Anal Cancer

Cancer is made of changed cells that grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby areas. And they can spread to other parts of the body. This is called metastasis.

The anus is the last part of the digestive tract. It's where stool comes out of the body. It’s a short tube made of layers of tissue surrounded by a ring of muscles (sphincter muscles). You control these muscles during a bowel movement so stool can pass through. Most anal cancers start in the cells that make the inside lining of the anus. This is called squamous cell carcinoma. From the lining it can move deeper into the other layers of the anus and sphincter muscles.

Different types of tumors can form in the anus. Some of these tumors are not cancer. These tumors can include:

• Benign or noncancerous anal tumors. Polyps are small growths that may be flat or bumpy. Or they may look like mushrooms. They are not cancer. There are different types of polyps depending on their location and their cause. Inflammatory polyps, lymphoid polyps, and skin tags (fibroepithelial polyps) are examples of noncancerous (benign) polyps. Other types of benign tumors include adnexal tumors, leiomyomas, and granular cell tumors. They also include hemangiomas, lipomas, and schwannomas. These are all rare.

• Anal warts (condylomas). These are noncancerous growths that may occur just outside the anus and in the lower anal canal. They are caused by infection with a human papilloma virus (HPV). People who have had anal warts are more likely to get anal cancer.

• Precancerous lesions. Many people who get the most common type of anal cancer (squamous cell carcinoma) first had some patches of irregular cells. Your healthcare provider may call these lesions anal intraepithelial neoplasia (AIN). Each year, a small percentage of people with AIN get invasive cancer.

• Malignant anal tumors. These are cancerous tumors. The most common type is squamous cell carcinoma. This type of anal cancer starts in the cells that line the anal margin and most of the anal canal. Cloacogenic carcinomas (or transitional cell carcinomas) are a type of squamous cell carcinoma. Adenocarcinomas are another type of anal tumor. They account for a small number of cases of anal cancer. Other types of malignant anal tumors are very rare.

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known, but risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change. 

The risk factors for anal cancer include:

• HPV (human papillomavirus) infection.

• Many sex partners.

• Anal sex.

• A weakened immune system because of HIV or other causes.

• Smoking.

• Older age.

• Frequent inflammation in the anal area.

• Having anal fistulas.

Talk with your healthcare provider about your risk factors for anal cancer and what you can do about them.

There’s no sure way to prevent anal cancer, but there are some things that may help lower your risk for it, such as: 

• Get the HPV vaccine before you start having sex.

• Don’t have anal sex.

• Use condoms every time you have any type of sex (vaginal, anal, or oral).

• Treat HIV.

• Don’t smoke.

Are there screening tests for anal cancer?

There are currently no regular screening tests for anal cancer for people at average risk. Screening tests are done to check for disease in people who don’t have symptoms.

Many people who get anal cancer (squamous cell carcinoma) first have patches of changed cells in the lining of the anus. These are precancer cells that are called anal intraepithelial neoplasia (AIN). Finding and treating AIN may keep it from becoming cancer. Tests called anal cytology or an anal Pap test can help find AIN. Talk with your doctor about testing for anal cancer if you’re at high risk because you have any of these:

• Regular anal sex.

• A history of cervical, vaginal, or vulvar cancer.

• HIV.

• A history of organ transplant.

• A history of anal warts.

Sometimes anal cancer doesn’t cause symptoms until it grows or spreads. Common symptoms of anal cancer are:

• Bleeding from the anus.

• Pain or pressure in your anal area.

• Itching around your anus.

• Fluid leaking from your anus.

• Narrower stools or other changes in your bowel movements.

• A lump or swelling near your anus.

• Swollen lymph nodes in your anal or groin area.

Many of these may be caused by other health problems. But it’s important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

Your healthcare provider will ask you about your health history, symptoms, risk factors, and family history of disease. He or she will do a physical exam. This may include a digital rectal exam (DRE). During a DRE, your provider puts a gloved, lubricated finger into your rectum to check for hard or lumpy areas. 

You may also have one or more of these tests:

• Anoscopy

• Proctoscopy

• Ultrasound

• Biopsy

After a diagnosis of anal cancer, you’ll likely need other tests. These help your healthcare providers learn more about the cancer. They can help determine the stage of the cancer. The stage is how much and how far the cancer has spread (metastasized) in your body. It is one of the most important things to know when deciding how to treat the cancer.

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Be sure to ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.

Your treatment choices depend on the type of anal cancer you have, test results, and the stage of the cancer. Other things to think about are if the cancer can be removed with surgery and your overall health. The goal of treatment may be to cure you, control the cancer, or help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, and what the risks and side effects may be.

Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. Surgery and radiation are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy is a systemic treatment. You may have just one treatment or a combination of treatments.

The standard treatment options for Anal Cancer are:

• Radiation Therapy combined with chemotherapy.

Other options:

• Surgery is reserved as a back up option

In addition, we offer several clinical trials for patients with anal cancer at the UC Cancer Center that may change the current standard of care.

Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Talk about your concerns with your healthcare provider before making a decision.

Cancer treatment such as chemotherapy and radiation can damage normal cells. This can cause side effects such as hair loss, mouth sores, and vomiting. Talk with your healthcare provider about side effects you might have and ways to manage them. There may be things you can do and medicines you can take to help prevent or control side effects.

Depending on where the tumor is and how big it is, a lot of tissue may need to be removed with surgery. If the anus and rectum are removed, you’ll no longer be able to pass stool the same way. The surgeon will make an opening on your belly called a colostomy. A plastic bag sticks to the skin around the colostomy to collect the stool as it passes through the opening. If you need surgery for anal cancer, be sure to talk with your doctor about what you can expect.

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on your mind and body. Keep talking with your healthcare team about any problems or concerns you may have.  Work together to ease the effect of cancer and its symptoms on your daily life.

Here are tips:

• Talk with your family or friends.

• Ask your healthcare team or social worker for help.

• Speak with a counselor.

• Talk with a spiritual advisor, such as a minister or rabbi.

• Ask your healthcare team about medicines for depression or anxiety.

• Keep socially active.

• Join a cancer support group.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with a focus on high-protein foods.

• Drink plenty of water, fruit juices, and other liquids.

• Keep physically active.

• Rest as much as needed.

• Talk with your healthcare team about ways to manage treatment side effects.

• Take your medicines as directed by your team.

Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:

• New symptoms or symptoms that get worse.

• Signs of an infection, such as a fever.

• Side effects of treatment that affect your daily function or don’t get better with treatment.

Ask your healthcare provider what signs to watch for, and when to call. Know how to get help after office hours and on weekends and holidays.

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.