The anus, which is about 1-1/2 inches long, connects the rectum (lower part of the large intestine) to the outside of the body. It allows solid waste (also called stool or feces) to pass from the body. The sphincter is two muscles that open and close the anus to let waste pass. The anus is lined with squamous cells, which also are found in the bladder, cervix, vagina, urethra and other places in the body.
Types Of Anal CancerSeveral types of tumors may be found in the anus. While some of them are malignant (cancer), others are benign (not cancer) or precancerous (may develop into cancer). The main types of anal cancer are:
Not everyone with risk factors gets anal cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.
SymptomsAnal cancer often does not have symptoms. When it does have symptoms, they vary from person to person. If you have anal cancer symptoms, they may include:
These symptoms do not always mean you have anal cancer. However, it is important to discuss any symptoms that last more than two weeks with your doctor, since they may signal other health problems.
DiagnosisOne or more of the following tests may be used to find out if you have anal cancer and if it has spread. These tests also may be used to find out if treatment is working.
Imaging tests, which may include:
Fine-needle aspiration biopsy: Anal cancer may spread through the lymph system, and sometimes it is found in lymph nodes. A tiny needle is placed into a lymph node, and cells are removed and looked at with a microscope. A positive lymph node biopsy may help the doctor decide what areas to treat with radiation therapy.
TreatmentEvery effort is to preserve the sphincter without affecting control of bowel movements, and we at Omega Hospitals use all means possible to decrease the risk of a colostomy. A colostomy is when the end of the colon (large intestine) is brought through an opening (stoma) in the abdominal wall. A bag is attached to the outside of the patient’s belly to collect bowel movements.
In the majority of cases, a colostomy is not required, as many cancers can be cured with chemotherapy and radiation alone. A colostomy may be needed if the tumor does not respond well to therapy or recurs after treatment. For advanced anal cancers or unusual types, the surgeon may need to remove the rectum and anus and create a permanent colostomy. Sometimes this is the only way to remove all the cancer cells.
Combination therapy with radiation and chemotherapy is considered the gold standard treatment for most anal cancers. Sometimes, very small or early-stage tumors may be removed surgically without the need for further treatment. If the cancer is advanced, major surgery may be required to remove the tumors.
If you have anal cancer that has spread and/or have HIV or AIDS, we offer the most advanced treatments, as well as clinical trials of new agents.
The team of specialists focusing on your care will discuss with you the best options to treat it. This depends on several factors, including:
Treatments for anal cancer, which may be used to fight the cancer or help relieve symptoms, may include:
Radiation TherapyRadiotherapy is often the first treatment used in anal cancer, with or without chemotherapy. Radiotherapy uses repeated treatments of high energy X-rays in small doses to kill cancer cells. The treatments are given Monday to Friday over a period of 5 - 6 weeks, and usually as an out-patient.
You may be given radiotherapy:
External Radiotherapy consists of treating the patient from distance. This is one of the earliest forms of radiotherapy treatments. Technology innovations in the field of medicine for diagnosis, identification and imaging of tumors coupled with explosion of advancements in accelerator technology and tracking software’s led to more precise and accurate delivery of treatment by External Radiotherapy (XRT).
Different types of delivery of XRT are:
3DCRT: - This technique consists of treatment of the tumors with radiation in such a way that the radiation dose is conformed to the target. This helps in achieving the aim of sparing the normal organs and other critical structures to a certain extent. Main limitation is that the radiation beams that are delivered are un-modulated and there is no control over the uniformity of the dose that is being given. It is generally used in a low resource setting as this requires minimal technical expertise.
IMRT: - Intensity Modulated Radiotherapy is an advanced form of radiotherapy that evolved from 3DCRT in which the radiation beams are modulated at different angles to achieve a desired dose distribution more uniform inside a target and at the same time sparing a critical structure in the vicinity of the target. The technique requires great skill and technical expertise in planning and delivery of radiation. In this type of delivery of radiation, doses are given in such a way that it takes the shape of the target thus giving us the opportunity of saving even the normal organs that are very close to the target.
VMAT:- Evolved from and a type of IMRT, this is a highly advanced technique in which the beams are modulated same as IMRT but there are critical differences between them making it highly advanced technique of delivery of radiation. In this type, there will be continuous rotation of the gantry with varying speed, continuous variable dose rate, shaping of the target during this process. This helps in faster treatment delivery (treatment time generally varies between 3 to 4 minutes) depending on the location and size of the target. The technique is especially use in structures that move with respiration like lungs, prostate, liver etc.
Internal radiotherapy (brachytherapy) means radioactive material is placed next to the tumour, inside the body.
ChemotherapyIf surgery is needed to treat anal cancer, one of the following procedures:
These agents are specially designed to treat each cancer’s specific genetic/molecular profile to help your body fight the disease.
PreventionCertain lifestyle choices can help prevent anal cancer. One of the most important is to avoid HPV infection. Some ways you can lower your chances of getting HPV include:
Anal cancer screening can potentially detect early-stage cancer in healthy individuals who do not have symptoms Because tumors tend to be most receptive to treatment during its early stages, screening can be important.
Current anal cancer screening methods and guidelines include:
Most anal cancers are cured with combination therapy. If caught early, many cancers that come back after nonsurgical treatment are treated effectively with surgery. While combination radiation/chemotherapy produces more side effects, this approach also results in the best long-term survival rates. After completing this treatment, as many as 70-90% of patients are still alive and cancer free at 5 years.
After Treatment CareAfter treatment care Following treatment for anal cancer you may experience side-effects for a few months, such as bloating, wind, diarrhea or even occasional incontinence. This can be distressing, but should be temporary. Talk to your doctor or nurse for advice on how to manage these side-effects and, if problems persist, s/he can refer you to another specialist for treatment. You will be followed up for 5 to 10 years beyond treatment.