Anal cancer is a condition where malignant cells form in the tissues of the anus. In India over many people are diagnosed with this disease each year. It is often linked to higher rates of the Human Papillomavirus (HPV), a key risk factor, and tends to affect women more than men. When detected in its early stages, anal cancer can be treated successfully.
The anus, approximately 1-1/2 inches long, connects the rectum (the lower part of the large intestine) to the outside of the body. It enables solid waste (stool or faeces) to pass from the body. The sphincter, composed of two muscles, controls the opening and closing of the anus. The anal lining consists of squamous cells, which are also found in the bladder, cervix, vagina, and urethra.
Several types of tumours can be found in the anus. These may be malignant (cancer), benign (not cancer), or precancerous (with the potential to develop into cancer). The main types of anal cancer include:
This refers to early cancer or precancerous cells confined to the surface cells of the anal canal. It is also known as Bowen's disease.
This forms in the squamous cells that line the anus and is the most common type of anal cancer.
These develop in the glands located around the anus.
These, including basal cell and melanoma, are sometimes discovered in advanced stages when they occur in the anal area.
A risk factor is anything that increases your likelihood of developing anal cancer. These factors include:
Squamous cell carcinoma of the anus is most frequently found in people over the age of 50.
Human Papillomavirus (HPV) infection.
Human Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS).
Having multiple sexual partners (more than 10).
Anal intercourse.
Frequent anal redness, swelling, and soreness.
Tobacco use.
Including taking immune-suppressing medication after an organ transplant.
Important Note: Having risk factors does not guarantee that you will develop anal cancer. It is advisable to discuss any personal risk factors with your doctor.
Making certain lifestyle choices can help to prevent anal cancer, with avoiding HPV infection being one of the most important measures. Ways to lower your risk of contracting HPV include:
Anal cancer often presents with no symptoms. When symptoms do occur, they vary among individuals but may include:
Important Note: These symptoms can also indicate other health issues. It is important to consult your doctor about any symptoms that persist for more than two weeks.
If you present with symptoms that could suggest anal cancer, your doctor will perform an examination and ask you about your health, lifestyle (including smoking and drinking habits), and family history. Since many anal cancer cases are linked to HPV infection, your doctor may ask about your exposure to HPV or if you have received the HPV vaccination. Knowledge of your risk factors is essential for your doctor when screening for cancer.
Your doctor will typically perform one or more of the following tests to determine if you have anal cancer:
The doctor inserts a gloved, lubricated finger into your anus to feel for any abnormalities.
A short tube with a camera is inserted into the anal canal and lower rectum, allowing the doctor to visually examine the anus for any abnormalities. A small tissue sample (biopsy) may also be taken for further testing.
A hollow tube, called a proctoscope (which is generally longer than an anoscope), is inserted into your anal canal and rectum. It is fitted with a light and camera for visual examination. The proctoscope can also be used to collect tissue for a biopsy.
A long, flexible tube, called a colonoscope, is inserted into the rectum. This device, equipped with a light and camera, allows the doctor to examine any part of your colon (large intestine) and can be used to take a biopsy.
If abnormalities are found, a small sample of tissue is removed for laboratory testing. Examination under a microscope can confirm the presence of cancer cells. Biopsies are usually collected using devices like an anoscope, proctoscope, or colonoscope. In some cases, a biopsy may show abnormal, but non-cancerous cells, a condition called anal intraepithelial neoplasia. These cells line the anus and, while not cancer, are monitored regularly as they may develop into cancer in the future.
Barium, a chemical, is administered via an enema to help the bowel lining show up on an X-ray. X-rays are then taken.
An endoscope is inserted into the anus. A probe on the end uses high-energy sound waves (ultrasound) to create an image (sonogram) of the organs, which helps the doctor view abnormalities of the anus and rectum.
This uses a CT scanner to create a 3D image of your abdominal organs, allowing the doctor to view the inside of your large intestine and rectum without inserting a colonoscope.
Important Note: Preparation for these tests may be required, such as dietary changes or the use of a laxative or enema. Your doctor will advise on the best test for you and how to prepare.
If anal cancer is diagnosed, additional tests may be necessary to determine if the cancer has spread (metastasised) from its original site to other parts of the body. Anal cancer can spread to nearby lymph nodes, blood vessels, or surrounding healthy tissue. The extent of the spread influences the appropriate treatment options.
Tests to determine the spread of cancer include:
This scanner creates detailed, cross-sectional images of various body parts, which your doctor examines for cancer spread to lymph nodes or other organs.
This uses strong magnets and radio waves to generate detailed body images. It helps the doctor check for swollen lymph nodes, which could indicate cancer spread.
This test helps locate cancerous tumour cells. A safe form of radioactive sugar is injected; rapidly growing malignant cells absorb more of this sugar. The PET scan then images where the radioactive glucose is being used, with bright spots indicating areas of high sugar uptake, potentially pointing to malignant tumours. The PET machine can often also perform a more detailed CT scan, and comparing the results of both scans provides a clearer picture.
A standard X-Ray of your chest may be performed to check the organs and bones. Cancer that has spread to the lungs would be visible on the X-Ray.
This exam checks for cancer spread to the vagina, cervix, uterus, or ovaries. A speculum (a small metal tool) is typically used for visual inspection, and a Pap smear (a procedure to test for cancer cells in the cervix and upper vagina) may also be performed.
A fine needle is inserted into a lymph node, and cells are removed and examined under a microscope. A positive lymph node biopsy confirms the cancer has spread to the lymph nodes, which can guide the planning of radiation therapy.
At SSCHRC, every effort is made to preserve the sphincter and maintain control of bowel movements, thereby decreasing the risk of needing a colostomy. Should a colostomy be necessary, highly qualified nurses provide support for the transition to help maintain your quality of life. For anal cancer that has spread, and/or in patients with HIV or AIDS, SSCHRC offers the most advanced treatments and access to clinical trials for novel agents.
Anal cancer can often be treated successfully with a combination of chemotherapy and radiation therapy. If the cancer has spread (metastasised), a combination of therapies, including surgery and participation in a clinical trial, may be suggested.
Your care team will discuss the best treatment options with you, considering several factors:
Treatment for anal cancer will be customised to your specific needs. Treatments may be used to fight the cancer or to help relieve symptoms, and can include:
Anal cancer surgery is most successful when performed by a specialist with extensive experience in the procedure. Surgeons at SSCHRC perform a large number of anal cancer surgeries each year, employing the most advanced techniques.
Surgical procedures for anal cancer may include:
The tumour, along with some surrounding tissue, is surgically removed.
The anus, the rectum, and part of the colon are removed through an incision in the abdomen. The end of the intestine is attached to an opening (stoma) in the abdomen, and body waste is collected outside the body in a plastic bag (a colostomy).
SSCHRC provides the most up-to-date and effective chemotherapy options for treating anal cancer.
New radiation therapy techniques allow SSCHRC doctors to target anal cancer tumours more precisely, delivering the maximum amount of radiation with minimal damage to healthy cells. Some anal cancers can be treated with intensity modulated radiation therapy (IMRT), which precisely targets the cancer and causes less damage to healthy tissue.
SSCHRC is at the forefront of cancer treatment, developing innovative targeted therapies. These agents are specifically designed to treat a cancer's unique genetic/molecular profile to help the body fight the disease. Many of the doctors treating cancer at SSCHRC are dedicated researchers who have pioneered and actively lead national and international clinical trials involving novel targeted agents.