Risk Factors

Doctors can't always explain why one person gets anal cancer and another doesn't. However, certain risk factors may make a person more likely than others to develop anal cancer. A risk factor is something that may increase the chance of getting a disease.

Having a risk factor does not mean that a person will get anal cancer. Many people who get anal cancer have none of these risk factors, and many people who have known risk factors never get cancer. A person who has one or more of these risk factors should talk with his or her doctor about cancer risk.

Risk factors for anal cancer include the following:

• Being infected with human papillomavirus (HPV)
• Being over 50 years old
• Frequent anal redness, swelling, and soreness
• Having anal fistulas (abnormal openings)
• Having many sexual partners
• Having receptive anal intercourse (anal sex)
• Smoking cigarettes

Symptoms

Anal cancer may cause these common symptoms:

• A change in bowel habits
• A lump near the anus
• Bleeding from the anus or rectum
• Itching or discharge from the anus
• Pain or pressure in the area around the anus

Most often, these symptoms are not due to cancer. A person with these symptoms should tell his or her doctor so any health problems can be diagnosed and treated as early as possible.

Screening and Diagnosis

Men and women are encouraged to get regular screenings for cancers of the colon, rectum, and anus. Read about cancer screening guidelines here.

If symptoms suggest anal cancer, the doctor will try to find out what's causing the problem. The doctor may order one or more of the following tests:

• Physical exam and history: The doctor will check for signs of disease, such as lumps or anything else that seems unusual.
• Digital rectal examination (DRE): The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual.
• Anoscopy: The doctor uses a short, lighted tube called an anoscope to look at the anus and lower rectum.
• Proctoscopy: The doctor uses a short, lighted tube called a proctoscope to look at the rectum.
• Endo-anal or endorectal ultrasound: The doctor places an ultrasound transducer (probe) into the anus or rectum. The probe sends out sound waves that bounce off tissues and internal organs. A computer creates a picture from the echoes.
• Biopsy: The doctor removes tissue from the anus and sends it to a lab. If an abnormal area is seen during the anoscopy, a biopsy may be done at that time. The doctor in the lab looks at the tissue under a microscope. The removal of tissue to look for cancer cells is called a biopsy. In most cases, a biopsy is the only sure way to tell whether cancer is present.

Staging

If anal cancer is diagnosed, the doctor needs to learn the extent (stage) of the disease to help choose the best treatment.

Staging is a careful attempt to find out the following:

• How deeply the cancer has invaded the walls of the anus
• Whether the cancer has invaded nearby tissues
• Whether the cancer has spread, and if so, to what parts of the body

The doctor may order one or more of these staging tests:

• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of the inside of the pelvis and abdomen. The patient may receive contrast material by mouth or by injection into a blood vessel. The contrast material makes abnormal areas easier to see.
• Chest x-ray: An x-ray of the organs and bones inside the chest.
• Endo-anal or endorectal ultrasound: The doctor places an ultrasound transducer (probe) into the anus or rectum. The probe sends out sound waves that bounce off tissues and internal organs. A computer creates a picture from the echoes.

Stages of Anal Cancer

Stage 0: The cancer cells are found only in the innermost lining of the anus. The doctor may call this carcinoma in situ.

Stage I: The tumor is 2 centimeters or smaller.

Stage II: The tumor is larger than 2 centimeters.

Stage III: The cancer has spread to lymph nodes near the rectum, lymph nodes in the pelvis, or to nearby organs.

Stage IV: The cancer has spread to distant organs.

Treatment

At Huntsman Cancer Institute, anal cancer is treated by a team of specialists, including gastroenterologists (doctors who specialize in treating problems of the digestive organs), surgeons, medical oncologists (doctors who treat cancer with medicine), radiation oncologists (doctors who treat cancer with radiation), nurses, dietitians, and social workers.

Common treatment options for anal cancer include the following:

• Surgery
• Chemotherapy
• Radiation therapy
• Clinical trials

A patient may have a combination of treatments. The treatment that's right for each patient depends on many factors:

• The size of the tumor
• Where the tumor is in the anus
• Whether the cancer has spread to lymph nodes or other parts of the body
• Whether or not the patient is infected with the human immunodeficiency virus (HIV)
• The patient's age and general health

The health care team can describe all of the treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may even change from one treatment session to the next.

Having HIV can affect treatment of anal cancer. Cancer therapy can further damage the already weakened immune systems of patients who have the virus. For this reason, patients who have anal cancer and HIV are usually treated with lower doses of anticancer drugs and radiation than patients who do not have HIV.

Surgery

There are different types of surgery for anal cancer. The type depends mainly on where the cancer is located and how large the tumor is.

Common types of surgery for anal cancer include the following:

• Local resection: The surgeon cuts the tumor out of the anus, along with some of the healthy tissue around it. This procedure may save the sphincter muscles so the patient can still control bowel movements. Local resection may be used if the cancer is small, has not spread, and is located in the lower part of the anus.
• Abdominoperineal resection: The surgeon makes an incision in the abdomen and removes the anus, rectum, and part of the sigmoid colon. The surgeon sews the end of the intestine to an opening, called a stoma, made in the surface of the abdomen so body waste can be collected in a disposable bag outside of the body. This is called a colostomy. Lymph nodes that contain cancer may also be removed during this surgery.

Chemotherapy

Chemotherapy uses drugs to kill and control cancer cells. Learn more about this treatment in our introduction to chemotherapy video.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. Radiation therapy only affects cells in the treated area.

Doctors use two types of radiation therapy to treat anal cancer. Some people receive both types:

• External radiation: The radiation comes from a large machine outside the body. The machine aims beams of radiation at the cancer. Patients go to a hospital or clinic for treatment. This type of treatment uses computers to closely target the cancer, which protects healthy tissue near the anus.
• Internal radiation therapy (brachytherapy): The radiation comes from radioactive material usually contained in very small implants called seeds. The seeds are put near or directly into the cancer, using thin plastic tubes.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or any questions regarding research studies. For more information, also visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, work, or normal daily life.

There are several places you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services offer emotional support and resources for coping with cancer and its impact on daily life to HCI patients and their families.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers many programs to increase the quality of life and well-being of HCI patients and their families.