Anal cancer: symptoms, causes and treatment

Definition of anal cancer

What is anal cancer?

Anal cancer or anal cancer is a type of cancer that develops in the anus or rectum. The anus is an opening located at the end of the large intestine, just below the rectum. All the waste products of human digestion in the form of feces come out of this organ.

Initially, the digested food will move from the stomach to the small intestine. Then, food moves from the small intestine to the large intestine. In this part, water and salt from the food will be absorbed. The rest will be disposed of as waste which is known as feces. Stool will be stored in the rectum and will be passed through the anus.

The inner lining of the anal canal is mucosa and most abnormal cells begin at this point. In addition, cancer is also found in the anal canal and the edge of the anus (perianal). In some cases, this disease can also originate from colorectal cancer that has spread.

How common is this condition?

Anal cancer is a type of cancer that is quite rare and most often affects people over 50 years of age. However, everyone has a different risk of this disease, not only based on age.

Types of anal cancer

Before knowing what types of cancer are, it helps to know that various types of tumors can grow in the anus, both benign and malignant.

1. The tumor is benign

Generally, benign tumors do not have the potential to turn into cancer cells. Here are some types of benign tumors that can grow in the anus:

• Polyps, small lumps found on the mucosa.
• Skin tags, in the form of connective tissue growth covered with squamous cells.
• Anal warts, grow on the outside and bottom of the anal canal.
• Adnexal tumors, benign lumps that grow on the hair follicles or sweat glands on the outside of the anus.
• Leiomyoma, a benign tumor that grows in smooth muscle cells.
• Hemangioma, grows on the cells of the anal blood vessel wall.
• Lipoma, grows on the fat cells of the anus.

2. The tumor is malignant

The buildup of cells in the anus also has the potential to become cancerous. This condition is calledpre-cancerous. This type of malignant tumor is also known as dysplasia.

Dysplasia of the anus can be divided into two, namely:

• Anal intraepithelial neoplasia (AIN) low levels, look like normal cells, the risk of turning into cancer cells is lower.
• Upper-level AIN, having different characteristics from normal cells, is easier to mutate into cancer cells.

Generally, cancer cells begin to develop in squamous cells. The following are the types of anal cancer depending on the type of body cell affected:

1. Squamous cell cancer

The most common type of anal cancer is squamous cell cancer. As many as 90% of anal cancer cases that occur are classified as squamous cell types. This type of cancer is also known as epidermoid cancer.

This type of cancer begins in the squamous cells, which are located in the walls of the anal canal and the border of the anus.

2. Non epidermoid cancer

The non-epidermoid type is a term used to describe other types of anal cancer, namely:

• Adenocarcinoma

This type of cancer is produced in the mucus-producing cells of the anal canal. Adenocarcinoma type cancer is very rare.

Adenocarcinoma usually appears on the apocrine glands, or glands that produce sweat, on the skin of the anus.

• Basal cell carcinoma

Basal cell carcinoma is a type of skin cancer. Its development begins in the area around the anus.

This type of basal cell carcinoma tumor appears more frequently in areas with a lot of sun exposure, such as the hands and face. Therefore, this type of cancer is actually rarely found in cases of anal cancer.

• Melanoma

Melanoma is also a very rare type of skin cancer. Its appearance begins in skin cells called melanocytes.

In this disease, melanoma usually appears on the skin or lining of the anal wall. However, the incidence rate is very low.

Signs & symptoms of anal cancer

Anal cancer sometimes causes no symptoms at all. However, bleeding in the rectum is an early sign of this disease. Blood is removed only a little, so it is often mistaken for hemorrhoids (hemorrhoids).

Common symptoms

However, the signs that cause symptoms are not only that. Generally, people with anal cancer feel the following signs and symptoms:

• Itching in or around the rectum.
• A lump in the anal canal.
• Pain in the anus and a lump sensation in the anal area.
• Constipation (difficult to defecate).
• Abnormal discharge from the anus.
• Difficulty controlling family stool (fecal incontinence).
• Swollen lymph nodes in the anal or groin area.

Every person is very likely to feel the symptoms differently. There are also those who feel the symptoms of cancer that are not mentioned above.

When to go to the doctor

You should visit your doctor immediately if you have any of the signs or symptoms above, especially if they feel unnatural and don't go away.

Causes of anal cancer

This disease arises and develops from a mutation or change in genes. Problematic genes will damage healthy cells and affect their function in the body.

Normal body cells should grow and reproduce naturally, then they will die and be replaced with new cells. However, the damaged cells will grow uncontrollably and continue to live.

This condition can lead to the appearance of cancer cells and tumors. Cancer cells will attack the surrounding tissue, even to other organs.

Quoted from the American Cancer Society, experts believe that the causes of anal cancer are closely related to sexually transmitted infections human papillomavirus (HPV). The HPV virus is found in the majority of anal problems that occur.

Therefore, infection with the HPV virus is thought to be the main cause of the development of anal cancer (anal).

Anal cancer risk factors

Anal cancer is a disease that can affect people of all ages. However, there are various factors that can increase the risk of developing this disease.

The following are risk factors for anal cancer:

• Increasing age

This disease is more common in adult and elderly patients, like cancer in general.

• Female gender

If you are female, your chances of getting this disease are greater than that of men.

• Have had or are currently suffering from cervical, vaginal, or vulvar cancer

If you have had any of these problems, your risk of developing anal cancer is also higher. This is thought to be closely related to HPV virus infection.

• Infection Human papillomavirus (HPV)

Both women and men who have the HPV virus in their bodies have the same chance of developing this disease. As many as 90% of cases of this disease are associated with infection with the HPV virus.

• Frequently changing sexual partners

You are more likely to get this disease if you have had sex with more than one person. This is due to the high risk of transmitting the HPV virus if you are sexually active.

• Weak immune system

A weak immune system can also increase your risk of developing this disease. In addition, people who have autoimmune diseases or have kidney transplants are also at risk of developing anal cancer.

Anal cancer diagnosis & treatment

The information described is not a substitute for medical advice. ALWAYS consult your doctor.

Some of the types of procedures that doctors perform to diagnose anal (anal) cancer are:

1. Examination of the anal canal and rectum

The doctor will perform an examination by touching or inserting a finger into your anus to detect mucus or lumps.

In addition, the doctor may also perform a visual examination with anoscopy of your anus.

2. Taking pictures of the anal canal

To take clear pictures, the doctor will use an ultrasound procedure by inserting a small tube into the anal canal.

3. Take a sample of anal tissue for examination

If the doctor suspects an abnormality in your anus, the doctor may perform a biopsy procedure. This procedure is done by taking tissue that is suspected of having cancer cells.

What are the treatment options for anal (anal) cancer?

Treatment for cancer is generally a combination of chemotherapy and radiation. With a combination of the two, the chances of cancer will disappear and the patient's chances of recovery are greater.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to kill the growth of cancer cells. These drugs can destroy or prevent cancer cells from multiplying again.

There are two types of chemotherapy for cancer, which include:

• Systemic chemotherapy

Medicines that are taken orally or injected into a vein enter the body's bloodstream and reach cancer cells.

• Regional chemotherapy

The drug is given directly in the cerebrospinal fluid of the body, organs, or parts of the body affected by cancer cells, for example the stomach.

The type of chemotherapy given depends on the type and stage of cancer you have. However, the most common drugs used in chemotherapy to treat anal (anal) cancer are:

• Carboplatin with paclitaxel (Taxol)
• 5-FU with cisplatin
• Oxaliplatin, Leucovorin and 5-FU
• Docetaxel (Taxotere), cisplatin and 5-FU
• Cisplatin, Leucovorin and 5-FU

Radiotherapy

Radiation therapy or radiotherapy uses X-rays and protons to kill cancer cells. During this therapy, it is possible that the radiation will damage healthy tissues in your body.

There are two types of radiation therapy for cancer, namely:

• External radiation therapy, using a machine that emits radiation from outside into the body.
• Internal radiation therapy, in which a radioactive substance is inserted into the body through a needle, seed, wire, or catheter.

The type of radiotherapy treatment that will be given depends on the type and stage of cancer you have.

Operation

Another treatment that is done to treat cancer is surgery. There are two types of surgery that doctors recommend:

• Local resection

In this procedure, the surgeon will remove the tumor and some of the healthy tissue around it from the anus. This procedure is performed at an early stage of the cancer and has not spread.

This procedure will not interfere with the function of the sphincter muscles (muscles openings in the body), so you can still control the urge to have a normal bowel movement.

• Abdominoperineal resection

Abdominoperineal resection is performed by removing the anus, rectum, and part of the large intestine.

The surgeon will sew the end of the intestine into the hole made in the stomach, so that stool or feces can collect in a bag outside the body. This process is called a colostomy.

It should be noted that cancer treatment therapy can potentially worsen the body's immune system in patients who have the HIV virus. Therefore, usually patients with HIV will be treated with lower doses of drugs and radiation.

Treatment of anal cancer at home

In addition to following treatment at the hospital, anal cancer patients are also expected to change their lifestyle according to cancer patients, namely:

• Maintain ideal body weight.
• Stay active by participating in sports and spending less time lying down.
• Follow a diet recommended by your doctor or nutritionist, such as increasing your consumption of fruits, vegetables, whole grains, and nuts. Reduce consumption of red meat, foods high in sugar, and preservative foods.
• It's best to stop drinking alcohol.

Anal cancer prevention

If you look at the causes and risk factors, the ways to prevent anal cancer that you can apply are:

• Get the HPV vaccine to prevent HPV infection in the body.
• Quit smoking and avoid cigarette smoke around.
• In HIV patients, it is mandatory to follow a doctor's treatment and increase their immunity by eating foods that are healthy for the body.
• Practice healthy sexual activity, such as not changing partners or using condoms.