Anus cancer

Anal oncology, or anal cancer, is a rare malignant disease. The pathology is located from the upper borders of the internal anal sphincter (from the pectineal line) to the skin anal line.

Anal cancer is observed in only 1.5% of all cases of colon cancer, and this may be as little as one case per hundred thousand patients. The disease may affect women to a lesser extent and men to a greater extent. The highest incidence rate in this case is observed in men of non-traditional sexual orientation (up to 40 cases per hundred thousand patients), especially in the presence of HIV infection.

If the disease is detected at an early stage of development, the prognosis for recovery may be more favorable.

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Causes of anal cancer

It is impossible to reliably name the causes of anal cancer, since oncology is still one of the most studied areas of medicine at the moment. However, the main factors that increase the risk of the disease are known:

• the presence of the human papilloma virus in the body;
• genital and rectal warts;
• anal fistula;
• constant irritation of the anus due to dilation of hemorrhoidal veins, formation of anal fissures, anal sexual contact, leukoplakia;
• smoking (smokers have an almost 10-fold increased risk of developing cancer);
• age period from 50 to 85 years;
• decreased immune defense of the body due to operations, transplants, autoimmune and infectious diseases;
• HIV infection.

Radiation exposure during treatment of cancer of the genitourinary organs, prostate, and rectum can also provoke the development of anal cancer.

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Symptoms of anal cancer

Usually, cancerous growths are latent and without obvious symptoms for a long time. However, this does not apply to anal cancer: fortunately, signs of the disease are detected already in the initial stages. This can be explained by the fact that the neoplasm is localized in the anus, rich in nerve plexuses and vessels.

Initial symptoms of anal cancer are usually as follows:

• sensation of a foreign object in the anus;
• pain during defecation;
• the appearance of streaks or clots of blood in the stool;
• itching in the anal area.

Unfortunately, in the vast majority of cases, even such obvious symptoms remain unnoticed, as patients associate them with hemorrhoids, anal fissures, etc. Indeed, the above-mentioned signs are not clear characteristics of a cancerous tumor, so they can be ignored.

As the malignant tumor progresses and grows, the following symptoms are added to the already existing ones:

• bowel movement disorder (increased or, conversely, decreased frequency of urges);
• after defecation, there may be a feeling of incomplete passage of feces;
• the appearance of purulent or mucous discharge from the anus;
• enlargement of nearby lymph nodes (in the anal area or in the groin).

The anus may spasm, thereby worsening the already weak urge to defecate. Sometimes, various-sized, sluggish ulcers form near the anus.

In later stages, signs of cancer intoxication appear: fatigue, drowsiness, lack of appetite, weight loss.

Diagnosis of anal cancer

Considering that anal cancer at the onset of the disease does not have individual specific symptoms, the diagnosis of anal cancer should include modern differential diagnostic procedures in order to detect the pathology in time and distinguish it from other benign conditions.

A general external examination of the patient, examination, questioning, and determination of existing risk factors are mandatory. Then a more extensive examination is carried out, including various laboratory and instrumental types of diagnostics:

• digital rectal examination is a simple but very informative method for assessing the condition of the rectal area. It allows you to evaluate the tissues and mucous membranes of the anus, detect and determine the disease itself;
• anoscopy - using an anoscope (a small lighted ball-shaped device) that is placed in the anus, you can see and evaluate the anus and lower rectum;
• rectoscopy (rectoscopy, proctoscopy, proctosigmoidoscopy) is a procedure for endoscopic examination of the rectum and sigmoid colon. The device, a rectoscope, is a small cylinder with a rod that is inserted into the anus up to 30 cm deep;
• rectal ultrasound – prescribed to detect tumors that cannot be detected by digital rectal examination;
• X-ray of the colon (irrigoscopy) – performed after filling the intestine with a contrast agent. Helps to detect tumors, polyps, fistulas, etc.;
• computed tomography (or magnetic resonance imaging) of the rectum with rectal contrast - a procedure similar to an X-ray, but allowing a more detailed study of the resulting image;
• positron emission tomography is a more modern analogue of computed tomography;
• biopsy with subsequent histological evaluation of tissues – taking an element of tumor tissue to determine its malignancy.

If the diagnosis of anal cancer is confirmed, then additional examinations are carried out to check for metastases in nearby and distant lymph nodes and organs.

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Treatment of anal cancer

There are several treatment options for anal cancer. Treatment is selected depending on the size of the tumor, the degree of neglect, the patient's age and condition.

• Surgical treatment is the radical removal of the neoplasm and surrounding tissues by surgery. One of the most effective treatment options, which, however, is also the most traumatic: it is often necessary to remove the tumor by making an incision in the abdominal cavity. In the future, the patient will have to install a stoma - an artificial opening for the removal of feces. For this reason, surgery is performed only as a last resort.
• Radiation therapy is the use of ionizing rays, which allows the tumor to be destroyed while simultaneously preserving the functionality of the anal sphincter. In addition to the tumor itself, the nearest lymph nodes (in the groin area) are also irradiated with radiation.
• Chemotherapy is the administration or introduction of special cytostatic drugs that inhibit or reduce tumor growth. Chemotherapy is usually used in combination with other therapeutic methods.

Prevention of anal cancer

There are no specific methods for preventing anal cancer, but you should pay attention to the factors that contribute to the development of the disease. For quality prevention, you must take the following precautions:

• use condoms during sexual intercourse, especially with casual sexual partners, to avoid HIV infection;
• avoid damage to the mucous membrane of the anus and rectum (treat cracks and hemorrhoids promptly, avoid anal sex);
• monitor proper digestion, prevent constipation;
• maintain a high level of immunity, give up bad habits.

If the mucous membrane is damaged, it is recommended to perform a biopsy and cytology of the anus tissue. Regular visits to a proctologist (once a year) will help to detect and treat the disease in time.

Anal Cancer Prognosis

The prognosis for anal cancer depends on the stage of the disease at which treatment was started. Timely therapeutic measures can guarantee long-term remission: five-year survival after surgery (without metastasis), according to statistics, is up to 70%, and with metastasis - up to 20%.

Complex therapy (radiation + chemotherapy) provides cure in 80% of patients (provided that the tumor size is less than 30 mm). Recurrence of the disease may occur in approximately 10% of patients.

To improve the prognosis of anal cancer, it is recommended to periodically see a proctologist after treatment and take preventive measures against the disease.

Anal cancer is not an asymptomatic disease, and the task of patients is to notice in time and not miss the signs of a formidable pathology.