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Anal cancer is a common kind of cancer that is not often discussed.
Many people find it embarrassing to discuss this neoplasm and its effects, even with their own physicians.
The result is that this cancer often goes too long without detection and treatment.
More than 7,000 people are diagnosed with anal cancer in the United States every year, while almost 1000 die from it.
Understanding more about anal cancer allows people to prevent some of these deaths with early detection and treatment.
What Is Anal Cancer?
The anus is the final stage of the gastrointestinal tract, where digested food and waste product are disposed.
Stool passes through the intestines, then the rectum, and finally the anus as it exits the body.
The anus is made up of mucosal tissue well as an anal sphincter, which is a ring of muscle that keeps feces inside until people decide to pass it.
It also contains many nerve fibers and a rich blood supply.
Anal cancer is cancer that occurs in this small area.
Like all cancers, anal cancer occurs when cells mutate to become unhealthy cells that grow irregularly.
These cells may eventually form a mass, or they may instead make up a small area of constantly irritated tissue.
Either of these can eventually metastasize or spread to other parts of the body.
Healthy cells have growth restrictions that help them to be a part of healthy tissue without crowding other cells.
Cancer cells have lost these restrictions and begin to grow without control.
The uncontrolled growth of anal cancer cells can lead to a mass or tumor, that partially blocks or obstructs the anal canal and can eventually make it difficult to pass stool.
People may notice a lump on or inside their anus.
They may notice an increase in itching or other kinds of irritation.
Some people merely notice that it is more difficult to pass stool and that they feel constipated more often than normal.
They may observe that their stools are smaller around and skinnier, as the stool is compressed when it passes through a constricted anal canal.
Some people may pass only looser stool or diarrhea because this is the only kind that can get through a smaller area.
Changes in stool are often one of the first signs of this kind of cancer.
In addition, the fast growth of cancer cells means that they have a high need for nutrients and oxygen.
Cancer cells often take more than their fair share of the body’s resources, which can cause weakness, fatigue, and weight loss.
They also often develop a rich blood supply to support their higher nutrient needs.
This can lead to bleeding and other issues common in anal cancer such as anemia or anal discomfort.
In fact, noticing blood in one’s stool is the first sign of cancer for many people who have this disease.
Anal cancer is a scary disease, but it is not a death sentence.
This kind of cancer is very survivable when detected early.
Unfortunately, it is often found in later stages, when it can be more difficult (but still not impossible) to treat.
If it is found in its earliest stages, anal cancer has a five-year survival rate of more than 80% percent.
This means that more than four out of five people who get anal cancer will be alive in five years.
If found in later stages, the survival can be as low as one in five people.
Many people are embarrassed to discuss changes in stool or unusual sensations in their anus with their doctor.
However, doctors will not be judgmental about these complaints and will take steps to find and treat the underlying problem.
Identifying this kind of cancer early is the most important way to increase survival rates.
Anal Cancer History
Anal cancer was traditionally one of the rarest cancers.
It is still extremely rare, but the incidence is rising. It is more common in men, although both sexes are affected by the increase.
The increase in incidence rates is likely due to changes in sexual behavior, increasing rates of HPV infection, high rates of tobacco use, and also a constantly increasing lifespan.
The high rates of human papillomavirus (HPV) infection combined with an increase in types of sexual behavior that spread this virus to the anal canal are two of the major contributing factors.
Around 90% of new anal cancer cases in developed countries are at least partially caused by the human papillomavirus, or HPV.
Early identification is also probably responsible for the recent increase in the diagnosis of anal cancer.
Newer tests allow doctors and other healthcare staff to identify anal cancer at much earlier stages before they would have been diagnosed in the past.
Some populations are now screened routinely for this type of cancer, which will increase rates of diagnosis but also improve the life expectancy and prognosis.
Traditionally anal cancer was not talked about by most people.
There is a taboo regarding discussing one’s bowel movements or changes in the anatomy that produces bowel movements.
People assumed that their symptoms were due to hemorrhoids or other anal conditions until it was too late.
For this reason, many cases of anal cancer were only identified once they had progressed to a late stage.
As with all cancers, treatment options for anal cancer have increased and also become more effective at killing the disease while maintaining a high quality of life.
The increase in awareness about this disease combined with new diagnostic and treatment options has led to earlier identification and higher survival rates.
Rates of anal cancer have been increasing in the past decades.
However, they are predicted to decrease with the recent introduction of a vaccine against HPV.
Only young people get this vaccine, so it may take many decades to see a measurable impact on diagnosis rates.
New treatments for diseases that cause immune deficiency also may help to decrease the incidence of anal cancer as well as several other types of cancer.
A strong immune system is important in fighting some types of cancer, including this one.
While there is currently an increase in anal cancer, there is a silver lining.
There have recently been many strides in the diagnosis and treatment of this disease.
People who have anal cancer are often found in the earliest stages and have a wide variety of treatment options.
Public and private support for people who have anal cancer is also increasing and contributing to higher survival rates.
In the modern world, no one with anal cancer needs to suffer in silence or be afraid to ask for help.
Anal Cancer Risk Factors
Any person can develop anal cancer. However, some people are more at risk.
Some of the risk factors for anal cancer include:
- Being over the age of 50 years old. Most diagnoses of anal cancer are made in people who are 60 years old or even older.
- Exposure to strains of the human papillomavirus, or HPV. Certain strains of this virus can cause genital and anal warts as well as several types of pelvic cancer.
- The high number of sex partners. This is likely due to the higher risk of catching HPV in people who have had more partners.
- Conditions that suppress the immune system, such as HIV. A strong immune system is the first defense against cancer.
- Drugs that suppress the immune system, such as long term corticosteroids
- Long term anal irritation, such as from hemorrhoids or Crohn’s disease. Doctors do not understand exactly why, but cells that have been irritated for a long time are more likely to have cancerous changes.
- Receptive anal sex raises the risk of both irritation and exposure to HPV
- Smoking cigarettes or other tobacco products. This contributes to an increased risk of many types of cancer. If you are having trouble quitting, it is important to talk to a doctor.
- A family history of anal cancer or other types of GI cancers.
If you have any of the symptoms of anal cancer or one of these risk factors, it is very important to talk to your physician about your health history.
Your doctor can tell you what tests are most appropriate for you.
They can also give advice about how to lower your risk for certain diseases.
This can include increased screening as well as lifestyle changes.
Human papillomavirus, or HPV, is the virus that causes genital and anal warts as well as cervical cancer.
People who have been exposed to certain types of the HPV virus are at particularly high risk of developing anal cancer.
In addition, people who have had other types of pelvic cancer, such as cervical or bladder cancer, are at very high risk.
People who have diseases that suppress the immune system may be screened for anal cancer routinely as they have a very high risk of developing the disease.
If you or a loved one are at high risk of anal cancer, there are several types of screening that may be able to catch any developing cancer before it has progressed to a less treatable stage.
Even if a person has no risk factors for anal cancer, it is important to see a doctor if any symptoms appear.
While risk factors increase the chance of developing cancer, people can get this and other types of cancer even with no risk factors at all.
Anal Cancer Screening
Doctors do not routinely screen all people for anal cancer.
However, they will screen people who are at high risk.
It is very important for people who are at high risk of this disease to discuss their risk factors with their doctor.
Doctors can then make an educated decision about whether and when to screen for this and other diseases.
Screenings may be performed once a year or even less often, depending on the number of risk factors.
There are many benefits to screening for anal cancer.
Screening exams are usually fast, inexpensive, and covered by insurance.
They can help to find abnormal cells in the anus before these cells have even turned into true cancer.
This allows people to have the most effective and least invasive treatment as well as better prognosis.
Early diagnosis is the key to increased survival for most cancer.
If you suspect that you have anal cancer, the first step is to go to a doctor.
While doctors do not routinely screen patients for anal cancer, there are several tests that they can use when people have high-risk factors or symptoms of the disease.
The least invasive of these tests is called an anal Pap smear.
This test is similar to a cervical Pap smear in that the doctor will take a swab of cells in your anus which will then be prepared and looked at under a microscope in a laboratory.
These cells will be examined for changes that indicate they are changing to cancer cells or already have begun to make these changes.
Doctors also may examine your anus both digitally (with a finger) and visually, using a short lighted scope.
They may take a stool sample and test it for blood. Some doctors prefer to use ultrasound to examine the anus, a test that uses sound waves to look at tissues and is less invasive.
If they see any abnormalities, or if the Pap smear indicates abnormal cells, the doctor will then perform a test called a colposcopy.
In this test, the doctor will insert a lighted scope and then gently wash the inside of your rectum with a special fluid that makes abnormal or cancerous cells change color.
The doctor then can take biopsies, or small samples, of these abnormal cells so they can be examined more carefully under a microscope.
While these tests may not be comfortable for many people, doctors usually work hard to make them as comfortable as possible.
They will use lubricating gels to decrease physical discomfort and allow patients to remain as covered as possible using drapes and special positioning tables.
In addition, some tests are performed using either local or general anesthesia to reduce the discomfort or pain.
Some patients may be sedated or made completely unconscious during procedures and testing if they have a great deal of fear about the test.
There are usually many options for reducing discomfort and negative emotions during screening for anal cancer.
It is important to see a doctor if you have symptoms of anal cancer and trust that the discomfort will be worth the benefits to your health.
Anal Cancer Symptoms
Many people ignore the early signs of anal cancer.
These signs and symptoms can be embarrassing and painful.
In addition, many people with anal cancer assume that they have hemorrhoids or other causes of anal irritation that could pass on their own.
It is important to talk to a physician if you have any of the following signs of anal cancer:
- Bleeding from your anus or rectum
- Bright red blood or blood clots in your feces
- Pain in the anus or the immediate area
- A feeling of being unable to completely defecate
- A noticeable mass on or near the anus
- Changes in the skin around the anus
- Itching or irritation on or in the anus
- A change in the shape of your stools
- A change in the consistency of your stools
Many different illnesses can cause these symptoms.
For example, internal hemorrhoids can present in much the same manner.
However, people who have these symptoms should see a doctor who can give them a diagnosis and treatment for the cause of their discomfort.
In many cases, the cause is not cancer but rather a more easily treatable problem.
If the cause truly is cancer, early detection and treatment are key to living a long and healthy life.
Anal Cancer Diagnosis and Stages
Once a person has been diagnosed with anal cancer or even simply abnormal cells in the anus, doctors will perform tests to determine the extent of cancer and whether it has spread to lymph nodes or other organs.
These tests may include a CT (computerized tomography) scan, an MRI (magnetic resonance imaging), or a PET (positron emission tomography) scan.
These scans are usually non-invasive, involve no discomfort, and can be performed without any painkillers or anesthesia.
More biopsies may be taken if the imaging tests indicate other areas of cancer or changes in nearby lymph nodes.
Biopsies identify exactly what kind of cancer the anal tumor belongs to, which can help to develop a more targeted treatment.
In a biopsy, an area of abnormal cancerous growth is removed and examined under a microscope.
This area may simply be abnormal cells that have not become cancerous yet.
It may be squamous cell carcinoma, which is the technical name of the most common type of anal cancer.
It also may be a condition called Bowen’s disease, which is squamous cell carcinoma that is only on surface tissue and has not spread to deeper layers of the anus.
Basal cell carcinoma is a very rare type of anal cancer because it is usually caused by sun exposure.
Adenocarcinoma, or cancer of glandular tissue, is also a very rare kind of anal cancer.
Last, anal cancer may be metastasized, or spread, from cancer in a different area of the body.
Doctors then use the results of scans, biopsies, and other tests to determine the stage of anal cancer.
This will determine the most effective treatment options as well as the prognosis, which is a word that means the likely outcome of cancer.
The stages of anal cancer are:
- Stage I. In this stage, the anal cancer is very small, less than 2 centimeters, and has not spread outside of the anal canal at all.
- Stage II. Stage II anal cancer has not spread but is greater than 2 centimeters.
- Stage IIIA. In this stage, anal cancer has spread in the immediate area. This may include lymph nodes or other structures of the pelvis, such as the bladder or reproductive organs. It may be any size in this stage.
- Stage IIIB. In this stage, anal cancer has spread to nearby organs and lymph nodes or has spread to a wide range of lymph nodes. As with stage IIIA, this stage of anal cancer can be any size.
- Stage IV. Stage IV is the most serious and dangerous stage. In this stage, anal cancer has spread to lymph nodes or organs outside of the pelvis.
When anal cancer metastasizes, it can become incredibly difficult to treat. It most often metastasizes to the liver and lungs.
Once this happens, anal cancer can become very difficult or even impossible to completely treat.
It is important to identify and treat anal cancer before it reaches a later stage.
However, even late-stage anal cancer is often treatable with modern technology.
Regardless of the type of anal cancer or the stage, a team of doctors and other health care professionals can develop an individualized treatment plan that allows the best possible prognosis and the least side effects for the patient.
Anal Cancer Treatment and Drugs
Surgery is the most common treatment for anal cancer.
In the earliest stages, the cancer can often be removed without affecting surrounding tissue.
Doctors will work hard to remove the cancer without affecting the anal sphincter whenever this is possible.
The anal sphincter is responsible for holding back feces and thus is important in bowel control.
Anal cancer can often be removed without affecting the anal sphincter in stage I and stage II cancers.
This allows many people to go on from surgery and lead a normal life.
If the surgeon can remove anal cancer with wide margins of healthy tissue, surgery may be the only treatment necessary.
In some cases, doctors may also recommend chemotherapy.
This is a treatment in which the patient takes medications that kill cancer cells.
While this was once a very rough treatment with side effects such as vomiting and hair loss, newer kinds of chemotherapy are more targeted and thus have fewer side effects.
Radiation is another treatment for anal cancer that kills cancer cells by exposing them to deadly levels of radioactive rays.
Doctors may recommend using both of these for some types of anal cancer to ensure that all of the cancer cells have been killed.
If the tumor is very large, doctors may recommend using chemotherapy and radiation before performing surgery to reduce blood and tissue loss.
While earlier stages can be treated without life-changing effects, later stage anal cancer requires further treatment because it has spread to other areas.
Doctors will often perform surgery, but this surgery is more extensive than the kinds used for stages I and II.
Surgery to remove cancers that are stage IIIA and beyond may affect the anal sphincter and thus cause some incontinence or bowel leakage.
If cancer has spread extensively, doctors often perform a surgery called an abdominoperineal (or AP) resection.
In this surgery, much of the large bowel is removed and a stoma, or hole in the abdomen, is inserted for waste to collect in a bag.
This is called a colostomy. Other pelvic organs such as the uterus may also be removed if they have cancerous tissue.
An AP resection is often performed along with radiation and chemotherapy.
If anal cancer is end-stage or difficult to treat, patients may be referred to as a research trial.
These are performed for new drugs and treatments that are being studied.
Enrolling in a research trial allows people with advanced cancers to get the latest technologies and benefit from new treatments before they are widely available on the open market.
Whether or not surgery, radiation, and chemotherapy are good options, patients may opt to receive palliative care.
Palliative care is specialized medical care to increase a patient’s quality of life while they are dealing with serious illnesses.
A team of doctors, nurses, therapists, and other palliative care professionals will provide the specialized support that helps patients to deal better with the effects of their illness and the potential effects of treatment.
There are a wide variety of treatments for anal cancer.
Your treatment team can explain which are the best options for you and help you to make this very important decision about your care.
Anal Cancer Coping and Support
People who have anal cancer may have many questions about their situation, including:
- How will having anal cancer affect my life?
- How can I deal with the side effects of treatment?
- Which doctors and hospitals in my area are the best for this kind of disease?
- Are there any natural remedies that can make my treatment more effective or reduce side effects?
- How can I bring up my diagnosis with loved ones?
- Does anyone understand what I am feeling and going through?
- How have other people with this disease get through it
- What can I expect after an ostomy or other invasive surgery?
Doctors and nurses can help people to find answers to many of their questions.
However, many people benefit from having others to talk to as well. Medical staff can help people find the support that they need.
One of the major barriers to getting support for this kind of cancer is the negative emotions associated with it.
Many people feel shame about having anal cancer.
Some people also feel very afraid, because cancer of any kind can be life-threatening without treatment.
They may feel alone because this is rare cancer and they don’t know anyone else who has it.
It is very important for people with any kind of anal cancer to seek support to help them cope with the diagnosis and treatments.
Many hospitals have cancer support groups where people with similar cancers can come together to talk openly about their treatments.
There are other ways that patients can find support for their cancer.
They can talk to a therapist or psychologist about their feelings.
This is often helpful because a professional can help them to find coping mechanisms that make it easier to get through cancer diagnosis and treatments.
There are even therapists that specialize in helping people with cancer.
People with anal cancer also can often turn to friends, family, and other supportive people to help them deal with the effects of their cancer.
Patients may find that their medical staff, including doctors and nurses, are also a valuable source of support.
Many people with anal cancer find support online.
There are specialized groups on most social media pages as well as many internet pages and forums devoted to giving people information and support regarding their disease.
Some people also find support in faith communities.
For many people, exploring their religious beliefs is an important way of dealing with situations like this that threaten their health and/or life.
People who have anal cancer often use several or all of these means of coping and support to help them deal with the effects of anal cancer and its treatment.
There is no shame in asking for help and support when it is needed.
Regardless of how a person chooses to deal with an anal cancer diagnosis, it is important to deal with emotions and fears without shame.
There is no shame in fighting cancer. In fact, many people who are facing a similar diagnosis may be inspired by the bravery and openness of others.
It is important to face the situation, make educated decisions regarding treatment, and to accept all forms of support throughout this journey.
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