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Anal Cancer Treatment
Anal Cancer key points
- Anal cancer is a cancer in which there is a malignant growth of cancerous cells in the tissues of the anus
- The human papillomavirus (HPV) greatly increases the risk of anal cancer
- The earliest symptoms of this cancer are bleeding from the anus or rectum or a lump near the anus
Located at the end of the large intestine, below the rectum, through which stool is discharged from the body,the anus’sformation is partly from the outer skin layers of the body and partly from the intestine. The sphincter muscles which are two ringed like muscular structures, open and close the anal canal when letting the stool pass out of the body. The skin outside the anus is called the perianal area and tumors in this area are skin tumors, not anal cancer.
Symptoms of Anal Cancer
The following are the most common symptoms of anal cancer:
- Unwanted bleeding from the anus or rectum
- Feeling of pain around the anus
- Itching or any unusual discharge from the anus
- Growth of a lump near the anus
- Any peculiar change in the bowel habits
There are certain risk factors that may also lead to anal cancer:
- Infection from human papillomavirus (HPV)
- Too much sex with different partners
- Receptive anal intercourse (anal sex)
- Age factor. Being older than 50 years
- Anal redness, swelling, and soreness
- Abnormal anal openings
- High consumption of cigarettes
Diagnosis of Anal Cancer
The following tests and procedures may be used:
- Physical exam and history: An overall examination of the body is conducted to check the general health status. Also during this exam any signs of diseases or unusual lump formation are checked. The doctor might also gauge the medical history of the individual for a better understanding.
- Digital rectal examination (DRE): DRE is a routine examination of the anus and the rectum to detect any lump formation within.
- Endo-anal or endorectal ultrasound: This is a procedure in which a probe (ultrasound transducer) is inserted into the anus. This probe then creates high-energy sound waves which form the picture of the anus called sonogram.
- Proctoscopy: The anus is examined with a short, lighted tube called a proctoscope.
- Anoscopy: In anoscopy a short, lighted tube known as anoscope is used to examine the anus and the lower rectum.
- Biopsy: In biopsy, some cells or tissues are removed and clinically examined by the pathologist to check for any tentative signs for cancer.
Stages of Anal Cancer
The following stages are used for anal cancer:
In stage 0, malignant cells are seen in the innermost layer of the anus. These malignant cells may spread across to the nearby healthy tissues. Stage 0 is also termed as high-grade squamous intraepithelial lesion (HSIL).
In stage I, the malignant growth formation has occurred with the size of the tumor at 2 cms or smaller.
Stage II of anal cancer is further sub-divided into two stages:
- In stage IIA, the tumor size is between 2 to 5 cms.
- In stage IIB, the tumor size is larger than 5 cms.
Stage III anal cancer has been also further sub-divided into three stages:
- In stage IIIA, the tumor size is 5 cms or smaller and has spread to the lymph nodes.
- In stage IIIB, the tumors being of any size has spread to the nearby organs but hasn’t reached the lymph nodes.
- In stage IIIC, the tumor has already affected the nearby organs and has also spread to the lymph nodes.
In stage IV, cancer has already spread across fast affecting the major organs such as lungs and liver.
Ways in which Anal Cancer spreads in the body:
After the confirmation of the anal cancer is done, various tests are conducted to what extent has the cancer spread to other parts of the body. There are mainly three ways through which the cancer spreads:
- The cancer starts spreading from where it started into the nearby areas
- The cancer spreads from the lymph system. The lymph vessels carry the cancer to the other parts of the body.
- The cancer is spread through the blood vessels to other parts of the body
Staging process is used to determine whether the cancer has spread to the other parts of the body or not. The diagnosis from the staging process helps to determine the stage in which the cancer has reached and the suitable treatment options. The following tests are used in the staging process:
- CT scan (CAT scan)
- Chest X-ray
- MRI (magnetic resonance imaging)
- PET scan (positron emission tomography scan
- Pelvic exam
Treatment option overview
Three types of standard treatment are used:
- Radiation therapy
Human immunodeficiency virus can also have an effect on the treatment of anal cancer. Hence new types of treatment are also being used like:
- Radio sensitizers: These are drugs that make the tumor cells more sensitive. The strong combination of the radiation therapy with radio sensitizers kills more cancer cells.
- Radiation therapy: In radiation therapy, high-energy x-rays are used to kill the cancer cells or restrict them from growing.
- Chemotherapy: In chemotherapy drugs are injected in the body to stop the growth of cancer cells, either by killing the cells or stopping there multiplication.
Before the doctor takes a call on performing a surgery, some tests are conducted to check the general health of the patient and ensure that he/she is medically fit for the surgery.There would be some blood tests and certain tests to check the normal functionality of the heart. Appointments with the doctor and anesthetist will be there and the patient can clarify any doubts about the operation. A consent form agreeing to have the operation will be required to be signed by the patient.
Before the surgery
The patient will be asked to fast before for a few hours until the surgery is conducted. The patient is prepared for the surgery on the day it is scheduled and the patient will be required to take a bath and shave off the area where the surgery is to be performed.A pair of compression stockings will be given to the patient to prevent any blood clots from occurring in the legs.
During the Surgery
Anal Cancer Surgery may be performed by the following methods:
- Local resection: It is a surgical procedure in which the tumor is completely removed along with some healthy tissues that surrounds it. This procedure is used when it is confirmed that the tumor hasn’t spread.
- Abdominoperineal resection: An incision is made in the abdomen through which the anus, the rectum, and part of the sigmoid colon are removed. A new opening may be created to allow the stool to pass from the body.
- Resection with colostomy: A part of the colon that contains the malignant cells and nearby healthy tissue is removed, a stoma is created, and a colostomy bag is attached to the stoma.
After the surgery
Post-surgery after the patient wakes up; there is a possibility that he/she might feel drowsy.The blood pressure is monitored. There could be some tubes attached to the patient’s body too like:
- An intravenous infusion (drip) to supply necessary fluids to the body until the patient is able to eat and drink normally
- A tube attached to the point where surgery has been performed to drain out the fluid discharged from the wound
- A catheter attached to the bladder to pass the urine
- A naso-gastric tube to remove the fluids from the stomach until the patient is able to start with bowel movements normally
- The patient might experience some pain and to avoid that painkillers will be given
- Antibiotics will be given to enable the healing of the wound as quickly as possible
Factors which affect the chances of recovery:
The chances of recuperating depend on the following:
- The size of the tumor
- The location of the tumor in the anus
- Whether the cancer has spread to other parts of the body
Follow-up tests may be needed:
Certain follow up tests may be required post treatment to know if the treatment has been successful or if there has been any recurrence in the cancer.
Cost of Treatment
The following factors determine the cost involved in treating Anal cancer:
- Hospital that patient chooses for his/her treatment
- Fees for the visiting oncologist/specialist
- Cost of medicines
- Cost of tests and diagnostic procedures
- Cost of surgery
- Cost of follow-up care