Anal Cancer

Anal cancer is more common in American women than men. It is often seen above age 60. The situation is different in younger adults, where the cancer is more common in single homosexual men. Receptive anal intercourse significantly increases the risk of developing this cancer.

Causes:

The following is a list of factors that increase the risk of this cancer:

Receptive anal intercourse
Genital warts

Signs and Symptoms:

Patients present with bleeding, pain and discomfort in the anal area. They may or may not feel the cancer tissue.

Diagnosis:

When there is a suspicion of anal cancer, patients should be seen by a specialist who will perform a physical examination followed by endoscopy to visualize the anus and the rectum. CT scan or MRI of pelvis should be part of the work up of a patient with this cancer. If an abnormal area is seen in the endoscopy or physical examination, a biopsy is performed and the tissue sample is sent to a pathologist.

Treatment

This disease is highly curable with a combination of Chemotherapy and Radiation therapy. Surgery is most appropriate only for patients with very early stages of the disease, especially when the location of the cancer makes it easy to operate. However, the majority of patients are treated with Chemotherapy and Radiation therapy. Even for patients with more advanced disease, a combination of chemotherapy and radiation therapy may still control this disease in a high percentage of patients.

Patients are treated with a combination of 5-FU and Mitomycin and radiation. This regimen has become a standard treatment for anal cancer. 5-FU is given as a continuous infusion over four to five days and Mitomycin is given once a month. The same regimen is repeated every four to six weeks. Patients benefit from having a Port-A-Cath for administration of chemotherapy. The most significant side effects of this regimen are:

Radiation therapy:

Radiation treatment is given over six to eight weeks. Patients may notice some side effects such as:

Difficulty passing urine
Burning sensation in pelvic areas
Diarrhea
Tiredness

Most side effects will subside after completion of radiation; however, some may persist for a very long period of time.

Prognosis:

Overall prognosis for this cancer is very good. Most patients with early stage cancers can be cured. In others, the disease can be controlled very well for a period of time, varying from months to years. If the disease reoccurs, the treatment will consist of chemotherapy or surgery.

Follow-up

After completion of treatment, in any combination that it might have taken place, patients need to remain under surveillance for the possibility of a recurrence of the cancer. Follow-up should be scheduled on a regular basis, initially every one to three months for a period of one to two years. The frequency of follow-up will depend on the condition of the patient and his disease. In each follow-up visit, patients are examined and normally a chest x-ray is obtained every few months. A CT scan and endoscopy are performed once a year.

Treatment of recurrent disease will depend on the stage and extent of the recurring disease. Most of these patients are treated with chemotherapy, using the same agents mentioned above. Radiation therapy may be helpful in managing painful or symptomatic areas where the cancer has spread. There are a variety of pain medications which may be used to alleviate the pain. For patients with advanced disease, where most treatments have failed, one could consider assistance from hospice.