The anus is basically an opening at the terminal or end portion of the gastrointestinal tract through which stool or solid waste, exits the body. The anus begins at the bottom of the rectum, which is the last part of the large intestine.
What are anal cancers ?
Anal Cancers are basically tumours of the anus.
How is an anal cancer caused ?
- Anal cancer is strongly connected to Human Papilloma Virus (HPV) infection. With the help of the polymerase chain reaction (PCR), the HPV genome has been isolated in the majority of cases.
- Other important risk factors also include the human immunodeficiency virus (HIV) infection, immunosuppressed transplant recipients and cigarette smoking.
- Herpes simplex virus (HSV) could play a secondary role in disease progression.
- Dietary habits, other chronic inflammatory diseases of the digestive tract and the presence of chronic lesions like haemorrhoids do not appear to prompt squamous cell carcinoma of anus.
What are the types of anal cancers ?
The inner lining of the anus is made up of flattened epithelial cells called squamous cells. So, most of the anal cancers originate in these cells (squamous cell carcinomas). However, there are other different types of cells as well, and sometimes cancers can initiate in the other cells. There is a spectrum of neoplastic changes in and around the anus, starting from benign precancerous dysplasia to invasive malignancy. The invasive malignancies include squamous cell carcinomas (starting in the squamous cells), adenocarcinomas (starting in the glandular cells), skin tumours (malignant melanomas) or Gastrointestinal Stromal Tumours.
What are the clinical features of anal cancers ?
Small, early cancers are sometimes diagnosed accidentally following the removal of anal tags. More advanced lesions may present either as a mass, or non-healing ulcer, bleeding, pain, itching, discharge and incontinence of stools. Not uncommonly lesions are palpated first by the patient. Doubtful lesions are to be biopsied always.
How are anal cancers diagnosed ?
- A complete physical examination of the body is mandatory.
- You will have to be checked by a proctologist (a doctor who is specialist of colon, rectum, and anus diseases) for diagnostic tests.
- Endoscopy :It is a test which makes use of a tube with a mounted miniature video camera on one end to check the body, for the cause of anal symptoms. It can also be used to obtain biopsy tissue from the inside of the anus.
- Anoscopy : An anoscope (which is a hollow tube, 4 inches in length) is coated with a lubricant and pushed in gently into the anus and rectum. By an accompanying light, the doctor can see the lower rectum and anus clearly.
- Rigid Proctosigmoidoscopy : The proctosigmoidoscope is comparable to an anoscope, apart from the fact that it is about 10 inches long. It lets the doctor examine rectum as well as the lower part of the colon. You will need to empty your bowels by either taking laxatives or an enema prior to the test.
- Biopsy : Removed tissue examined under a microscope by a pathologist is the only sure-shot way to make an anal cancer diagnosis.
- Imaging Tests : To determine the exact extent of disease, additional tests may need to be performed so doctors can view, assess and judge the cancer and determine how far it has progressed or spread. These tests may include the following such as X- rays, CT Scan, MRI Scan or PET Scans.
How are anal cancers staged ?
Physical examination is most definitive if carried out when the patient is under general anaesthesia. There is a local & distant staging. Local staging includes magnetic resonance imaging (MRI) of the pelvis. Distant metastases will be examined and assessed with computerized tomography (CT) thorax and abdomen.
How are anal cancers treated ?
Anal cancer is highly treatable when found early. Treatment options depend on the type of cancer, staging of the cancer, and its location. There are three types of standard treatment for anal cancer:
- Radiation Therapy : a cancer treatment that utilizes high-energy x-rays or basically radiation to eradicate cancer cells. The two main types of radiation therapy used to treat anal cancer are external beam therapy and internal radiation therapy, also known as brachytherapy.
- Chemotherapy : another kind of cancer treatment that uses either drugs or chemical substances (hence the name chemotherapy) to kill cancer cells and prevent them from dividing.
- Surgery : Surgical treatments for anal cancer include either conservative local resection, in which a small tumour in the anus and some of the surrounding healthy tissue are resected or abdominoperineal resection, in which the tumour mass in the anus and rectum are resected through an abdominal incision. Affected lymph nodes also have to be removed.
What is the care to be taken after the removal of an anal cancer ?
Metastatic diagnostic workup and monitoring post-treatment has to include imaging and scanning of the limbs, thorax, chest, retroperitoneum, and abdomen with radiography, MRI or CT scans. Adjuvant chemotherapy or radiotherapy may be required in cases wherein excision cannot be done completely.
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Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
