Anal Cancer Treatment in Noida, Delhi, India

Overview Anal cancer is a rare type of cancer that develops in the tissues of the anus, which is the final part of the gastrointestinal tract. Measuring about 1-1/2 inches in length, the anus connects the rectum to the outside of the body, allowing solid waste to pass. Anal cancer occurs when there is an uncontrollable growth of cells in this region, leading to the formation of a tumor. These tumors can be either benign, which means they do not spread to other parts of the body, or malignant, which are cancerous and can spread. Although uncommon, anal cancer can be effectively treated with a combination of therapies if detected early.

Types of Anal Cancer Anal cancer can originate from different types of cells within the anal canal. The main types include:

1. Squamous Cell Carcinoma: This is the most common form of anal cancer, originating from the squamous cells that line the anal canal. Rapid growth in these cells leads to tumor formation.
2. Cloacogenic Carcinoma: Also known as transitional cell carcinoma, this type develops in the transitional area between the outer part of the anus and the lower rectum.
3. Basal Cell Carcinoma: A rare form of cancer that typically affects areas of the skin exposed to the sun, including the skin around the anus.
4. Melanoma: This type of anal cancer arises from pigment-producing cells (melanocytes) found in the skin or the lining of the anus.
5. Adenocarcinoma: Another rare type, this cancer develops in the glandular cells of the anal canal, which are responsible for mucus production.
6. Squamous Cell Carcinoma in Situ (Bowen’s Disease): This is a non-invasive type of cancer affecting the surface layer of the anal canal.

Symptoms of Anal Cancer The symptoms of anal cancer can vary but often include:

1. Anal Bleeding: One of the most common signs of anal cancer.
2. Pain Around the Anus: Discomfort or pain in the anal area.
3. Changes in Bowel Habits: This includes constipation, diarrhea, or changes in stool consistency.
4. Thin Stool: A change in the shape or size of the stool.
5. Discharge or Itching: Unusual discharge from the anus or persistent itching.
6. Swelling or Lump: A noticeable lump or swelling near the anus.

Causes of Anal Cancer The exact cause of anal cancer remains unknown. However, it is believed to develop when abnormal cells in the anus acquire mutations in their DNA, causing them to grow uncontrollably. These abnormal cells can form a tumor, which may invade and destroy healthy tissue. Anal cancer has also been closely linked to sexually transmitted infections like Human Papillomavirus (HPV) and Human Immunodeficiency Virus (HIV), with HPV being a significant cause.

Diagnosis of Anal Cancer The diagnosis of anal cancer typically involves several tests and procedures, including:

1. Digital Rectal Exam: A physical examination where the doctor feels the inside of the rectum to check for lumps or abnormalities.
2. Biopsy: A sample of tissue is taken from the affected area to be examined under a microscope for cancer cells.
3. Ultrasound: Imaging test using sound waves to create a picture of the inside of the anus.
4. X-ray: Basic imaging to check for abnormalities.
5. CT Scan: Detailed imaging to assess the extent of cancer.
6. MRI: Advanced imaging to evaluate soft tissues and detect the spread of cancer.
7. Positron Emission Tomography (PET) Scan: A type of imaging that shows how tissues and organs are functioning.
8. Anal Papanicolaou (Pap) Test: A procedure to collect and examine cells from the anus for cancerous changes.

Stages of Anal Cancer Anal cancer is classified into stages, ranging from Stage 0 to Stage IV, depending on the extent of cancer spread:

• Stage 0: Abnormal cells are found in the innermost layer of the anus. This stage is also called high-grade squamous intraepithelial lesion (HSIL).
• Stage I: The tumor is 2 centimeters or smaller and confined to the anus.
• Stage II: The tumor is larger than 2 centimeters but has not spread to lymph nodes or distant sites.
• Stage III: Cancer has spread to nearby lymph nodes and organs. It can be further classified as:
  • Stage IIIA: Spread to nearby organs such as the anus or groin.
  • Stage IIIB: Spread to more distant organs like the bladder, urethra, or vagina.
  • Stage IIIC: Extensive spread to nearby organs and lymph nodes.
• Stage IV: The most advanced stage, where cancer has spread to distant parts of the body.

Treatment for Anal Cancer The treatment for anal cancer varies based on the stage and severity of the disease. Common treatments include:

1. Radiation Therapy: This involves using high-energy X-rays or protons to target and kill cancer cells. The therapy is usually delivered over several sessions, depending on the stage of cancer.
2. Chemotherapy: Chemotherapy uses drugs to destroy cancer cells throughout the body. Often, a combination of chemotherapy drugs is administered intravenously.
3. Surgery: Surgery may be recommended in advanced cases or when other treatments are ineffective. Types of surgery include:
   • Abdominoperineal Resection: The removal of the anus, rectum, and part of the bowel through incisions in the abdomen and around the anus. It often requires a permanent colostomy.
   • Colostomy: A surgical procedure where a stoma (opening) is created in the abdomen, and one end of the colon is brought through it to allow stool to be collected in a colostomy bag.

Risk Factors for Anal Cancer Certain factors can increase the risk of developing anal cancer, including:

1. HPV Infection: A significant risk factor, with most squamous cell carcinoma cases linked to HPV.
2. Smoking: Smokers are at a higher risk of developing anal cancer.
3. Other Cancers: A history of other cancers in the abdominal area, such as cervical, vaginal, or penile cancer, increases the risk.
4. HIV Infection: Individuals with HIV are more susceptible to anal cancer.
5. Weak Immune System: A compromised immune system makes the body more vulnerable to cancer.
6. Sexual Activity: Receptive anal sex and having multiple sexual partners increase the risk.
7. Gender and Race: Anal cancer is more common in white women and African men.

Prevention of Anal Cancer While there is no guaranteed way to prevent anal cancer, the following steps can reduce the risk:

1. Use Protection: Practicing safe sex reduces the risk of HPV and HIV, both linked to anal cancer.
2. Quit Smoking: Stopping smoking lowers the risk of many cancers, including anal cancer.
3. Get Vaccinated: Vaccination against HPV can prevent infections that may lead to anal cancer.

Care After Treatment After treatment for anal cancer, follow-up care is crucial for recovery and monitoring:

1. Regular Follow-Up: Frequent check-ups and tests are necessary for at least two years post-treatment to detect any signs of recurrence or side effects from treatment.
2. Support Services: Patients may benefit from regular visits to psychologists, recreation therapists, dietitians, and other specialists to support recovery.

Outlook The prognosis for anal cancer largely depends on the stage at which it is diagnosed. Early-stage cancers have a much better prognosis, with a higher likelihood of successful treatment. Advanced stages require more intensive treatment and have a more guarded outlook.

Last Update Reviewed by Dr. Vishal Bansal, Senior Consultant – Surgical Oncology, on 19-May-2024.