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WHAT ARE SYMPTOMS OF ANAL CANCER

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Anal cancer is a rare kind of cancer that affects the very end of the large bowel.

Less than 1,200 people are diagnosed with cancer of the anus each year in the UK.

What are symptoms of anal cancer

The symptoms of anal cancer are often comparable to more common and less serious conditions affecting the anus, such as piles (haemorrhoids) and anal fissures(small tears or sores).

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Symptoms of anal cancer can be inclusive of:

  • bleeding from the bottom (rectal bleeding)
  • itching and pain around the anus
  • small lumps around the anus
  • a discharge of mucus from the anus
  • loss of bowel control (bowel incontinence)

However, some people with anal cancer do not have any symptoms.

See your caregiver if you develop any of the above symptoms. While they’re unlikely to be caused by anal cancer, it’s best to get them checked out.

Diagnosing anal cancer

Your caregiver will usually ask about your symptoms and carry out some examinations.

They may feel your tummy and perform a rectal examination. This involves your doctor putting a gloved finger into your bottom so they can feel any abnormalities. Your caregiver will refer you to hospital if they feel further tests are necessary.

The National Institute for Health and Care Excellence (NICE) recommended in its 2015 guidelines that caregivers should consider referring someone with an unexplained anal lump or anal ulcer. The person should get an appointment within two weeks.

If you’re referred to hospital, a number of different tests may be performed to check for anal cancer and rule out other conditions.

Some of the tests you may have include a:

  • sigmoidoscopy – where a thin, flexible tube with a small camera and light is put into your bottom to check for any abnormalities
  • proctoscopy – where the inside of your rectum is inspected using a hollow tube-like instrument (proctoscope) with a light on the end
  • biopsy – where a small tissue sample is removed from your anus during a sigmoidoscopy or proctoscopy so it can be examined in a laboratory under a microscope

If these tests suggest you have anal cancer, you may perform some scans to check whether the cancer has spread. Once these are done, your doctors will be able to “stage” the cancer. This means giving it a score to describe how large it is and how far it has spread.

How anal cancer is treated

If you’re diagnosed with anal cancer, you’ll be taken care of by a multidisciplinary team. This is a team of different specialists who work together to offer the best treatment and care.

The main treatments used for anal cancer are:

  • chemoradiation – a combination of chemotherapy and radiotherapy  surgery – to remove a tumour or a larger section of bowel

In conditions where the cancer has spread and can’t be cured, chemotherapy alone may be considered to assist relieve symptoms. This is known as palliative care..

The main treatments are described in more detail below.

Chemoradiation

Chemoradiation is a treatment that adds chemotherapy (cancer-killing medication) and radiotherapy (where radiation is used to kill cancer cells). It’s currently the most effective treatment for anal cancer. You don’t usually have to stay in hospital when you’re having chemoradiation.

Chemotherapy for anal cancer is usually offered in two cycles, each lasting four to five days, with a four-week gap between the cycles. In many cases, part of the chemotherapy is given through a small tube called a peripherally inserted central catheter (PICC) in your arm, which can stay in place until your treatment has completed.

The tube means you don’t have to stay in hospital during each of the cycles of chemotherapy. However, you’ll be attached to a small plastic pump, which you take home with you.

A few hospitals now give tablet chemotherapy for anal cancer, which avoids the need for the pump and PICC.

Radiotherapy is usually offered in short sessions, once a day from Monday to Friday, with a break at weekends. This is usually carried out for five to six weeks. To prepare for radiotherapy, additional scans will be needed.

Both chemotherapy and radiotherapy often cause considerable side effects, including:

  • tiredness
  • sore skin around the anus
  • sore skin around the penis and scrotum in men or vulva in women
  • hair loss – reduced hair loss from the head, but total loss from the pubic area
  • feeling sick
  • diarrhea

These side effects are often temporary, but there’s also a risk of longer-term problems, such as infertility. If you’re bothered about the potential side effects of treatment, you should discuss this with your care team before treatment begins.

Other possible long-term side effects can include:

  • bowel control problems
  • long-term (chronic) diarrhoea
  • erectile disfunction
  • vaginal pain when having sex
  • dry and itchy skin around the groin and anus
  • bleeding from the anus, rectum, vagina or bladder

Tell your doctor if you observe any of these symptoms so they can be investigated and treated.

Surgery

Surgery is a less common treatment option for anal cancer. It’s often only considered if the tumour is small and can be easily removed, or if chemoradiation hasn’t worked.

If the tumour is very small and clearly defined, it may be cut out during a procedure called a local excision. This is a relatively simple procedure, performed under general anaesthetic, that usually only needs a stay in hospital of a few days.

If chemoradiation has been unsuccessful or the cancer has returned after treatment, a more complex operation known as an abdominoperineal resection may be recommended. As with a local excision, this operation is peformed under general anaesthetic.

An abdominoperineal resection involves removing your anus, rectum, part of the colon, some surrounding muscle tissue, and sometimes some of the surrounding lymph nodes (small glands that form part of the immune system) to lower the risk of the cancer returning. You’ll usually be required to stay in hospital for up to 10 days after this type of surgery.

During the operation, a permanent colostomy will also be formed to allow you to pass stools. This is where a section of the large intestine is diverted through an opening made in the abdomen known as a stoma. The stoma is attached to a special pouch that will collect your stools after the operation.

Before and after the operation, you will see a specialist nurse who can offer support and advice to help you adapt to life with a colostomy. Adjusting to life with a colostomy can be hard, but most people become accustomed to it over time.

Follow-up

After your course of treatment ends, you will need to have regular follow-up appointments to monitor your recovery and check for any signs of the cancer returning.

To start with, these appointments will be every few weeks or months, but they’ll gradually become less frequent over time.

What causes anal cancer

The exact cause of anal cancer is yet unknown, although a number of factors can increase your risk of developing the condition. These include:

  • infection with human papiloma virus()HPV – a common and usually harmless group of viruses passed through sexual contact, which can affect the moist membranes lining your body
  • having anal sex or lots of sexual partners – possibly since this increases your risk of developing HPV
  • having a history of cervical,vaginal,vulval cancer
  • smoking
  • having a weakened immune system – for example, if you have HIV

Your risk of developing anal cancer increases as you get older, with half of all cases diagnosed in people aged 65 or over. The condition is also slightly more common in women than men.

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