Anal Cancer?

June 26, 12:14 PMPhoenix Women's Health ExaminerAngela Bowen

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Farrah Fawcett put a tragic face on a little known cancer with her determined battle from 2007-2009. AP file photo.

Yes Anal Cancer.  5,290 new cases and 710 deaths from anal cancer.  Farrah Fawcett tragically put a face on this cancer and has brought awareness of it to new light.  There are several risk factors that can lead to anal cancer and several different causes, but the leading culprit is HPV-16, a sexually transmitted disease.                

Women are slightly more likely to be diagnosed with anal cancer than men (60% of cases are diagnosed in women, 40% in men).  Women presenting with anal cancer typically have tumors beginning inside the anus, whereas men are more likely to develop the tumors outside the anus.  Because women are less likely to receive colorectal screenings than men, it is often more difficult to diagnose early in women.

Basics of Anal Cancer

Anal Tumors can be benign (non-cancerous), potentially cancerous or malignant (cancer).

Benign

·         Inflammatory polyps – abnormal  tissue from mucous membranes due to injury or infection

·         Lymphoid polyps – small amounts of lymph tissue (immune system tissues) can develop under the anal lining

·         Fibroepithelial polyps – “skin tags” are growths of connective tissue covered by squamous cells (cells of the skin)

·         Adnexal tumors - tumor starting in a hair follicle or sweat gland

·         Leiomyomas – abnormal growth of smooth muscle cells

·         Granular cell tumors – nerve cell tumors  

·         Hemangiomas – lining cells of the blood vessels developing into an abnormal growth

·         Lipomas – fat cell tumors

·         Schwannomas – nerve covering cells developing into an abnormal growth

Potentially malignant

·         Condylomas – anal warts cause by Human Papiloma Virus (HPV).  Most are benign, but some contain regions with the potential to develop into a malignant tumor.  If removed early, the risk of cancer is very low.

·         Squamous cell tumors – tumors of the outer layer of skin, also highly linked to HPV

Malignant

Anal cancers most often spread to the lungs and liver when they metastasize (become systemic cancers which are far more deadly and incurable).

·         Squamous  cell carcinomas (carcinoma in situ, CIS, Bowen Disease) – cancerous growth of Squamous cell tumors. 

·         Cloacogenic carcinoma – Squamaous cell cancer of the anus

·         Adenocarcinoma – cancer beginning in the anal glands

·         Melanomas, basal cell carcinoma – a rare location for skin cancer, unfortunately this is hard to detect and are usually found in later stages of progression.

Risk Factors for Anal Cancer

Human Papiloma Virus

Most squamous cell carcinomas (the most prevalent form of anal cancer) are linked to exposure to HPV, in particular the HOV-16 strain.  Most people who are infected with HPV do not develop genital warts, which are more likely to be found quickly and treated.

Sexual History

The more partners a woman has had, the more likely she is to have been exposed to many different strains of HPV, and the more likely she is to develop a disease related to HPV, such as anal and cervical cancers.  Condoms do not protect effectively against all strains of HPV, and most men are carriers without ever showing signs or symptoms of having HPV such as genital warts.  Also associated with sexuality is the frequency of anal sex, particularly under the age of 30.

Smoking

Smoking increases the risk of cancer.  Period.  People who quit smoking are very slightly more likely to get cancer than those who do not smoke, but both are significantly less likely to develop cancer than someone who smokes. 

Immune Deficiency

Immune deficiency can be caused by HIV or by immunosuppressant drugs prescribed as part of an organ transplant regimen.  This suppression potentially allows development of above mentioned growths which would normally not become cancerous as well as prevent effective HPV protection.

Detection, Treatment and Prognosis

Detection is absolutely necessary for early treatment and successful recovery.  Regular sexual health examinations, colorectal screening for men and women over the age of 50 and evaluation of risks for women over the age of 35 should be discussed with primary care doctors to ensure that preventative screenings are being performed regularly.  Anal cancer is rare, but can be very effectively treated when caught early with very likely recovery.  Common symptoms of anal cancer which should immediately be addressed with your doctor include:

-          Rectal itching

-          Rectal bleeding

-          Pain in the general rectal region

-          Abnormal discharge

-          Swelling in the anal or groin area

-          Changes in diameter of stool