currently have the HPV virus — most of them don’t know it. 80 percent of people in the U.S. will have the HPV virus at some time in their life. HPV is spread through close intimate contact. Yet, 10 percent of virginal girls test positive for the HPV virus.

Think about it — 80 percent of all people in the U.S. will have HPV at one time or another in their life. We don’t routinely screen for HPV. There is no treatment for it. There is only screening for the diseases that it causes. Take control of your health. Women should ask their OB/GYN about the combined PAP/HPV test. Currently, there is no HPV test for men.

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