Anal Cancer

Dr. Ayush PandeyMBBS,PG Diploma

November 21, 2018

October 14, 2021

Anal Cancer
Anal Cancer

What is Anal Cancer?

Anal cancer is a rare malignancy of the gastrointestinal system. It accounts for a small percentage (1.5%) of the gastrointestinal cancers, but there is evidence of a steady increase in its occurrence. Anal cancer is cancer of the anus or the anal canal, the end portion of the rectum.

What are the main signs and symptoms of Anal Cancer?

  • Common signs and symptoms:
    • Pain and bleeding from the anus.
    • Presence of fistulas (abnormal narrow tunnel-shaped connection between the anal canal and the skin of the hip) or leucoplakia (white, thick, non-scrapable patches).
    • Swollen lymph nodes that are easily detected during a physical examination.
    • Cancer of the anal margins manifests with a characteristic ulcer showing everted, indurated (with a firm base) and raised borders.
  • Uncommon signs and symptoms:
    • Presence of a mass in the anal region.
    • Pruritus or itching along with a discharge.
    • Impaired function of the muscular ring (sphincter) that controls stool passage, leading to anal incontinence.
    • Enlargement of the liver.
    • Distant spread of primary anal cancer.

What are the main causes of Anal Cancer?

  • Most common cause
    The human papillomavirus infection, a sexually transmitted disease, shows increased association with anal cancers.
  • Risk factors include:
    • Weak immunity
    • Age and gender
      It is more common among elderly people and women.
    • Medical conditions
    • Lifestyle
      • Smoking.
      • Engaging in intercourse with multiple partners.
      • Homosexuality, especially among males.

How is Anal Cancer diagnosed and treated?

  • Diagnosis
    Anal cancer cannot be diagnosed solely on the basis of clinical presentation and symptoms. Along with a physical examination under anaesthesia for the assessment of a tumour, doctors advise the following tests for detection of anal cancer:
    • Endo-anal ultrasound imaging
    • Magnetic resonance imaging (MRI)
    • Computed tomography (CT) scan/positron emission tomography (PET) scan
  • Treatment
    • The primary treatment for anal cancer, in most cases, is radiotherapy with or without chemotherapy. For older and weak patients, it is necessary to modify the chemotherapy and antibiotic prophylaxis.
    • The disadvantage of radiotherapy lies in radionecrosis (tissue damage or death due to radiation), because of which surgery becomes a safer line of treatment. Abdominoperineal excision (removal of the anus, a part of the colon and rectum) for aggressive cancers or those with high rates of recurrence and local excision for small tumours has become the standard treatment for anal cancers.
    • Management of inguinal lymph nodes involves radiation therapy. In cases of relapse or failure of radiation therapy, surgical resection of the lymph nodes is required.
    • Recurrent anal cancers require abdominoperineal resection combined with a colostomy (removal of the colon).
    • Intra-operative radiotherapy and brachytherapy (inserting radioactive implants) lower the chances of recurrence of anal cancer post-treatment.
    • Other treatment options include photodynamic (by using the light of a particular wavelength) therapy and immunotherapy.

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