Anal Cancer is a condition that develops in the tissues present in the anus. Anus is the small tubular structure connecting the lower section of the large intestine called the rectum to outside the body. The anus functions by controlling the excretion of unwanted body waste through bowel movements.

Diagnosis & Tests:

The general practitioner would carry out a detailed examination of the patient subsequent to which, the patient would be referred to a professional in bowel conditions –the gastroenterologist. In the hospital, the doctor would query the patient regarding general health conditions and any past medical conditions. The patient would be examined by the doctor and blood sample would be drawn for checking the general health and the functioning of the liver. A series of tests would be conducted for confirming the presence of anal cancer.

• Rectal Exam
  At times also called the PR exam wherein the doctor would conduct an examination of the back route with a lubricated gloved finger.
• Biopsy
  A small amount of cell sample is drawn from the tumour for microscopic analysis. Generally, this employs the use of either a specialised biopsy piece of equipment called the punch biopsy or a small section of the tumour would be incised by the doctor – called the incisional biopsy. Both of these biopsies are conducted under the influence of local or general anaesthesia. In case the tests reveal an affirmative outcome, then additional tests would be carried out to analyse the metastasis of the cancer.
• X-Rays
  These are taken for assessing whether the cancer has metastasized.
• Ultrasound Scan
  This simple scanning procedure employs sound waves for capturing images of the interior of the abdominal region that are conducted in the hospital scanning section. On lying down on a flat surface, a gel is applied all over the abdomen subsequent to which a small hand-held device is moved all over it. The sound waves produced are transformed into images employing a computer. The pain-free procedure lasts for nearly twenty minutes. At times an ultrasound scan procedure called as endoanal ultrasound could be performed wherein a tiny, slender probe is introduced into the back route (rectum) that provides images of the size and spread of the tumour.
• CT or Computerised Tomography Scan
  A CT scan captures a sequence of x-rays that are passed via computer to reproduce 3-D pictures of the inner areas of the body. The pain-free procedure lasts for ten to thirty minutes. CT scans employ miniscule amounts of radiation that are not harmful to either the patient or those coming in contact with the patient. The patient would be requested not to ingest liquids or solids for nearly four hours prior to the scan. Majority of the individuals undergoing the scan are offered a drink or administered a shot for allowing certain areas to be seen more lucidly. Prior to getting the injection or the drink it is imperative to inform the individual conducting the test whether one is allergic to iodine or asthmatic. Following the scan, one could return home.
• MRI or Magnetic Resonance Imaging Scan
  This test procedure is analogous to a CT scan, however this employs magnetic fields rather than x-rays. During the course of the scan, the person would be requested to lie totally motionless on a couch inside a metallic cylindrical enclosure which is a potent magnet. Hence, prior to entering inside the room, one must remove any kind of metallic items in one’s possession. The doctor also must be informed in case one has previously worked with metals or were employed in the metal industry or whether one has any metal present in the body (for instance, a heart monitor, a pacemaker, surgical clips or bone pins). In case these might be present in the body, then a MRI would not be performed on that person due to the magnetic fields. An injection would be administered for allowing greater picture clarity of the interiors of the body. The test procedure would last for nearly thirty minutes and is totally painless, though the MRI machine could sound loud. Earplugs or headphones would be offered for this reason. In case, one is apprehensive of closed spaces, one might find the feeling of being inside the machine quite suffocating or stifling. A 2-way intercom facilitates easy communication with the person operating the scanner.
• Staging and Grading
  The staging of cancer depicts the size and the extent of metastasis past the initial location of occurrence. Gaining knowledge of the specific type and the staging of the cancer assists doctors in deciding upon the best line of treatment. Cancer could proliferate in the body through either the bloodstream or via the lymphatic system. The lymphatic system is a component of the body’s protection mechanism from infection and ailments and comprises of a system of lymph glands or lymph nodes that are connected by fine ducts that contain lymph fluid. The doctor would generally examine the close by lymph nodes while staging the cancer.
• Stage 1
  The cancer is observed to affect the anus and has a size of lesser than two centimetres or 3/4th inch. It has not yet metastasized to the sphincter muscle.
• Stage 2
  The cancer is more than two centimetres in size, however has not reached into the close by lymph nodes or to other body parts.
• Stage 3A
  The cancer has metastasized to the lymph nodes near the rectum, or to the closely situated organs like the bladder or vagina.
• Stage 3B
  The cancer has metastasized to either the lymph nodes in the groin region, pelvis or to the lymph nodes near the anus, along with the closely placed organs like the bladder or vagina.
• Stage 4
  The cancer has metastasized to lymph nodes in the abdominal region or other organs of the body like the liver.At times, a different staging system known as the TNM staging system is employed in place of the number system specified above.

   

  • T
    Depicts the tumour size and if it has spread to the close by organs.
  • N
    Depicts if the cancer has metastasized to the lymph nodes.
  • M
    Depicts whether the cancer has metastasized to another body organ like the liver (secondary or metastatic cancer).

Though this system is more multifarious, it could offer more accurate data regarding the tumour staging.

In case the cancer relapses subsequent to original treatment, then it is called as recurrent cancer.

Grading

Grading refers to the microscopic appearance of the cancerous cells and provides insight about how rapidly the cancer could develop. Low-grade would mean that the cancer cells appear quite alike normal cells. They generally have a slow growth and are less prone to proliferating. Among high-grade tumours, the cells appear quite anomalous and have a likelihood of swifter growth and spread.

An anal cancer diagnosis conducted annually in the UK revealed roughly eight hundred patients in a total populace of 61 million (2009). According to an estimate provided by the American Cancer Society, nearly 5,070 newly emergent anal cancer cases were detected in the U.S. in 2008, from which nearly sixty percent were of women. Majority of the anal cancer patients are identified in the age group of early sixties. In 2008, nearly 680 individuals died due to anal cancer in the U.S. having an estimate populace of nearly three hundred million in 2009. Reports have cited that this form of cancer is on a perennial upswing in both sexes especially among U.S. men. A varying drift in sexual practices – merged with usage of tobacco and infection due to a particular HPV or human papilloma virus strain are amongst the reasons behind this surge.

Anal Cancer is prevalent among that populace of both sexes that freely consented to anal intercourse and among individuals with depleted immune systems. Experts have stated that anal cancer is closely related to few strains of HPV.

The anus, anal canal and the Squamous Cell Carcinomas

The anus lies at the end of the GI or gastrointestinal tract while the anal canal is the interconnecting tube between the rectum and the outside part of the body. The anal canal is delimited by the sphincter – a muscle with its contraction and relaxation action is responsible for controlling bowel movements.

The squamous cells are flat and fish-scale like in appearance, forming a lining inside the anal canal. Most of the anal cancer cases developing from these squamous cells are called squamous cell carcinomas.

The spot where the anal canal gives way to the rectum is known as the transitional zone. This zone is lined by squamous cells and glandular cells that produce mucus thus providing lubrication for easy passage of stool or feces. Adenocarcinoma – a cancerous form affecting the anus could arise from the glandular cells, yet squamous cell carcinomas constitute for most of the anal cancer cases.

Anal Cancer Symptoms:

• Bleeding from the rectum while passing feces.
• Pain and discomfort experienced in the anal region.
• Lumpy formations in the area around the anus that often gets misjudged for piles or hemorrhoids.
• The anus emitting at times either mucus-like or jelly-like discharge.
• Itchiness in the anal region.
• Variations in the movements of the bowels that could comprise of diarrhea, being constipated or loose stools.
• Incapacity to control bowel movements known as fecal incontinence.
• Feeling bloated or distended.
• Women might feel a sharp pain in the lower back due the pressure being exerted by the tumor on the vagina.
• Dryness felt in the vagina.

Anal Cancer Causes:

The true reasons behind the occurrence of anal cancer is still quite blurred, though the below stated factors could possibly raise the risks.

• Presence of HPV or Human Papilloma Virus – Some HPV forms have been strongly associated with anal cancer. Nearly, eighty percent of anal cancer cases arise due to HPV infection.
• Sexual Promiscuousness – has additionally been associated with HPV. The greater the shifting among sexual partners, the higher is the risk factor of contracting HPV that has strongly been related to anal cancer.
• Amenable anal intercourse – Both the sexes that opted for anal intercourse had an increased likelihood of developing anal cancer. A study has revealed that those HIV-infected men that had sexual contacts with the same sex were close to ninety times more prone to developing anal cancer as compared to the general populace.
• Other cancerous forms – Those women that had a past of vaginal or cervical cancer and men with a history of penile cancer are at a greater likelihood of contracting anal cancer. This has also been related to HPV infection.
• Aging – Aging is known to be directly proportional to development of anal cancer that seems to rise as age increases.
• A diminished immune system – Those with lowered immunity like HIV or AIDS infected persons, those having undergone transplants or are on the course of immunosuppressant medicines are noted to be at increased risk of developing anal cancer.
• Smoking – Those who smoke are more prone to contracting anal cancer than non-smokers. Factually, smoking has been noted to be the harbinger of a host of cancerous forms.
• Non-malignant anal abrasions – Inflammation arising from benign anal lacerations caused due to either irritable bowel disease or IBD, hemorrhoid, fistulae or cicatrices are known to raise the chances of developing anal cancers.