Anal cancer is a condition wherein malignant (cancer) cells develop in the anus tissues. Anal cancer is a rare kind of cancer. Anal cancer, like other cancers, is caused by a genetic mutation that causes normal, healthy cells to become aberrant.
Healthy cells proliferate and replicate at a predetermined rate before dying at a predetermined period. Abnormal cells reproduce and expand uncontrollably and do not perish. The aberrant cells that are collecting form a bulk (tumor). The problem with malignant cells is that they can infect surrounding tissues and spread outside of the original tumor (metastasize).
Feces (solid waste) leaves the body through the anus, which is located below the rectum at the end of the large intestine. The perianal region is the skin that surrounds the exterior of the anus. Tumor cells of the perianal skin that do not affect the anal sphincter are normally treated in the same way as anal malignancies, while some may benefit from local therapy (treatment focused on a small region of skin).
The rates for this uncommon cancer are alarming. According to the American Society of Clinical Oncology, 9,440 cases of anal cancer will be detected in 2022, with approximately 1,670 deaths due to anal cancer.
In the United States, however, 150,030 people are expected to be diagnosed with colorectal cancer in 2022, with 52,520 people expected to die from the condition in the same year.
Approximately half of all anal malignancies are detected before they spread beyond the main location, whereas 13 percent to 25% are detected after cancer cells spread to the lymph nodes, and 10% are detected after cancer has traveled to distant organs or metastasized.
Risk factors for anal cancer include the following:
1. Human papillomavirus (HPV) infection: Human papillomavirus (HPV) infection is linked to the majority of anal malignancies.
2. Having a reduced immune system due to a sickness or disease, such as the human immunodeficiency virus (HIV) or an organ transplant.
Taking anti-immunosuppressive medications. Those whose immune systems are suppressed by medications (immunosuppressive drugs). These drugs are used to combat transplant rejection in people who have had organ transplants or stem cell transplants. The medications are also used to treat the symptoms of autoimmune diseases. Immunosuppressants are potent medications that must be closely monitored to avoid complications such as anal cancer.
Biologics, Calcineurin inhibitors, Corticosteroids (prednisone), Inosine monophosphate dehydrogenase (IMDH) inhibitors, Janus kinase inhibitors, Mechanistic target of rapamycin (mTOR) inhibitors, and Monoclonal antibodies are all examples of immunosuppressive drugs.
3. Cigarette smoking.
4. Having had vulvar, vaginal, or cervical malignancies in the past.
5. Having a lot of sexual partners: People who have had a lot of sexual partners throughout their lives are more likely to get anal cancer.
6. Having anal intercourse that is responsive (anal sex).
7. Gender and age: The majority of cases of anal cancer occur in people over the age of 50. The majority of anal malignancies (80%) are found in adults over the age of 60. Anal cancer is more frequent in men before the age of 35. Anal cancer is slightly more frequent in women beyond the age of 50.
SIGNS AND SYMPTOMS OF ANAL CANCER
Note: Anal cancer or other illnesses can produce these and other signs and symptoms. A condition can only be diagnosed by a medical professional.
2. A lump in the area of the anus.
3. Excessive itching or discharge from the anus Many people mistake hemorrhoids for the source of their bleeding and irritation. An anal cancer diagnosis may be delayed as a result of this.
4. In the region around the anus, there is pain or pressure.
5. An alteration in bowel habits.
DIAGNOSIS
The following tests and methods are used to diagnose anal cancer:
2. Examine your anal canal and rectum visually. Your doctor may examine your anal canal and rectum with an anoscope, which is a short, illuminated tube.
3. Ultrasounding your anal canal to capture sound waves. Your doctor puts a probe into your anal canal and rectum, comparable to a thick thermometer, to take a picture of your anal canal. Ultrasound waves, which are high-energy sound waves, are emitted by the probe and start moving off tissues and organs throughout the body to generate an image. Your doctor examines the image for anything out of the ordinary.
4. Removing a specimen of tissue for examination in the lab. If your doctor notices anything out of the ordinary, he or she may collect small samples of the damaged tissue (biopsy) and send them to a lab for testing. Doctors can tell whether the cells are malignant by looking at them under a microscope.
If you’ve been diagnosed with anal cancer, your doctor may suggest additional testing to see if the cancer has spread to your lymph nodes or other parts of your body.
The following tests may be performed:
Computerized tomography (CT)
Magnetic resonance imaging (MRI)
Positron emission tomography (PET)
Your doctor will assign a stage to your cancer based on the results of the procedures. Anal cancer stages range from 0 to IV, with the minimum stages suggesting that the tumor is tiny and localized to the anus. The cancer has progressed to other parts of the body at stage IV.
As physicians improve cancer detection and therapy, the cancer staging system keeps evolving and becoming more complex. Your doctor will choose the treatments that are best for you based on your cancer stage.
TREATMENT
When detected early, anal cancer is frequently curable.
There are three forms of standard treatment:
2. Radiation treatment
3. Chemotherapy
Clinical trials are being used to explore new types of treatment.
5. Immunotherapy
The new treatments may become the standard treatment if they prove to be better over time.
The type of treatment you receive for anal cancer is determined by the size of the disease, where it has spread if it has, and your overall health.
Chemoradiation, a combination of irradiation and chemotherapy, is the most common treatment for anal cancer (or chemoradiotherapy).
Chemotherapy or radiotherapy on their own, as well as surgery, are some of the other options.
The specialist care team who will be looking for you will: describe the treatments, benefits, and side effects; collaborate with you to develop the optimal treatment plan for you; and assist you in managing any side effects, including any dietary modifications.
During and after any treatments, you’ll undergo regular check-ups. You may also be subjected to tests and scans.
Consult your specialists if you are concerned about any symptoms or adverse effects. You need not wait until your next appointment.
Consult your specialists if you are concerned about any symptoms or adverse effects. You need not wait until your next appointment.
Chemotherapy and radiotherapy
Chemotherapy and radiotherapy are frequently utilized in the treatment of anal cancer. Chemoradiation is a term used to describe this process. To kill cancer cells, radiotherapy uses high-energy radiation. Chemotherapy is a type of treatment that is used to kill cancerous cells. If the anal cancer has not spread, chemoradiation is frequently used. It indicates that the majority of persons with anal cancer don’t really require surgery.
Anal cancer is occasionally treated with surgery.
If the cancer is tiny and hasn’t spread, chemoradiation doesn’t work or the cancer returns, and you can’t have radiotherapy (for example, once you’ve had radiotherapy in the pelvic region before), you may undergo surgery.
Anal cancer surgery usually entails removing only the cancerous portion of the anus.
If the cancer has progressed or returned, surgery may be required to remove the entire anus, the rectum (which connects the anus and the colon), and a portion of the bowel.
This means you’ll require a pouch (stoma bag) to collect feces on the outside of your body. This is referred to as a colostomy. If you require a colostomy, you will be cared for by a colostomy nurse. They will be able to assist you.
The Surgical Procedures for Anal Cancer
- Local resection: A surgical operation in which the tumor and some healthy tissue around it are removed from the anus. If the malignancy is tiny and has not spread, local resection may be utilized. The sphincter muscles may be saved as a result of this treatment, allowing the patient to continue to control bowel motions. Local resection is frequently used to remove tumors that originate in the lower region of the anus.
- Abdominoperineal resection: A surgical technique that involves removing the anus, rectum, and a portion of the sigmoid colon through an incision in the belly. The end of the intestine is sewn to an opening on the surface of the abdomen called a stoma, which allows body waste to be removed in a disposable bag outside of the body. This is referred to as a colostomy. During this procedure, cancerous lymph nodes may also be removed. This method is only performed for cancer that persists or returns after radiation therapy and chemotherapy.
PREVENTION
There is no guaranteed way to prevent anal cancer, you can only reduce your risk of anal cancer:
- Use a safer method of sex. HPV and HIV, are sexually transmitted viruses that can increase your risk of anal cancer. Since they can be contrasted sexually, they can be prevented by practicing safe sex. Use condoms if you choose to have anal intercourse. Make sure you’re having safe sex. If you can’t abstain, limit the number of sexual partners you have and use protection. In your lifetime, the more sexual partners you have, the more likely you are to get a sexually transmitted infection like HIV or HPV. Patients with HIV or AIDS are more likely to develop cancers because the treatments affect their immune systems. HPV is most commonly linked to cervical cancer, but it may also raise the risk of anus, throat, penis, vulva, and vaginal cancers.
- Sharing needles is not a good idea.
- Vaccinate yourself against HPV. There is a vaccination available to guard against HPV infection. It’s intended for adolescents, both boys, and girls, but it can also be administered to adults. Human papillomavirus (HPV) is a virus that causes cancer in humans (HPV). HPV is a sexually transmitted virus that can cause several cancers— anal cancer inclusive. For girls and boys aged 11 and 12, the HPV vaccine is recommended.
- Quit smoking. Anal cancer is more likely to occur if you smoke. If you’re currently smoking, you should consider quitting it for your health. Exposure to secondhand smoke, even if you don’t use tobacco, may enhance your risk of cancer. Tobacco avoidance — or the decision to cease using it — is a critical component of cancer prevention. If you need assistance quitting cigarettes, talk to your doctor about medications to help you stop, and other methods.
- Eat a wide range of fruits and vegetables. The core of your diet should be vegetables, fruits, and other plant-based foods.
- Maintain a healthy body mass index (BMI). Choose less high-calorie foods, such as refined carbohydrates and animal fat, to lose weight and become leaner.
- Be moderate with alcohol. The quantity of alcohol you drink and the duration of time you’ve been drinking consistently your chance of several types of cancer, including cancers of the breast, lung, colon, kidney, and liver.
- Limit your intake of processed meats. According to a report from the World Health Organization’s International Agency for Research on Cancer, eating high amounts of processed beef can marginally enhance the risk of certain types of cancer.