6 early warning signs of Anal Cancer everyone is too embarrassed to talk about
Anal cancer is a cancer (malignant tumor) which arises from the anus, the distal opening of the gastrointestinal tract. It is a distinct entity from the more common colorectal cancer.
From data collected 2004-2010, the relative five year survival rate in the United States is 65.5%, though individual rates may vary depending upon the stage of cancer at diagnosis and the response to treatment.
Although it’s not as common as colorectal rectal or colon cancer, anal cancer has been on the increase, probably because early diagnosis is very rare.
This emphasizes the importance of early detection; however, it’s quite difficult since a lot of the symptoms tend to appear in the later stages of the disease. The most common ones are:
Pain or a feeling of fullness in the anal
Irregular bowel movements
Swollen lymph nodes in the anal or groin
Sexual activity: Having multiple sex partners due to the increased risk of exposure to HPV. Receptive anal intercourse, whether male or female, increases the chances of anal cancer sevenfold due to HPV. Those who engage in anal intercourse with multiple partners are 17 times more likely to develop anal cancer than those who do not.
Smoking: Current smokers are several times more likely to develop anal cancer compared with nonsmokers. Epidemiologist Janet Daling, Ph.D., a member of Fred Hutchinson’s Public Health Sciences Division, and her team found that smoking appears to play a significant role in anal-cancer development that is independent of other behavioral risk factors, such as sexual activity. More than half of the anal-cancer patients studied were current smokers at the time of diagnosis, as compared to a smoking rate of about 23 percent among the controls. “Current smoking is a very important promoter of the disease,” said Daling. “There’s a fourfold increase in risk if you’re a current smoker, regardless of whether you’re male or female.” They explained that the mechanism behind smoking and anal-cancer development is unknown, but researchers speculate that smoking interferes with a process called apoptosis, or programmed cell death, which helps rid the body of abnormal cells that could turn cancerous. Another possibility is that smoking suppresses the immune system, which can decrease the body’s ability to clear persistent infection or abnormal cells.
Immunosuppression, which is often associated with HIV infection.
Benign anal lesions.
A history of cervical, vaginal or vulval cancers
Cloacogenic. Cloacogenic carcinoma is a rare tumor of the anorectal region originating from a persistent remnant of the cloacal membrane of the embryo.
The tumor accounts for 2-3% of anorectal carcinomas and occurs more than twice as often in women.
Since many, if not most, anal cancers derive from HPV infections, and since the HPV vaccine before exposure to HPV prevents
infection by some strains of the virus and has been shown to reduce the incidence of potentially precancerous lesions, scientists surmise that HPV vaccination may reduce the incidence of anal cancer.
On 22 December 2010, the U.S. Food and Drug Administration approved Gardasil vaccine to prevent anal cancer and pre-cancerous lesions
in males and females aged 9 to 26 years. The vaccine has been used before to help prevent cervical, vulvar, and vaginal cancer, and associated lesions caused by HPV types 6, 11, 16, and 18 in women.
Anal Pap smears similar to those used in cervical cancer screening have been studied for early detection of anal cancer in high-risk individuals.
In 2011, the HIV clinic at Jackson Memorial Hospital implemented a program to enhance access to anal cancer screening for HIV-positive men. Nurse practitioners perform anal Papanicolaou screening, and men with abnormal results receive further evaluation with high-resolution anoscopy. The program has helped identify many precancerous growths, allowing them to be safely removed.
Localised disease (carcinoma-in-situ) and the precursor condition, anal intraepithelial neoplasia (anal dysplasia or AIN) can be ablated with minimally invasive methods such as Infrared Photocoagulation.
Previously, anal cancer was treated with surgery, and in early stage disease (i.e., localised cancer of the anus without metastasis to the inguinal lymph nodes), surgery is often curative. The difficulty with surgery has been the necessity of removing the internal and external anal sphincter, with concomitant fecal incontinence. For this reason, many patients with anal cancer have required permanent colostomies.
Metastatic or recurrent disease
10 to 20% of patients treated for anal cancer will develop distant metastatic disease following treatment. Metastatic or recurrent anal cancer is difficult to treat, and usually requires chemotherapy. Radiation is also employed to palliate specific locations of disease that may be causing symptoms. Chemotherapy commonly used is similar to other squamous cell epithelial neoplasms, such as platinum analogues, anthracyclines such as doxorubicin, and antimetabolites such as 5-FU and capecitabine. J.D. Hainsworth developed a protocol that includes Taxol and Carboplatinum along with 5-FU. Median survival rates for patients with distant metastases ranges from 8 to 34 months.