Anal canal cancer

What are the symptoms that you need to look out for?

The symptoms of anal cancer mimic those of various other conditions like haemorrhoids, irritable bowel syndrome and other gastrointestinal diseases. The most common of these include:

• Passing thin stools
• Rectal bleeds
• Changes in bowel habits
• Excessive itching
• Anal discharge
• Feeling pain and pressure around the anus
• Formation of a lump or mass in the anal region

What causes anal canal cancer?

Anal cancer is a result of uncontrollable growth and accumulation of abnormal cells in the anus, eventually, result in the formation of a tumour. This is believed to be a result of undesired mutations in the DNA of the anal cells. As the cancer advances, it can enter the bloodline and metastasize to other parts of the body.

What are the various risk factors associated with anal canal cancer?

Various risk factors that increase your chances of developing anal canal cancer include:

• Age – The cancer is most likely to affect people above 50 years of age
• Not practising safe sex – Having many sexual partners and not practising safe sex puts you at a higher risk of developing anal cancer
• Anal sex – Practicing anal sex also puts you at an increased risk of anal cancer
• Smoking – The risks of anal cancer are higher in people who smoke excessively
• History of other cancer – People who have a history of cervical, vulvar or vaginal cancer, are at an elevated risk of anal cancer.
• Human papillomavirus (HPV) – Being infected with HPV has been associated with increased risks of certain cancers including HPV
• Immunosuppressants – This mostly includes people who have received an organ transplant.

Screening and diagnosis

Our doctor will evaluate the patient’s symptoms and medical history. They will also perform to diagnose cancer or to rule out other conditions. These tests will include:

• Digital rectal exam – This refers to the physical examination of the rectum by inserting lubricated fingers into it and feeling for any growth or mass
• Visual inspection – This is carried out with the help of an anoscope, which is a small, illuminated tube that is introduced via the anal canal
• Ultrasound – This involves the use of an ultrasound probe which is introduced into the patient’s body via the anus. Ultrasound uses soundwaves to generate images of the anal canal.
• Biopsy – It is done by examining a tissue sample collected from the anus of the patient. This helps to trace any malignancy and confirm the diagnosis

Treatment

Surgery - The aim of the surgery is to remove the tumour and the surrounding tissues that have been affected by it. In case the anal cancer is at an early stage, the tumour can be easily removed without inducing any damage to the sphincter muscles. In case of advanced anal cancer, the patient may need and abdominoperineal resection, or AP resection. This involves the surgical removal of the anal canal, the rectum and a portion of the colon.

Chemotherapy – It uses special drugs, that are given orally or intravenously, to target rapidly-growing cancerous cells. Chemotherapy may also be used in combination with radiation therapy to treat cancers that have not yet metastasized. This is referred to as chemoradiation.

Radiation therapy – It used x-ray beams of high intensity to target the cancerous cells. This may be given before the surgery, to reduce the size of the tumour, and after the surgery to destroy cancerous cells that were left behind during the surgery. These radiations may be given externally, using a special radiation machine, or from within, using certain radiation-emitting substances.

Immunotherapy – It involves the use of certain drugs that help to boost the body’s immune system and is usually recommended to patients with advanced anal canal cancer.