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Anal Cancer

What is anal cancer?

Cancer describes a set of diseases in which a series of genetic changes affect normal cells in the body, causing the cells to lose the ability to control their growth and to respect their neighbors. As cancers grow, they invade the tissues around them (local invasion). They may also spread to other locations in the body via the blood vessels or lymphatic channels where they may implant and grow (metastases). Tumors, or growths in the body, may be benign or malignant (cancerous). When they are benign they may grow but they do not spread to other locations. Malignant tumors have the ability to invade deeply and to spread (metastasize).

Anal cancer arises from the cells around the anal opening (verge) or within the anal canal (1-2 inches long) up to its junction with the rectum. Most anal cancers arise from skin cells and are called squamous cell carcinomas. Some arise from the special mucosal cells lining the upper anal canal and are called cloacogenic carcinomas. Although several other types of cancer may occur in this area, these two are the most common. They behave similarly and are treated in the same fashion. Cells that are becoming malignant but have not invaded below the surface are "pre-cancerous" (carcinoma-in-situ). This condition is called Bowen's disease.

How common is anal cancer?

Anal cancer is fairly uncommon. It accounts for about 1-2% of gastrointestinal cancers. About 3,400 new cases of anal cancer are diagnosed each year in the U.S.A., and about 500 people will die of the disease each year. This may be compared to 140,000 new cases of colorectal cancer with 50,000 deaths per year.

Who is at risk?

We do not know the exact cause of most anal cancers. But we do know that certain risk factors are linked to anal cancer. A risk factor is something that increases a person's chance of getting a disease.

  • Age - Most people with anal cancer are over 50 years old.
  • Anal warts - Infection with the human papilloma virus (HPV) which causes condyloma (warts) may increase the chance of developing anal cancer.
  • Anal sex - Persons who participate in anal sex are at an increased risk.
  • Smoking - Harmful chemicals from smoking increase the risk of most cancers including anal cancer.
  • Immunosuppression - People with weakened immune systems, such as transplant patients who must take drugs to suppress their immune systems and patients with HIV (human immunodeficiency virus) infection, are at a somewhat higher risk.
  • Chronic local inflammation - People with long-standing anal fistulas or open wounds are at a slightly higher risk.
  • Pelvic radiation - People who have had pelvic radiation therapy for rectal, prostate, bladder or cervical cancer are at an increased risk.

Can anal cancer be prevented?

Few cancers can be totally prevented but your risk may be decreased significantly by reducing your risk factors and by getting regular checkups. Avoid anal sex and infection with HPV and HIV. Use condoms whenever having any kind of intercourse. Although condoms do not eliminate the risk of infection, they do reduce it. Stopping smoking lowers the risk of many types of cancer, including anal cancer.

What are the symptoms of anal cancer?

Many cases of anal cancer can be found early. Anal cancers form in a part of the digestive tract that the doctor can see and reach easily. Anal cancers often cause symptoms such as:

  • Bleeding from the rectum or anus
  • The feeling of a lump or mass at the anal opening
  • Pain in the anal area
  • Persistent or recurrent itching
  • Change in bowel habits (having more or fewer bowel movements) or increased straining during a bowel movement
  • Narrowing of the stools
  • Discharge (mucous or pus) from the anus
  • Swollen lymph nodes (glands) in the anal or groin areas.

These symptoms can also be caused by less serious conditions such as hemorrhoids but you should never assume this. If you have any of these symptoms, see your doctor.

How is anal cancer diagnosed?

Finding cancers early is the key to cure. Regular checkups with a digital (finger) exam of the rectum and anus will find many problems which are easy to treat when found early. Routine screening for colorectal and anal cancer in people without any symptoms includes a digital rectal exam and test for blood in the stool yearly and a flexible endoscopy exam (lighted probe) every 5-10 years starting at 50 years of age.

If anal cancer is suspected based on your doctor’s exam, a biopsy will be performed to confirm the diagnosis. If the diagnosis of cancer is confirmed, additional tests to determine the extent of the cancer may be recommended.

How are anal cancers treated?

Treatment for most cases of anal cancer is very effective. There are three basic types of treatment used for anal cancer:

  • Surgery – an operation to remove the cancer
  • Radiation therapy – high-dose x-rays to kill cancer cells, and
  • Chemotherapy – giving drugs to kill cancer cells.

Combination therapy including radiation therapy and chemotherapy is now considered the standard treatment for most anal cancers. Occasionally a very small or early tumor may be removed surgically (local excision), with minimal damage to the anal sphincter muscles.

Will I need a colostomy?

The majority of patients treated for anal cancer will not need a colostomy. If the tumor does not respond completely to combination therapy, if it recurs after treatment, or if it is an unusual type, an abdominoperineal resection (APR) removal of the rectum and anus and creation of a colostomy may be necessary.

What happens after treatment for anal cancer?

Follow-up care to assess the results of treatment and to check for recurrence is very important. Most anal carcinomas are effectively treated. In addition, many tumors that recur may be successfully treated if they are caught early. A careful examination by an experienced physician at regular intervals is the most important method of follow-up. Additional studies may be recommended. You should report any symptoms or problems to your doctor right away.

Conclusion

Anal cancers are unusual tumors arising from the skin or mucosa of the anal canal. As with most cancers, early detection is associated with excellent survival. Most tumors are well treated with combination chemotherapy and radiation. Recurrences may often be treated successfully. Follow the recommended screening examinations for anal and colorectal cancer and consult your doctor early when any anorectal symptoms occur.

Colorectal Cancer

Colorectal cancer is the second most common cancer in the United States, striking 140,000 people annually.. and causing 60,000 deaths. That's a staggering figure when you consider the disease is potentially curable if diagnosed in the early stages.

Who is at risk?

Though colorectal cancer may occur at any age, more than 90% of the patients are over age 40, at which point the risk doubles every ten years. In addition to age, other high risk factors include a FAMILY history of colorectal cancer and polyps and a PERSONAL history of ulcerative colitis, colon polyps or cancer of other organs, especially of the breast or uterus.

How does it start?

It is generally agreed that nearly all colon and rectal cancer begins in benign polyps. These pre-malignant growths occur on the bowel wall and may eventually increase in size and become cancer. Removal of benign polyps is one aspect of preventive medicine that really works!

What are the symptoms?

The most common symptoms are rectal bleeding and changes in bowel habits, such as constipation or diarrhea. (These symptoms are also common in other diseases so it is important you receive a thorough examination should you experience them.) Abdominal pain and weight loss are usually late symptoms indicating possible extensive disease.

Unfortunately, many polyps and early cancers fail to produce symptoms. Therefore, it is important that your routine physical includes colorectal cancer detection procedures once you reach age 40. Those detection methods are a digital rectal exam and a chemical test of stool for blood. A sigmoidoscopy - the inspection of the lower bowel with a lighted tubular instrument - should be part of routine physical check-ups.

How is colorectal cancer treated?

Colorectal cancer requires surgery in nearly all cases for complete cure. Radiation and chemotherapy are sometimes used in addition to surgery. Between 80-90% are restored to normal health if the cancer is detected and treated in the earliest stages. The cure rate drops to 50% or less when diagnosed in the later stages. Thanks to modern technology, less than 5% of all colorectal cancer patients require a colostomy, the surgical construction of an artificial excretory opening from the colon.

Can colon cancer be prevented?

There are steps that reduce the risk of contracting the disease. One way is having benign polyps removed by an outpatient procedure called colonoscopy. In addition to removing the polyps, the long flexible tubular instrument used in the procedure provides a more thorough bowel examination.

Though not definitely proven, there is some evidence that diet may play a significant role in preventing colorectal cancer. As far as we know, a high fiber, low fat diet is the only dietary measure that might help prevent colorectal cancer.

Finally, you must be aware of changes in your bowel habits and make sure bowel examinations are included in routine physicals once you fall under the "high risk" category.

Can hemorrhoids lead to colon cancer?

No, but hemorrhoids may produce symptoms similar to colon polyps or cancer. Should you experience these symptoms, you should have them examined and evaluated by a physician, preferably by a colon and rectal surgeon.

da Vinci® Colorectal Surgery

For rectal cancer, surgeons perform low anterior resection (LAR) to connect the rectum to the colon after removing the cancer. An abdominoperineal resection (APR) may also be performed if the rectal cancer is located too close to the anus.

Colorectal procedures are usually performed via traditional open surgery, meaning a large open abdominal incision is made from the pubic bone to just below the breastbone. While open surgery can provide an effective treatment for colorectal cancer, it often involves significant trauma and a long recovery.

Laparoscopic surgery is a minimally invasive alternative to open surgery. However, this approach is considered to be technically challenging due to the extensive dissection required, along with the limitations of traditional laparoscopic technology.

da Vinci® Surgery: A Less Invasive Surgical Procedure

If your doctor recommends colorectal surgery, ask about minimally invasive da Vinci® Surgery. State-of-the-art da Vinci® requires just a few tiny incisions so you can recover, move on to additional treatment, if needed, and get back to your life.

When compared to open surgery, da Vinci® Surgery offers the following potential benefits:

  • Excellent cancer control
  • Low rate of complications
  • Fast return to a normal diet
  • Short hospital stay
  • Fast return of bowel function
  • Fast recovery

da Vinci® Surgery offers many benefits over traditional laparoscopic surgery including:

  • Excellent outcomes for cancer control
  • Fewer complications
  • Faster return to a normal diet
  • Faster recovery

Every surgery is unique to each patient and procedure, therefore benefits cannot be guaranteed.


Learn More about da Vinci® Robotic Colorectal Surgery

If you are a candidate for colorectal surgery, talk to an EvergreenHealth surgeon who performs da Vinci® colorectal surgery. To find a surgeon, you can:

  • Search our Find a Doctor for Robotic Surgery - Colorectal.
  • Call the EvergreenHealthline at 425.899.3000 and press "1" at the prompt.

For additional information on the da Vinci robotic colorectal surgery:

As with any surgery, these benefits cannot be guaranteed, as surgery is both patient- and procedure-specific. While gallbladder surgery performed using the da Vinci Surgical System is considered safe and effective, this procedure may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

Robotic Colorectal Surgery

For rectal cancer, surgeons perform low anterior resection (LAR) to connect the rectum to the colon after removing the cancer. An abdominoperineal resection (APR) may also be performed if the rectal cancer is located too close to the anus.

Colorectal procedures are usually performed via traditional open surgery, meaning a large open abdominal incision is made from the pubic bone to just below the breastbone. While open surgery can provide an effective treatment for colorectal cancer, it often involves significant trauma and a long recovery.

Laparoscopic surgery is a minimally invasive alternative to open surgery. However, this approach is considered to be technically challenging due to the extensive dissection required, along with the limitations of traditional laparoscopic technology.

da Vinci® Surgery: A Less Invasive Surgical Procedure

If your doctor recommends colorectal surgery, ask about minimally invasive da Vinci® Surgery. State-of-the-art da Vinci®  requires just a few tiny incisions so you can recover, move on to additional treatment, if needed, and get back to your life.

When compared to open surgery, da Vinci® Surgery offers the following potential benefits:

  • Excellent cancer control
  • Low rate of complications
  • Fast return to a normal diet
  • Short hospital stay
  • Fast return of bowel function
  • Fast recovery

da Vinci® Surgery offers many benefits over traditional laparoscopic surgery including:

  • Excellent outcomes for cancer control
  • Fewer complications
  • Faster return to a normal diet
  • Faster recovery

Every surgery is unique to each patient and procedure, therefore benefits cannot be guaranteed.

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