Anal Cancer: Identifying Symptoms, Understanding Causes, and Prognosis

Anal cancer is a type of cancer that affects the anus, the opening at the end of the large intestine, also known as the perianal region. Though it is rarer than more common cancers, awareness of the signs and symptoms of anal cancer is essential, as early recognition and treatment can improve prognosis. Furthermore, early diagnosis allows for effective management of anal cancer. Knowing the risk factors, complications, and treatment of anal cancer helps individuals take useful measures in safeguarding their well-being.

What is Anal Cancer?

Anal cancer, also known as carcinoma of the anal canal, is a relatively rare type of cancer that develops in the anus or the lining of the anal canal, which extends from the anus into the rectum. Most of the anal cancers are due to human papillomavirus (HPV) infection. Anal cancer symptoms include bleeding from the anus or rectum or even a lump near the anus. The main mechanisms for developing anal cancer are alterations and genetic mutations of cells in the anus, mainly abnormal growths and proliferations. The factors responsible for having anal cancer are genetics, aging, and health history, which may predispose someone to contracting this disease.

Anal cancers, which are rare but difficult to treat, often spread to the liver and lungs, making them a significant health concern in some cases.

Anal cancer is less prevalent in India than in Western countries, but its incidence is increasing due to increasing risk factors like HPV infections and HIV. It’s crucial to be aware of anal cancer signs and symptoms and seek medical attention if any changes occur. Mainly in the past, most patients who suffered from anal cancer received surgical operations aimed at eliminating the cancer. Today, most anal cancer treatment involves chemotherapy and radiation therapy. With this approach, surgery might not be needed.

Anal Cancer Types

Two different histological types of anal cancer exist: squamous cell carcinoma and adenocarcinoma.

• Squamous cell carcinoma : This is the most prevalent form, making up around 80% of cases. This arises from squamous cells that line the anal canal.
• Adenocarcinoma : This type arises from glandular epithelial cells in the lining of the anus.

Anal Cancer Symptoms

The signs and symptoms of anal cancer include:

• Internal or external anal or rectal bleeding
• Presence of mass lumps around the anal region
• Discomfort or distension in the anus or its surroundings
• Anal pruritus and secretions
• An alteration in routine bowel movement patterns
• Urge incontinence (tenesmus)
• Hemorrhage of the feces
• Enlarged lymph nodes in the anal or inguinal region

Anal Cancer Causes

Most of the individuals will have a doubt about what causes anal cancer. The exact cause for anal cancer is unknown, but risk factors like human papillomavirus (HPV) are associated with most cases, although most HPV-positive individuals don’t develop the disease. The following are some of the most common causes of anal cancer:

• Immunosuppression : Both HIV infection and indiscriminate, unprotected anal sex can predispose one to anal malignancy.
• Multiple sex partners : Sexual engagement with multiple partners for any type of sex puts individuals at risk of HPV and anal malignancy.
• Lack of vaccination : Certain strains of HPV are known causative agents for anal cancers.
• Age : 55 years and above; this is the age of most patients diagnosed with this cancer by the medical practitioners.
• Smoking : Drug users such as smokers have a higher risk of developing cancer.
• Condition or treatment : The bodies of people who have undergone organ transplants and take immunosuppression treatment are at higher risk of anal cancer.
• Anal/peritoneal fistula : The presence of a pathological connection between the anal canal and perianal skin.
• History of other cancers : Patients with vulva, vagina, or cervical cancer are at increased risk of developing the disease.

Anal Cancer Stages

The stage defines how much cancer has occurred in the body, whether or not it has enlarged, whether or not it has spread, and how much the reach has been from the first point where the cancer initially started. Knowing the stage is therefore pretty necessary for proper planning of treatment with regard to anal cancer.

There are several staging systems that describe the extent of the cancer. The TNM staging system is generally used for anal cancer staging. The pathology report may include a description of the cancer by this staging system. Anal cancer staging, by the TNM results, falls into the following stages:

Anal Cancer Complications

Anal cancer, if left untreated, can spread to nearby tissues but rarely to the lungs or liver. It is difficult to treat if it spreads to the liver and lungs. If left untreated or ineffective, it can lead to complications like severe pain, bleeding, incontinence, and sexual dysfunction, especially in men. Common complications include lymph node, liver, lung, or bone spread (metastasis).

Anal Cancer Diagnosis

Most of the anal cancers are diagnosed at an early stage due to the anatomical location being more accessible to the doctor’s observation. This evaluation is often made in patients with the above symptoms while performing an anal examination. Anal cancer may also be noticed as an unexpected finding when a patient undergoes a routine yearly check-up that involves a digital examination of the rectum. The rectal examination is carried out in order to evaluate the rectum, prostate, and several other pelvic organs. For example, anal cancers may be diagnosed if the patient undergoes a routine colon cancer screening such as a colonoscopy. The following diagnostic measures apply for diagnosis of anal cancer:

• Digital rectal examination : The doctor will insert a gloved finger into the anal canal and rectal cavity to palpate for any lumps or lesions.
• Anal ultrasound : A narrow, lighted instrument (anoscope) allows visualization of suspicious lesions.
• Biopsy : This involves the collection of tissue samples for an accurate diagnosis.
• Imaging tests : Anal ultrasound, MRI, and other cancer-staging imaging studies.

Anal Cancer Treatment

The treatment of anal cancers differs depending on tumor size, grade, spread of the disease, age, and overall physical condition of the patient, with the higher-grade cancers being more aggressive and those with spread being more prone. Anal cancer in most cases can be cured almost 100% if diagnosed and treated at an early stage. There are three basic types of treatment:

• Surgery: An operation to remove the tumor.
• Radiation therapy: This includes high-level X-ray rays that destroy the nucleus of cancerous tissues.
• Chemotherapy: These are the agents that destroy cancerous tissues.

New treatments, such as radiosensitizers and immunotherapy, are being tested in clinical trials. The treatment regime that includes the use of chemotherapeutic agents combined with radiology is referred to as the gold standard approach for management of most anal cancers. Unfortunately, some tumors, which are very small or in their early stages, may be removed surgically without radiotherapy or chemotherapy. If the disease is already at an advanced stage, the patient may need to undergo radical surgery to remove the lesions.

Anal Cancer Prognosis

The majority of anal cancers are treatable with a mixed approach. If diagnosed at an early stage, a number of malignancies that recur following non-surgical methods can be successfully addressed through surgery. Although combined radiation and chemotherapy have a greater incidence of adverse reactions, this method improves the chances of surviving the best. After the treatment has been completed, 70–90% of the patients are alive and free from the disease at 5 years from the date.

Regular follow-up with the surgeon for a fresh examination is essential. At the visit, this medical professional will evaluate the effectiveness of previous treatments and investigate for any recurrence of anal cancer. In some cases, there may be a need for further evaluation.

When to Seek help from a Doctor

One should consult a doctor if they have any of the following symptoms:

• Changes in bowel habits, such as diarrhea, constipation, or even bleeding
• Pain or discomfort in the anal region
• Presence of a mass or lump in the anal region
• Blood in the stool and more

For anyone having unexplained weight loss, visit a doctor. Early diagnosis and treatment can significantly make a difference. For any of these concerns, it is not too late to seek medical advice.

Conclusion

Knowledge of both the risk factors and symptoms can make the individual prepare adequately to protect health. An individual should thus seek a health care professional’s assessment for any anal area change because early detection and treatment improve outcomes and considerably reduce the impact of anal cancer.

Yashoda Hospitals in Hyderabad provides well-rounded treatment for anal cancer. Highly experienced oncologists and surgeons understand the latest available technology and therapy options that help treat the condition quite well. We have individualized care and support for patients along their treatment journey. If one is experiencing symptoms of anal cancer, don’t hesitate to reach out for consultation.

Have any questions or concerns about your health? We’re here to help! Call us at +918929967127 for expert advice and support.