Cancer of the anus

Anal oncology, or anus cancer - is a rare malignant disease. The pathology is located from the upper border of the internal anal sphincter (from the scallop line) to the dermal anal line.

Cancer of the anus is observed only in 1,5% of all cases of oncology of the large intestine, and this can amount to only one case per hundred thousand patients. The disease can affect to a lesser extent women and, to a greater extent, men. Recorded in this case, the incidence is observed in men of non-traditional sexual orientation (up to 40 cases per hundred thousand patients), especially if there is HIV infection.

If the disease is detected in the initial stage of development, the recovery prognosis may be more favorable.

[1], [2],

Causes of cancer of the anus

There is no definite reason for cancer of the anus, since oncology is still one of the most researched areas of medicine at the moment. However, the main factors that increase the degree of risk of the disease are known:

• the presence of human papillomavirus in the body;
• genital and rectal warts;
• anal fistula;
• constant irritation of the anus, due to the expansion of hemorrhoidal veins, the formation of cracks in the anal opening, anal sexual contact, leukoplakia;
• Smoking (for smokers the risk of getting cancer increases almost 10 times);
• the age range from 50 to 85 years;
• lowering the body's immune defenses due to surgery, transplantation, autoimmune and infectious diseases;
• HIV infection.

To provoke the formation of cancer of the anus is also capable of receiving irradiation during the oncology therapy of the genitourinary organs, prostate, rectum.

[3], [4], [5], [6]

Symptoms of anus cancer

Usually, cancers form a long time hidden and without obvious symptoms. However, this does not apply to the cancer of the anus: 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 neural plexuses and vessels.

The initial symptoms of anus cancer are usually as follows:

• sensation of foreign matter in the anus;
• morbidity in the act of defecation;
• the appearance of veins or clots of blood in the stool;
• itching in the anus.

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

With the progression and growth of malignant formation, the following symptoms join the already existing symptoms:

• a disorder of defecation (rapidity, or, conversely, a decrease in the frequency of urge);
• After defecation, the feeling of incomplete exit of stool masses may remain;
• the appearance of purulent or mucous separation from the anus;
• an increase in the proximal lymph nodes (in the anus or in the groin).

The anal opening can spasmodically, thereby worsening the already weak urge to defecate. Sometimes around the anus formed a variety of slow sluggish sores.

In later stages, there are signs of cancer intoxication: fatigue, drowsiness, lack of craving for food, emaciation.

Diagnosis of anus cancer

Given that the anus cancer at the beginning of the disease does not differ in the individual characteristics of the symptoms, the diagnosis of anus cancer should include modern differential diagnostic procedures to detect pathology in time and distinguish it from other, benign conditions.

Mandatory general external examination of the patient, examination, questioning, identification of existing risk factors. Further resort to a more extensive study, including various laboratory and instrumental types of diagnostics:

• finger examination of the rectum - an easy, but very informative method for assessing the state of the rectal area. It allows you to evaluate the tissues and mucosa of the anal passage, to detect and identify the disease itself;
• anascopy - with the help of an anascope (a small glowing ball-device), which is placed in the anus, you can see and evaluate the anus and the lower section of the rectum;
• sigmoidoscopy (rectoscopy, proctoscopy, proctosigmoidoscopy) - procedure of endoscopic examination of the rectum and sigmoid colon. The device - rectoscope - is a small cylinder with a rod, which is inserted into the anal opening to 30 cm in depth;
• rectal ultrasound - is assigned to detect tumors that can not be detected by digital rectal examination;
• X-ray of the large intestine (irrigoscopy) - is performed after filling the intestine with a contrast agent. Helps detect tumors, polyps, fistulas, etc .;
• computed tomography (or magnetic resonance imaging) of the rectum with rectal contrasting - a procedure similar to an X-ray, but allowing a more detailed study of the resulting image;
• positron emission tomography - 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 anus cancer is confirmed, then additional tests for the presence of metastases in the near and far lymph nodes and organs are carried out.

[7], [8], [9]

Treatment of anus cancer

Several variants of treatment of anus cancer are known. Treatment is selected depending on the size of the tumor formation, the degree of neglect, the age of the patient and his condition.

• Surgical treatment is the radical removal of the neoplasm and nearby tissues by the operation method. One of the most effective treatment options, which, however, is the most traumatic: often it is necessary to remove the tumor by carrying out a cut of the abdominal cavity. In the future, the patient will have to install an ostomy - an artificial hole to remove stool. For this reason, the operation is carried out only as a last resort.
• Radiation treatment - the use of ionizing rays, which allows you to destroy the tumor, while maintaining the functionality of the anal sphincter. In addition to the tumor itself, the nearest lymph nodes (in the inguinal zone) are irradiated by radiation.
• Chemotherapy - the intake or administration of special cytotoxic drugs that inhibit or reduce tumor growth. Chemotherapy is used, as a rule, in conjunction with other therapeutic methods.

Prevention of cancer of the anus

Specific methods of preventing cancer of the anus do not exist, but it is necessary to pay attention to the factors contributing to the appearance of the disease. For quality prevention, the following precautions should be observed:

• use condoms during sexual intercourse, especially with casual sexual partners, to avoid HIV infection;
• avoid damage to the mucosa of the anal opening and rectum (timely cure for cracks and hemorrhoids, avoid anal sex);
• follow the right digestion, prevent the appearance of constipation;
• maintain a high level of immunity, abandon bad habits.

If damage to the mucosa is recommended, a biopsy and cytology of the anus tissue should be performed. A regular visit to the proctologist (once a year) will help in time to detect and treat the disease.

Prognosis for anus cancer

The prognosis of anus cancer depends on the stage of the disease on which treatment was started. Timely therapeutic measures can guarantee a long-term remission: according to statistics, a five-year survival after surgery (with no metastasis) is up to 70%, and with metastases - up to 20%.

Complex therapy (irradiation + chemotherapy) provides a cure in 80% of patients (provided that the tumor size is less than 30 mm). Repeat the disease can occur in about 10% of patients.

To improve the prognosis of an anus cancer, after treatment it is recommended to periodically observe the proctologist and follow the preventive measures of the disease.

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