WHAT IS ANAL CANCER?
Anal cancer can be defined as a lesion in the anus where normal cells lose their ability to control their normal growth due to a series of genetic changes. This results in the formation of a lesion that can take various forms, and the cancerous cells invade the surrounding normal tissue. Some of these cancer cells can spread to other parts of the body through the bloodstream or lymphatic channels, leading to metastasis in other organs. The anus and anal canal are surrounded by muscles (sphincters) that keep the anal canal closed at rest and relax to allow the passage of stool during defecation. Anal cancer originates from the skin of the anal margin or the anal canal (squamous cell carcinoma) or may arise from the mucosa of the anal canal (adenocarcinoma). In advanced stages, it can invade the anal sphincters, compromising their function. When the cells have begun their degeneration process but have not yet become malignant, it is referred to as "severe dysplasia," "carcinoma in situ," or "Bowen's disease."
IS ANAL CANCER COMMON?
It represents only 1-2% of malignant tumors in the gastrointestinal tract. Therefore, it is relatively uncommon but is on the rise.
WHO IS AT RISK?
Anal cancer is commonly associated with the human papillomavirus (HPV). This virus can cause the formation of warts around the anus and in the anal canal. In women, it is the cause of cervical warts, which, in turn, are a risk factor for cervical cancer. It predominantly affects individuals over 50 years of age. Those at increased risk for developing anal cancer include individuals who engage in anal intercourse, smokers, immunosuppressed individuals with HIV (AIDS), individuals with conditions like fistulas or chronic anal fissures, and people who have undergone radiation therapy for rectal, prostate, bladder, or cervical cancer.
CAN ANAL CANCER BE PREVENTED?
It is challenging to determine whether this cancer can be entirely prevented, but it is essential to eliminate or reduce risk factors, such as smoking, anal sex, and chronic anal diseases. Avoiding exposure to papillomavirus (HPV) or HIV is crucial. The use of condoms is strongly recommended. For all patients with anal warts, especially those at risk, regular colon proctological examinations, including anoscopy, are recommended. As a preventive measure, a Pap test similar to the one performed on women's cervical tissue can also be performed.
WHAT ARE THE SYMPTOMS OF ANAL CANCER?
Many cases of anal cancer can be discovered early. Symptoms may include bleeding, the presence of a small hard lump in the anus, anal pain (less frequent), a feeling of anal moisture, the presence of secretions in underwear, anal itching, the passage of small stools, mucus or pus discharge from the anus, and the presence of lymph nodes in the groin or around the anus. Many of these symptoms are common to less severe conditions. However, it is advisable to seek a medical evaluation when these symptoms occur.
HOW IS ANAL CANCER DIAGNOSED?
Inspection during a colon proctological examination may be sufficient. Positivity in the Pap test and the presence of risk factors will increase suspicion. Biopsy, which involves taking a small fragment of the lesion in an outpatient procedure under local anesthesia, represents the most reliable method for a correct diagnosis. If the subsequent histological examination confirms the presence of anal cancer, further tests will be required to assess the presence of metastases in other organs, which is crucial for determining the appropriate treatment.
IS A STOMA (ARTIFICIAL ANUS) REQUIRED IN CASE OF SURGERY?
Usually, a colostomy is not required. Only in cases where the tumor is in an advanced stage and necessitates complete rectal removal does a permanent colostomy become necessary. This event is nowadays very rare.
WHAT HAPPENS AFTER TREATMENT FOR ANAL CANCER?
It is essential to follow a precise follow-up protocol. Periodic visits, blood tests, and instrumental examinations are carried out to assess the appropriateness and effectiveness of the treatment.
WHAT ARE THE RESULTS OF TREATMENT?
As with most cancers, early diagnosis is associated with an excellent survival rate and complete recovery. Anal cancer responds well to a combination of chemotherapy and radiation therapy, even in cases of recurrence. Surgery may be necessary, but usually, patients recover with radio-chemotherapy.
Anal cancer can be defined as a lesion in the anus where normal cells lose their ability to control their normal growth due to a series of genetic changes. This results in the formation of a lesion that can take various forms, and the cancerous cells invade the surrounding normal tissue. Some of these cancer cells can spread to other parts of the body through the bloodstream or lymphatic channels, leading to metastasis in other organs. The anus and anal canal are surrounded by muscles (sphincters) that keep the anal canal closed at rest and relax to allow the passage of stool during defecation. Anal cancer originates from the skin of the anal margin or the anal canal (squamous cell carcinoma) or may arise from the mucosa of the anal canal (adenocarcinoma). In advanced stages, it can invade the anal sphincters, compromising their function. When the cells have begun their degeneration process but have not yet become malignant, it is referred to as "severe dysplasia," "carcinoma in situ," or "Bowen's disease."
IS ANAL CANCER COMMON?
It represents only 1-2% of malignant tumors in the gastrointestinal tract. Therefore, it is relatively uncommon but is on the rise.
WHO IS AT RISK?
Anal cancer is commonly associated with the human papillomavirus (HPV). This virus can cause the formation of warts around the anus and in the anal canal. In women, it is the cause of cervical warts, which, in turn, are a risk factor for cervical cancer. It predominantly affects individuals over 50 years of age. Those at increased risk for developing anal cancer include individuals who engage in anal intercourse, smokers, immunosuppressed individuals with HIV (AIDS), individuals with conditions like fistulas or chronic anal fissures, and people who have undergone radiation therapy for rectal, prostate, bladder, or cervical cancer.
CAN ANAL CANCER BE PREVENTED?
It is challenging to determine whether this cancer can be entirely prevented, but it is essential to eliminate or reduce risk factors, such as smoking, anal sex, and chronic anal diseases. Avoiding exposure to papillomavirus (HPV) or HIV is crucial. The use of condoms is strongly recommended. For all patients with anal warts, especially those at risk, regular colon proctological examinations, including anoscopy, are recommended. As a preventive measure, a Pap test similar to the one performed on women's cervical tissue can also be performed.
WHAT ARE THE SYMPTOMS OF ANAL CANCER?
Many cases of anal cancer can be discovered early. Symptoms may include bleeding, the presence of a small hard lump in the anus, anal pain (less frequent), a feeling of anal moisture, the presence of secretions in underwear, anal itching, the passage of small stools, mucus or pus discharge from the anus, and the presence of lymph nodes in the groin or around the anus. Many of these symptoms are common to less severe conditions. However, it is advisable to seek a medical evaluation when these symptoms occur.
HOW IS ANAL CANCER DIAGNOSED?
Inspection during a colon proctological examination may be sufficient. Positivity in the Pap test and the presence of risk factors will increase suspicion. Biopsy, which involves taking a small fragment of the lesion in an outpatient procedure under local anesthesia, represents the most reliable method for a correct diagnosis. If the subsequent histological examination confirms the presence of anal cancer, further tests will be required to assess the presence of metastases in other organs, which is crucial for determining the appropriate treatment.
IS A STOMA (ARTIFICIAL ANUS) REQUIRED IN CASE OF SURGERY?
Usually, a colostomy is not required. Only in cases where the tumor is in an advanced stage and necessitates complete rectal removal does a permanent colostomy become necessary. This event is nowadays very rare.
WHAT HAPPENS AFTER TREATMENT FOR ANAL CANCER?
It is essential to follow a precise follow-up protocol. Periodic visits, blood tests, and instrumental examinations are carried out to assess the appropriateness and effectiveness of the treatment.
WHAT ARE THE RESULTS OF TREATMENT?
As with most cancers, early diagnosis is associated with an excellent survival rate and complete recovery. Anal cancer responds well to a combination of chemotherapy and radiation therapy, even in cases of recurrence. Surgery may be necessary, but usually, patients recover with radio-chemotherapy.