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Examining the risk factors for anal cancer
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The anus is the lowermost portion of the bowel; it connects the lower intestines to the outside world. The anus is lined by special skin and surrounded by a muscle, called the anal sphincter, which controls the passage of stool and gas.
Anal cancer involves the skin that lines the anus. Like cervical cancer, anal cancer is almost always due to an infection with HPV, the human papilloma virus, which is acquired through sexual transmission. While anal cancer is rare, Farrah Fawcett's recent passing from the disease serves as a potent reminder that this diease can be fatal.
STDs like gonorrhea or herpes are generally limited to one area of the genital tract; however, HPV produces what is known as a field effect, in layman’s terms this means it gets everywhere. When a woman or man is infected with HPV all of the skin of the lower genital tract is potentially at risk. Some HPV strains are benign and only cause warts, while others can lead to cancer.
HPV is ubiquitous - any one who has ever been sexually active is at risk. By the age of 25 approximately 75% of the population has been exposed to one or more HPV strains. For most people the virus is rapidly identified and contained by the immune system so it is transient and causes no significant health consequences.
What are the risk factors for anal cancer?
· Multiple sexual partners – the more partners the greater the likelihood of exposure to one of the cancer causing HPV strains.
· Receptive anal intercourse - while HPV introduced anywhere on the external genitals can lead to anal cancer receptive anal intercourse can inoculate the anal tissues with a higher viral load.
· A history of genital warts - while warts do not become cancer because they are due to the non-cancer causing HPV strains, STDS travel in packs. Therefore exposure to a benign wart-causing HPV strain increases the likelihood of exposure to a cancer causing one as well.
· A suppressed immune system - the body is less able to contact the virus so it is more likely to progress to cancer
· Smoking - toxins damage the immune system and the carcinogens accelerate tumor growth
Signs and symptoms of anal cancer include anal itching, bleeding, or a lump. These symptoms shouldn’t immediately cause panic as they may be due to a whole host of benign problems such as hemorrhoids, an allergic reaction, or a skin condition. However, if they do not get better with therapy screening for anal cancer may be indicated.
The good news is anal cancer is slow growing. It takes years for HPV to become a pre-cancer and then several more for it to become cancerous, although this progression is much faster in people with immune deficiencies. Persistent symptoms, especially in high-risk individuals, should be evaluated with high-resolution anoscopy, a careful exam of the anal tissues with a special microscope. A health care professional skilled in the technique should perform the exam. We are very fortunate in the Bay Area to have one of the more experienced units for screening and diagnosing anal cancer at UCSF.
What can you do to prevent anal cancer? Practice safe sex, if you are a woman get the HPV vaccine, and most importantly seek the right care if you have persistent anal symptoms.
For more info: check out the UCSF web site.
Remember, this column does not constitute individual medical advice
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