Rectum is that part of the, digestive system where food waste reaches after nutrients and water are absorbed in the small and large intestine respectively. Anus forms the outlet to the gastrointestinal tract or anal canal at the end of the rectum. Food waste is temporarily stored in the rectum before being passed through the anal canal, out of the anus as a stool.
Anal cancer is a rare condition in which due to certain genetic mutation, normal cells of the anal canal begin to grow abnormally at an uncontrolled rate.
Anal cancer is more commonly found in men in the age group of 50-60 years. Almost 50% of anal cancer cases are diagnosed in early stages while 15-30% when a cancer has spread and about 10-20% in advanced stages.
Types of Anal Cancer
In different parts of the anal canal, different cancers may develop
- Squamous Cell Carcinomas: This is the most common type which develops in the cells surrounding the anal margin and the anal canal.
- Adenocarcinomas: They for the 15% of anal cancers and mainly impact glands in the anal area, vulva or breasts.
Stages of the disorder:
There are four stages of anal cancer as shown below:
- Stage 0 is known as carcinoma in the original place. In this stage, only the cells found in the innermost lining of the anus begins to divide uncontrollably.
- Stage 1 occurs when the tumour has become about 2cm in size.
- Stage 2 is characterised by further growth of tumour to a size greater than 2cm
- Stage 3 involves spreading of cancer to the lymph nodes near the rectum and other nearby organs such as vagina, bladder and urethra.
- Stage 4 is when the tumour spreads beyond lymph nodes and nearby organs to more distant parts of the body.
Causes & Risk Factors
Cancer develops when normal, healthy cells multiply at an uncontrolled rate) due to a genetic mutation. Unlike healthy & normal cells, these abnormal cells don’t die and accumulate to form a mass of cells (tumor). These cancerous and abnormal cells penetrate nearby tissues and metastasize to spread anywhere in the body. The most common cause of ancer to be thought is Human Papillomavirus (HPV) which is a sexually transmitted cause.
Though the exact cause of anal cancer is not known but following are considered to increase the risk towards developing the same:
- Age: Most of these cancers are diagnosed in persons over the age of 50
- Multiple Sexual Partners and Anal Sex: Those who have encountered sex with different partners over their lifetimes are at a greater risk
- Anal Infection with Human Papillomavirus (HPV): This STV is said to be a most common cause of the cancer including cervical cancer. This can also cause genital warts
- Drugs or Immunosuppressive Drugs: There are drugs which are responsible to suppress immunity system
- Excessive Tobacco: it increases the risk of many cancers, including anal cancer
It is very uncommon for anal cancer to metastasize to distant organs of the body. However, these tumors do spreads to liver and lungs and are very difficult to treat.
Signs & Symptoms
A person suffering from cancer may experience the following symptoms:
- Bleeding from anus or rectum
- Pain in the region of anus or abdomen (for rectal cancer)
- Anal itching
- A mass or growth in the anal canal
- Changes in bowel habits (constipation or diarrhoea); urgency in bowel motions
- Sensation of full bowel even after emptying
- Sudden discharge from the back passage or difficulty controlling bowels
- If any of such symptoms bother you, then you need to talk to your medical practitioner immediately.
Which specialist should be consulted in case of signs and symptoms?
A general practitioner must be consulted if a person experiences abdominal and bowel discomfort. The doctor will refer the patient to a gastroenterologist, who is a specialist doctor for treatment of diseases of the digestive system. Further diagnosis and tests may also require the expertise of an oncologist (specialist in treating cancer).
The cancer is diagnosed on the basis of the following tests and procedures:
- Physical Examination: Through a digital rectal exam, the doctor inserts a gloved, lubricated finger into the patient’s rectum to feel for any lumps or growths.
- Visual Inspection of Anus and Rectum: Using a short, lighted tube called the anoscope, proctoscope or sigmoidoscope, the doctor inspects the rectum and anal canal for abnormal changes.
- Ultrasound: A probe is inserted into the rectum, which emits ultrasound waves that generate an image of the anal canal and rectum.
- Biopsy: A small sample of the affected tissue is taken from the person’s body and examined in the laboratory for cancerous cells.
- Staging the Cancer: Once the diagnosis of the cancer is confirmed, the doctor will conduct imaging tests like computerised tomography (CT) scan, magnetic resonance imaging (MRI) and positron emission tomography (PET) to determine the extent and spread of cancer.
The mode of treatment recommended for a patient depends on the stage of the cancer and the physical condition of the patient. Treatment consists of the following:
- Radiation Therapy: In this treatment, high-energy x-rays or other types of radiations are used to destroy cancer cells. Oncologists uses two types of radiation therapy; External therapy in which a machine outside the body is used to transmit radiation towards the cancerous cells. Other is internal therapy in which needles or catheters are used to place radioactive substances directly or near the cancer.
- Chemotherapy: In this certain drugs are used to block the growth of cancerous cells, either by destroying them or stopping their mutation. When injected into a vein or taken directly by mouth, these drugs dissolve in bloodstream and target cancer cells throughout the body. When directly placed on an organ or body cavity, it affects cancer cells in those areas.
- Local Resection: In this a tumor is sliced from the anus along with some healthy tissue. This is applicable only when the tumor is small and hasn’t spread yet.
- Abdominoperineal resection: In this the anus, the rectum and part of sigmoid colon are surgically removed through a cut made in the abdomen. Also the end of the intestine is sewed to an opening so body waste can be collected in disposable bag outside the body. This is also known as colostomy.
Complications related to Treatment options
Chemotherapy drugs cause strong side effects like hair loss, nausea and vomiting. The treatment also kills healthy cells in the gastrointestinal tract and hair follicles. Radiation treatment can cause redness in the skin and sores in and around the anus, along with changes in the anal canal.
Prevention from Recurring
There is no known method to prevent this cancer but people can reduce their risk factor towards developing it by following below healthy lifestyle habits:
- Practice safe sex and limit the number of your sex partners
- Abstain from anal intercourse
- Get vaccinated against HPV infection
- Stop smoking and use of other types of tobacco
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