Anal cancer (patient information)

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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor-In-Chief: Jinhui Wu, M.D.

Overview
Anal cancer is a digestive tract cancer. It is found in or on the anus. The anus is part of the gastrointestinal tract where stools leave your body. It is made up of different types of cells, and each type can become cancerous. Squamous cell carcinoma is the most common type of anal cancer. Symptoms include bleeding, pain, lumps, anus itching and discharge in the anal area. The options are surgery, radiation therapy, chemotherapy, or a combination of methods. Your treatment will depend whether the tumor has spread, and on the stage, size and location of the tumor.

What are the symptoms of Anal cancer?
Early anal cancer does not make any symptoms. When the cancer grows larger, People with anal cancer may experience the following symptoms. Hemorrhoids or other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that problems can be diagnosed and treated as early as possible.


 * Bleeding from the anal area
 * A change in bowel habits or change in the diameter of the stool
 * Pain in the anal area or inferior belly
 * Itching or discharge from the anus
 * A lump or swelling near the anus

Who is at highest risk?
Studies have found a number of factors that may increase the risk of anal cancer. In recent years, scientists point out that human papillomavirus (HPV) infection is the main cause of anal cancer. HPV infection and other risk factors may act together to increase the risk even more.


 * Human papillomavirus (HPV): Around the anus skin, some strains of HPV can cause venereal warts which is associated with anal cancer. HPV is often spread through sexual contact, particularly anal intercourse. People with many sex partners have an increased risk of contracting HPV.
 * Multiple sexual partners
 * Anal sex
 * Anal fistulas: presence of abnormal openings along the anal canal
 * Weakened Immune System：Infection with HIV (the virus that causes AIDS) or taking drugs that suppress the immune system increases the risk of anal cancer.
 * Gender: Clinical data show women have a higher risk than men.
 * Age: Like other digestive tract tumors, people occur in the age of 50 years or older.
 * Cigarette smoking：Like some cancer, smoking also increases the risk of anal cancer.

When to seek urgent medical care?
Call your health care provider if symptoms of anal cancer develop. If one emerges the following symptoms, seeking urgent medical care as soon as possible:


 * Severe abdominal pain, severe abdominal distension, and stopping defecation: The reason of a person with anal cancer appears these symptoms is mostly because of intestinal obstruction caused by lumps. This is the results of lumps growth on rectum wall. A surgery will be done urgently.
 * Defecation with a lot of blood: This is the result of cancer invading the vessels of rectum or anus walls. An abundant of blood loss may lead to shock and death. You need to go to hospital as soon as possible.

Diagnosis
Like other cancer diseases, doctors need to use many tests to diagnose cancer and determine whether it has metastasized. For most types of cancer, a biopsy is the best way to make a definitive diagnosis of cancer. If a biopsy is not possible, other image tests are recommended such as computed tomography (CT) scan, Magnetic resonance imaging (MRI) or Positron emission tomography (PET) scan.


 * Digital rectal examination (DRE): This is the most important and basic examination for anal cancer. In this test, the doctor inserts a gloved finger into the anus to feel for lumps, bleeding or abnormalities. This test is strongly suggested by general cancer guidelines for men annually after the age of 50 and women have one during routine pelvic examinations.
 * Anoscopy, proctoscopy and biopsy: After digital rectal examination (DRE), if the doctor feels a suspicious area, an anoscopy may be performed. The doctor may insert a thin, lighted and flexible tube into your anus to see the abnormality. If needed, proctoscopy, which is similar with the anoscopy can be used to view the rectum. If abnormal areas are noted, biopsies (tissue samples) can be obtained through the endoscope. The tissue samples will be checked by the doctors of pathology department under a microscope to see whether cancer is present or not. The test lasts about 20 to 30 minutes.
 * Computed tomography (CT) scan: This computer scan can combine a three-dimensional images into a detailed, cross-sectional view which shows any abnormalities or tumors. Usually, a contrast medium is injected into a patient’s vein to provide clearer detail.
 * Magnetic resonance imaging (MRI): An MRI uses magnetic fields but which is a different imaging type from computed tomography (CT) to produce detailed images of the body. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture.
 * Positron emission tomography (PET) scan: When doing this test, a small amount of a radioactive medium is injected into your body and absorbed by the organs or tissues. This radioactive substance gives off energy to accept to produce the images.
 * Complete blood test: In this test, a patient with stomach cancer can be detected anemia.
 * Stool test: This test is to detect whether blood is in your digestive track. You can collect stool samples in your home. You can catch the stool on plastic wrap and held in place by the toilet seat. Then put the sample in a clean container. There can be false-positive and false-negative results. Using the right collection technique, avoiding certain drugs, and observing food restrictions can reduce errors.

Treatment options
Patients with anal cancer have many treatment options. The options are surgery, radiation therapy, chemotherapy, or a combination of methods. The type of treatment your cancer depends on the type of cancer and how far it has spread.
 * Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.
 * Patients with anal carcinoma in situ or early stage cancer can often be treated by surgery.
 * For patients with later stages of cancer, they should be treated by effective chemotherapy and radiation therapy alone or following with surgery.
 * If a patient cannot have chemotherapy or radiation therapy, surgery may be suggested. Surgery may also be recommended if the cancer remains after initial treatment or returns after treatment has been completed.

Diseases with similar symptoms
Symptoms of anal and abdominal have no specificity. Other health problems may also cause similar symptoms. Go to see your doctor to verify your diseases as early as possible. Diseases with similar symptoms are listed in the following:
 * Hemorrhoids
 * Anal fistula
 * Anusitis or proctitis
 * Perianal abscess

Where to find medical care for Anal cancer?
Directions to Hospitals Treating anal cancer

Prevention
Since the cause of anal cancer is unknown and some people with anal cancer have no known risk factors, there is no sure way to prevent the cancer. Epidemiology data show the following intervention may help to reduce your risk of anal cancer
 * Avoidance infection of HPV, particularly preventing having multiple partners and having unprotected anal sex
 * HPV Vaccine
 * Give up smoking

What to expect (Outlook/Prognosis)?
The prognosis of anal cancer varies widely. It depends on the following:
 * The size of the tumor
 * Location of the tumor in the anus
 * Whether the cancer has distant spread
 * Whether the patient has Human Immunodeficiency Virus (HIV)
 * Whether cancer remains after initial treatment or has recurred