Most people think of cancer as an untreatable, life-threatening, and unbearably painful disease with no cure at all. But is it treatable in this modern world of science in which we are living? We are talking about anal cancer, and that’s an uncommon cancer of the intestine. Anal cancer mostly affects people 55-64 years old. It affects about one in 500 people at an advanced age. 

Mostly anal cancer is linked to infection with HIV and the human papillomavirus. Almost 90% of anal cancer cases are associated with HIV. It can cause noticeable blood on stools or toilet paper after a bowel movement. HPV is detected in the majority of anal cancers.

Let’s discuss some common symptoms and causes of anal cancer. 

What are the symptoms of anal cancer?

If you are suffering from anal cancer, you may have noticed pain and blood while passing stools. The very first sign of anal cancer is bleeding. The bleeding may be caused by the painful veins in the anus or rectum. Here are some other symptoms of anal cancer:

• Bleeding in anus or rectum
• It can result in itching around the rectum
• A lump or mass at the anal opening can be produced
• Pain in the anal area
• Narrowing of stool or other changes in bowel movements may result.
• Abnormal discharge from the anus can be seen
• The loss of bowel control can happen
• Lymph nodes swelling in the anal region

Anal cancer is noticeable in some patients. In other patients, it can be unnoticeable or painless. Your food is stored in the last part of the intestine after digestion. It is called the rectum which is mostly involved in bowel movement.

In some patients, they lose control of passing bowel. That can cause severe pain in the anal canal during bowel movements.

What are the types of Anal Cancer?

Like other parts of the body, the anus is also made up of different types of cells which may become cancerous. The type of cancer depends on the location of the cell where cancer starts:

• Squamous cell carcinoma is one of the most common types of anal cancer. This type of cancer is formed on the outer side of the anus.
• Cloacogenic carcinoma is about 25% of all anal cancers. Cloacogenic cancer can start from squamous cell cancer, it is also treated the same as the squamous cell.
• Adenocarcinoma begins is developed in the glands that make mucous located under the anal lining.
• Basal cell carcinoma is a type of skin cancer that can appear in the perianal (around the anus) skin.
• Melanoma is a cancer of skin pigment in the anal canal lining.

What are the causes of anal cancer?

The relationship between anal cancer and human papillomavirus is well known. HPV is a sexually transmitted virus. In America, 80 million people are affected by HPV.

 About 150 types of HPV are known, and these types may cause almost 90% of anal cancers.

HPV can cause genital and anal warts. Nine out of 10 HPV infections are not serious and they go away on their own. But if the infection becomes permanent or more severe due to a weak immune system, such as in people receiving transplant therapy or living with HIV, HPV can cause cancers later in life, including anal cancer.

HPV vaccines can prevent infection by specific types of HPV and should be given before the person is infected.

Non-cancerous conditions, like hemorrhoids, anal warts, or anal fissures are likely to be responsible for these symptoms. If you notice any of these symptoms in you, you should immediately contact your doctor or may get treated if you have been affected.

What are the risk factors?

Anal cancer can be affected by some important risk factors, but HPV plays an important part in it. These factors include:

• Having receptive intercourse (anal sex)
• Smoking
• A history of anal warts
• A history of precancer or cancer of the cervix, vagina, vulva, or penis (these are often caused by HPV)
• HIV infection
• Age over 50
• Organ transplantation
• Immunosuppressed conditions, such as those due to medications (steroids, biologic therapy, etc.)

What are the complications?

Many factors can affect anal cancer patients. 

• Radiation exposure has long-term risk factors and there are also short-term adverse effects of active chemotherapy. Chemotherapy is combined with radiation and is done on anal cancer patients. 
• Radiation complications may also be affected by factors like technique, total dose, volume, timeframe, and fraction size.
• Radiation exposure can also cause microvascular changes that alter the healing process.

When to see the doctor?

You should consult your physician if any of these signs appear to you

• Blood while passing stools
• Feel pain for several hours after passing stool
• Have difficulty in defecation
• Itching or foul-smelling discharge from the anus

Diagnosis:

Your physician may follow these steps for diagnosis:

• History: first he’ll ask for your history. He may ask about when the symptoms started to appear. He may ask about your past treatments or surgery records.
• Examination: Your doctor then examines your anal canal and rectum for abnormalities. In this examination, your doctor inserts a gloved, lubricated finger into your rectum. Your doctor may feel unusual growths in it.
• Your doctor may take ultrasound (sound wave pictures) of your anal canal. To take the picture of your anal canal, your physician will insert a probe into your rectum.

The probe emits high-energy sound waves, called ultrasound waves, which create a picture. Your physician observes the ultrasound and looks for anything abnormal.

• Anoscopy: It is the process in which a small tube is inserted into the anus. The tube is small and rigid and helps to view the lining of your anal canal. Your doctor may insert a few inches of the tube into your rectum. It will help to identify any abnormality. 
• Your doctor may remove a part of the tissue for laboratory testing. If your doctor discovers any unusual areas, he or she may send the affected samples to a laboratory for analysis. Doctors can determine whether a cell is cancerous by observing it under a microscope. 
• After the diagnosis is done and cancer is confirmed your doctor may perform some other tests to examine if cancer has spread to any other parts of the body. 

The following tests can be performed:

1. Computerized tomography (CT)
2. Magnetic resonance imaging (MRI) 
3. Positron emission tomography (PET)

What are the treatments for Anal Cancer?

Anal cancer is not always cured but several methods are performed on cancer patients.

• Chemotherapy

Chemotherapy is used to kill cancer cells and prevent them from growing again. It can be taken orally or can also be injected into the body. Pain relievers may also be used to control symptoms.

• Surgery

Surgery is to remove a cancerous cell in the anus which may also take some healthy tissue with it. Surgery is done to those people whose cancer hasn’t spread into other parts of the body. 

It’s best performed in early staged cancer and for small tumors.

• Abdominoperineal (AP) resection is an invasive surgery. This surgery is done by making an incision in the abdomen to remove the affected cell or colon.

Due to this process, the entire portion of the GI tract is removed, so the surgeon creates an ostomy in the patient, which is a connection from the GI tract to the skin. The patient who receives this surgery has to collect their stools in an ostomy bag.

• Alternative therapy

Radiation therapies are done on many patients with different types of cancer, which includes anal cancer. Radiations or X-Rays are used to kill the cancer cells in the body, there is a possibility that they may also kill healthy tissues around it. This treatment is usually combined with other cancer treatments. 

These factors are responsible for the recovery:

The prognosis depends on the following:

• The size of the tumor
• Spread to the lymph nodes
• Spread to other organs

The treatment options depend on the following:

• HIV association to the cancer
• Site of the tumor in the anal canal
• Recurrence of cancer after initial treatment

What are the stages of Anal Cancer?

These tests are done to examine the range of anal cancer after it is diagnosed by your doctor. These are the ways through which cancer spreads in the body.

Cancer is usually spread to the nearby cells from its origin cancerous cell.

These are the following stages of anal cancer:

• Stage 0: The disfigured calls are present in the inner layer called the mucosa. The cells appear as lesions in the skin of the anus.
• Stage I: The size of the cancer is less than 2 cm.
• Stage II: Tumor is 2-5 cm in diameter. Hence, the chances of spreading increase in this stage.
• Stage III: Spread of cancer to lymph nodes or nearby organs. It may spread to the bladder or vagina.
• Stage IV: Cancer has spread to distant organs such as the liver or lungs.

How it can be treated at home?

• Anal cancer cannot be completely cured at home but some factors can help reduce the pain. It can be treated by taking vitamins or some special diets or other massages that can also help. In some cases, these methods may not be useful at all.
• After the cancer is found and staged, your cancer care team will talk with you about treatment options. The treatment is done so that the muscles of the anal sphincter are not affected and the patient can still control his normal daily life.
• Your treatment options depend on many factors. It is important that where the tumor is located or to which extent it may have spread. When you are choosing your treatment they will consider your age, your health, or your preference.

How Anal Cancer can spread in the Body?

Cancerous cells spread fast into the body. They should be treated as soon as the symptoms spear or they can bring harm to the patient. These three ways are responsible for cancer spreading in the body.

Cancer can spread through the blood, the lymph system, and can also through tissues:

Tissue. The cancer cells spread from where cancer began by growing into nearby areas.

Lymph system. Cancer can spread into the lymph system from where it began. The cancer spreads to other parts of the body through lymph vessels.

Blood. Cancer may spread to other parts of the body through blood. the cancers spread through the blood to different parts of the body.

What are the side effects of Anal Cancer?

Side effects of radiation therapy vary based on which part of the body got treated and the amount of dose of radiation given.

Some short-term effects are:

• Diarrhea

• Skin changes (like a sunburn) in areas being treated

• Radiation proctitis (can result in irritation or pain).

• Discomfort during bowel movements

• Tiredness

• Nausea

• Low blood cell counts

• In women, radiation may irritate the vagina. This may lead to uncomfortable discharge from the body.

•Usually many of these symptoms disappear after some time when given radiation.

What are the Complications of Anal Cancer?

Cancer can spread to the surrounding cells or different parts of the body. There is only a small chance for a tumor to spread into different parts of the body, but when it spreads it is really difficult to treat them. Anal cancer is likely to spread to the lungs and the liver.

What are the preventions of Anal Cancer?

After the surgery, these are some precautions that can help to prevent infection or reoccurrence.

• Practice safer sex.  One should practice safe sex that can avoid HPV or HIV, which are the two diseases that are sexually transmitted and increase the rate of anal cancer. You should also use protection in the case of anal sex.

• Get vaccinated against HPV. It is a vaccine that protects against HPV infection. It's recommended for teens, which includes both boys and girls, but maybe it’s more given to adults.
• Stop smoking. Smoking is also a cause of anal cancer. You should stay away from smoking. Or you should stop if you smoke.