Diagnosis & Treatment of Anal Cancer
Anal Cancer: Introduction
What is cancer?
Cancer is when cells in the body change and grow out of control. To help you understand what happens when you have cancer, let's look at how your body works normally. Your body is made up of tiny building blocks called cells. Normal cells grow when your body needs them, and die when your body does not need them any longer.
Cancer is made up of abnormal cells that grow even though your body doesn't need them. In most cancers, the abnormal cells grow to form a lump or mass called a tumor. If cancer cells are in the body long enough, they can grow into (invade) nearby areas. They can even spread to other parts of the body (metastasis).
What is anal cancer?
Anal cancer is cancer that starts in the cells of the anus. Different types of tumors can form in the anus. Some of these tumors are not cancer. These tumors can include:
- Benign or noncancerous anal tumors. Polyps are small growths that may be flat or bumpy. Or they may look like mushrooms. They are not cancer. There are different types of polyps depending on their location and their cause. Inflammatory polyps, lymphoid polyps, and skin tags (fibroepithelial polyps) are examples of noncancerous (benign) polyps. Other types of benign tumors include adnexal tumors, leiomyomas, and granular cell tumors. They also include hemangiomas, lipomas, and schwannomas. These are all rare.
- Anal warts (condylomas). These are noncancerous growths that may occur just outside the anus and in the lower anal canal. They are caused by infection with a human papilloma virus (HPV). People who have had anal warts are more likely to get anal cancer.
- Precancerous lesions. Many people who get the most common type of anal cancer (squamous cell carcinoma) first had some patches of irregular cells. Your healthcare provider may call these lesions anal intraepithelial neoplasia (AIN). Each year, a small percentage of people with AIN get invasive cancer.
- Malignant anal tumors. These are cancerous tumors. The most common type is squamous cell carcinoma. This type of anal cancer starts in the cells that line the anal margin and most of the anal canal. Cloacogenic carcinomas (or transitional cell carcinomas) are a type of squamous cell carcinoma. Adenocarcinomas are another type of anal tumor. They account for a small number of cases of anal cancer. Other types of malignant anal tumors are very rare.
Understanding the anus
The anus is the last part of the digestive or gastrointestinal tract. It’s at the end of the rectum. It's where stool comes out of the body. It consists of a muscular ring (sphincter) that opens during a bowel movement to allow stool (feces) to pass through. It’s also made of flat cells that form the lining of the inside of the anus. Most anal cancers start in these flat lining cells, which are also called squamous cells. The lower part of the anus, where it meets the skin, is called the anal margin.
Learn more about our Colon & Rectal Surgery Providers.
What are the symptoms of anal cancer?
Sometimes anal cancer does not cause any symptoms at all. Bleeding from your rectum is the most common symptom of anal cancer. Other symptoms can include:
- Pain or pressure in your anal area
- Itching around your anus
- Discharge from your anus
- Swollen lymph nodes in your anal or groin area
- A lump or swelling near your anus
- Narrower stools
- An increase or decrease in bowel movements
- Straining during a bowel movement
When to see your healthcare provider
Many of these symptoms may be caused by other health problems. But it is important to see your healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer. Learn more or schedule an appointment with one of our Colon & Rectal Surgery Providers.
How is anal cancer diagnosed?
If your healthcare provider thinks you might have anal cancer, you will need certain exams and tests to be sure. Diagnosing anal cancer starts with your healthcare provider asking you questions. He or she will ask you about your health history, your symptoms, risk factors, and family history of disease.
He or she will also do a physical exam. This includes a digital rectal exam (DRE). During a DRE, your healthcare provider puts a gloved, lubricated finger into your rectum. He or she checks for hard or lumpy areas.
What tests might I need?
During a biopsy, your healthcare provider takes a small sample of tissue from your anus. The tissue is sent to a laboratory and looked at under a microscope.
If your healthcare provider feels anything unusual or if you have symptoms, he or she may also do tests to check if you have anal cancer. You may need more than 1 of these tests:
- Anoscopy. For this test, your healthcare provider puts a small lighted tube (anoscope) into your anus to look at the lining. The tube is about 3 to 4 inches long. Your healthcare provider will lubricate it before inserting it.
- Proctoscopy. For this test, your healthcare provider uses a longer lighted instrument (proctoscope) to look at the inside of your anus and rectum. It’s about 10 inches long. Again, the tube is lubricated before it is inserted.
- Biopsy. If your healthcare provider sees anything suspicious, you may need a biopsy. During a biopsy, he or she takes a small sample of tissue from your anus. The tissue is sent to a laboratory. Then it’s looked at under a microscope by a doctor who specializes in diagnosing diseases by looking at body tissues and fluids (pathologist). A biopsy is the only way to know for sure whether a change seen in the anus is cancerous (malignant) or noncancerous (benign).
Getting your test results
When your healthcare provider has the results of your biopsy, he or she will contact you with the results. Your provider will talk with you about other tests you may need if anal cancer is found. Make sure you understand the results and what follow-up you need.
Anal Cancer: Treatment Options
You may have questions and concerns about your treatment options. You may also want to know how you’ll feel, how your body will function after treatment, and if you’ll have to change your normal activities.
Your cancer care provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how well they may work, and what the risks and side effects are. Your healthcare provider may suggest a specific treatment. Or he or she may offer more than one. Then you can decide which one you’d like to use.
It can be hard to make this decision. It’s important to take the time you need to make the best choice. Talk with your healthcare provider about how much time you can take to explore your options.
Types of treatment for anal cancer
The type of treatment that is best for you depends on a number of factors. These include the type of tumor, its size and location, and whether it has spread beyond your anus. Factors also include your age, overall health, and what side effects you can stand.
Different types of treatment have different goals. Below is a list of anal cancer treatments and their goals. You may have more than 1 of these treatments:
- Radiation therapy. The goal of this treatment is to kill cancer cells using X-rays. This is a common treatment for anal cancer. Radiation can be used with or without chemotherapy (chemo).
- Chemotherapy. Chemo uses medicines to kill cancer cells. It can cause the tumor to shrink. Chemo combined with radiation therapy is used to treat, and even cure, most anal cancers without the need for surgery.
- Surgery. The goal of surgery is to remove the tumor from your anus, while leaving as much of the anus as possible intact. In most cases, surgery for anal cancer is not needed.
Second opinion before deciding on a treatment plan
If you or a family member has been diagnosed with anal cancer, you may want to consider getting a second opinion. Some insurance companies require a second opinion. The peace of mind a second opinion provides may be well worth the effort.
Clinical trials
Research is ongoing in the field of anal cancer. New medicines and treatments are tested in clinical trials. Before starting treatment, ask your healthcare provider if there are any clinical trials you should check on.
Working with your healthcare provider
Your healthcare provider will help you make a treatment plan. Talking about your treatment choices will be one of the most important meetings you'll have with your healthcare provider. Ask any questions you might have and be sure you understand the answers. You may want to include a family member or friend in these discussions.
How might surgery be used to treat anal cancer?
Surgery is not a common treatment for anal cancer. This is because chemotherapy and radiation are very effective in treating the cancer. The combination also has fewer side effects.
If you need surgery, the type of surgery depends on the type and location of the tumor. There are two types of surgery used to treat anal cancer.
Local resection
If the cancer is small and has not spread, your surgeon may do a local resection. For this, the surgeon removes the tumor along with some surrounding healthy tissue. Usually, with this type of surgery, the sphincter muscle is not damaged. This means that you’ll still be able to pass stool in the normal way.
Abdominoperineal resection
You may need this surgery if the cancer doesn’t respond to the chemotherapy and radiation. Or you may need it if it keeps coming back after treatment. For this type of surgery, the surgeon removes your anus and your rectum. This means you’ll no longer be able to pass stool in the same way. The surgeon makes a permanent opening in your abdomen. This is called a colostomy. A plastic bag is attached to the skin around the colostomy to collect the stool as it passes through the opening in your abdomen.
Risks of anal cancer surgery
All surgery comes with risks. The risks of anal cancer surgery include:
- Heavy bleeding
- Infection
- Damage to internal organs
- Blood clots
- Bulging of organs under the incision on your abdomen (hernia)
- Erection and orgasm problems in men. This is due to nerve damage.
- Scar tissue build up in your abdomen. This can lead to digestive problems.
Your risks depend on your overall health, what type of surgery you need, and other factors. Talk with your healthcare provider about which risks apply most to you. Keep in mind, though, that healthcare providers can only give you their best estimates. No one can guarantee that you will not have side effects.
Getting ready for your surgery
Your surgeon will talk with you about the surgery option that’s best for you. After you have talked about all the details of the surgery, you’ll sign a consent form. This gives the surgeon permission to perform the surgery. You may want to bring a family member or close friend with you to this appointment. Write down questions you want to ask about your surgery. Make sure to ask about:
- Insurance coverage and how much you might have to pay
- What tests need to be done before surgery
- What type of surgery you’ll have
- What will be done during surgery
- The risks and side effects of the surgery
- Whether you’ll have a colostomy after surgery
- When you can return to your normal activities
You’ll also talk with an anesthesiologist. This is the doctor who will give you the general anesthesia. This is the medicine that prevents pain and makes you sleep during surgery. He or she also monitors you during surgery to keep you safe. He or she will ask about your medical history and the other medicines you take.
Before surgery, tell your healthcare team if you’re taking any medicines. This includes over-the-counter medicines, vitamins, and other supplements. This is to make sure you’re not taking medicines that could affect the surgery.
What to expect during surgery
On the day of surgery, your healthcare team will take you into the operating room. Your healthcare team will include the anesthesiologist, the surgeon, and nurses.
During a typical surgery:
- You’ll be moved onto the operating table.
- You may need to wear special stockings on your legs. These are to help prevent blood clots.
- You’ll have electrocardiogram (EKG) electrodes put on your chest. These are to keep track of your heart rate. You’ll also have a blood pressure cuff on your arm.
- You’ll receive anesthesia through an intravenous (IV) tube in your hand or arm.
- When you’re asleep, your surgeon will do the surgery.
- A soft, flexible tube (urinary catheter) will be put into your bladder during surgery. It may be kept in place for a few days.
After your surgery
You’ll wake up in a recovery room. Your healthcare team will watch you closely. You’ll receive pain medicine. Depending on the type of surgery, you might need to stay in the hospital for one or more nights.
For the first few days after surgery, you’re likely to have pain. Your pain can be controlled with medicine. Talk with your healthcare provider or nurse about your options for pain relief. Some people don’t want to take pain medicine, but doing so can help your healing. If you don’t control pain well, for instance, you may not want to cough or turn over often. You need to do this as you heal from surgery.
You may have a urinary catheter for a few days. This a tube put through your urethra and into your bladder so that your urine goes into a bag outside your body.
You may have bowel problems. Talk with your healthcare provider, nurse, or a dietitian about what you can do to help reduce the chance of this.
You may feel tired or weak for a while. The amount of time it takes to heal from surgery is different for each person.
If you get a colostomy, you’ll need supplies to care for it. You’ll learn how to manage the colostomy before you go home.
Recovering at home
When you get home, you may get back to light activity. But you should avoid heavy activity for about 6 weeks. Your healthcare team will tell you what kinds of activities are safe for you while you recover.
Follow-up care
You may need radiation treatment or chemotherapy after surgery. Your healthcare provider will talk with you about this type of treatment and what you'll need to do.
When to call your healthcare provider
Let your healthcare provider know right away if you have any of these problems after surgery:
- Bleeding
- Redness, swelling, or fluid leaking from your incision
- Fever
- Chills
Anal Cancer: Frequently Asked Questions
These are answers to some frequently asked questions about anal cancer:
What is anal cancer?
Anal cancer is cancer that starts in the anus. The anus is at the end of the rectum. Through it, bowel movements leave your body. Different types of tumors can form in the anus. Some of these tumors are not cancer. These are known as benign tumors. Some are cancer. These are called malignant tumors.
Who gets anal cancer?
Anal cancer is a rare cancer. Most people who get it are between ages 50 and 80. Slightly more women than men get anal cancer. But the rate is increasing in men, especially in those who have anal sex.
Who is at risk for anal cancer?
Certain things can make one person more likely to get anal cancer than another person. These are called risk factors. Here are some things that may increase your risk for anal cancer:
- Human papillomavirus (HPV) infection or genital warts
- Multiple sex partners
- Anal intercourse, especially if it’s unprotected
- A weakened immune system
- Smoking
- Older age
- Repeated inflammation in the anal region
What are the symptoms of anal cancer?
These are the most common symptoms of anal cancer:
- Bleeding from the rectum
- Pain or pressure in the anal area
- Discharge from the anus
- A lump from swollen lymph nodes in the anal or groin area
- Itching around the anus
- Change in bowel movements
Although these are symptoms of anal cancer, they may also be caused by other, less serious health issues. If you have these symptoms, talk with your healthcare provider.
How is anal cancer diagnosed?
Your healthcare provider asks questions about your health history and family history. He or she will also do a physical exam to check for signs of the cancer. He or she may also order these tests:
- Anoscopy or proctoscopy. These tests use a small instrument or tube to look at your anus.
- Biopsy
How is anal cancer treated?
Anal cancer may be treated using radiation, chemotherapy (chemo), or surgery. The goal of radiation is to kill cancer cells by using X-rays. This is a common treatment for anal cancer. It can be used with or without chemo. Chemo is the use of medicines to shrink the tumor. In anal cancer, chemo combined with radiation can often cure the cancer without the need for surgery. The goal of surgery for anal cancer is to remove the tumor from the anus, while leaving as much of the anus as possible intact.
Healthcare providers are always finding new ways to treat anal cancer. These new methods are tested in clinical trials. Before starting treatment, you should ask your healthcare provider if there are any clinical trials to check on.
What's new in anal cancer research?
Cancer research should give you hope. Researchers around the world are learning more about what causes anal cancer and are looking for ways to prevent and treat it.
A vaccine for HPV is now available. It was developed to help prevent cervical cancer, but it may be able to prevent anal cancer as well. New medicine treatments for people with HIV will help delay a weakened immune system for several years. Experts are also studying new ways to test for anal cancer in its early stages before it has spread.
Researchers are also studying new treatments for anal cancer. Radiosensitizing agents may make radiation work better. They are being studied with chemo and radiation in clinical trials.
What should I know about clinical trials for anal cancer?
Clinical trials test new kinds of cancer treatments. You may also hear them called clinical studies. Healthcare providers use clinical trials to learn how well new treatments work and what their side effects are. Promising treatments are ones that work better or have fewer side effects than the current ones. People who join these trials get to use treatments before the FDA approves them for the public. People who join trials also help researchers learn more about cancer and help future people with cancer.