Anal cancer or an anal carcinoma is a malignant tumor in the area of the anal canal, which is about six centimeters long. Anal carcinoma is very rare, and women are affected by it far more often than men. If detected early, anal carcinoma is easily curable.
What is anal carcinoma?
Anal cancer or an anal carcinoma is a malignant tumor in the area of the anal canal, which is about six centimeters long. The anal canal is the term used to describe the area of the intestine, a few centimeters long, where the colon joins the anus. This area – unlike the rest of the intestine – is very sensitive and anatomically complicated. The protective mucosa of the rectum slowly disappears and merges with the skin of the anus. Usually, anal carcinoma is classified in the group of colon tumors. In terms of its biology and response to therapy, anal carcinoma is more similar to skin cancer.
Causes
Untreated infections are considered the main cause of the development of anal carcinoma. Mechanical stresses on the anal canal also massively increase the risk of developing the disease. Fistulas or fissures, i.e. changes or small, painful tears in the tissue, also contribute to the development of anal carcinoma. Condylomas are seen as another cause. Condylomas are benign growths caused by HP viruses 16 and 18. HPV is usually transmitted to the affected areas through sexual intercourse. Genetic susceptibility, poor nutrition, and other typical cancer-causing causes, such as smoking or excessive consumption of alcohol, have not yet been confirmed as causes of anal carcinoma.
Typical symptoms and signs
- Blood in the stool
- Pain during defecation
- Anal itching (itching at the anus)
- Irregular bowel movements
Diagnosis and course
Self-diagnosis is difficult because the initial symptoms can easily be mistaken for symptoms of hemorrhoids. These symptoms include pain during bowel movements, blood in the stool, increased itching around the anus, fecal incontinence, or abnormally shaped stools. If these symptoms occur, a doctor will first rule out hemorrhoids. If the doctor cannot, he will first perform a thorough physical examination. He will palpate the anal canal with his finger. An experienced doctor will detect anal carcinoma by means of this palpation examination. If the initial suspicion of anal carcinoma is confirmed, this is followed by an endoscopy of the rectum. Smaller tumors are removed directly. In addition, the stage of the cancer, whether it has affected other organs and the size of the individual foci are clarified. The chances of recovery from anal carcinoma are very good, provided that the cancer was detected early and has not yet metastasized. The 5-year survival rate is about 80%, in the case of anal carcinoma in the anus area even 90%. In the course of subsequent rehabilitation, a patient learns to live with the consequences of his disease. Unfortunately, many patients suffer from radiation damage, i.e. burns in the area of the lower abdomen, fecal incontinence or even an artificial bowel outlet that remains permanently.
Complications
Tumors on the anal verge are usually surgically removed and thus cured. This is especially true if the tumors are superficial. Complications are rare in these cases. Other anal tumors are usually treated with combined radiochemotherapy. This involves radiotherapy of the tumor and the lymph nodes in the pelvis and groin. At the same time, the patient undergoes chemotherapy. However, the cytostatic drugs used in this process have a toxic effect not only on cancer cells, but on all rapidly dividing cells. The complications that regularly occur during the treatment of anal cancer are therefore often side effects of the chemotherapy. Hair loss, nail damage and mucous membrane problems are common. In addition, fatigue, exhaustion, nausea and depression are often observed. In women, premature onset of menopause is possible. The cytostatic drugs can also affect blood formation in the bone marrow. Whether and to what extent these complications occur depends on the dosage and the individual disposition of the patient.Although treatment today is much gentler than it was a few years ago, irradiation of the affected areas can also lead to complications. Sometimes diarrhea and severe discomfort during urination occur. Furthermore, skin inflammations in the anal area occur. However, these side effects are usually not permanent and subside several weeks after the end of radiotherapy. In cases where combined radiochemotherapy is ineffective, the creation of an artificial bowel outlet is usually required.
When should you see a doctor?
Anal carcinoma is a malignant tumor that requires immediate treatment. A visit to the doctor is advised at the latest when symptoms such as stool irregularity, itching or pain during bowel movements occur. Regular constipation and other problems with bowel movements should also be clarified in order to rule out anal carcinoma and other diseases of the gastrointestinal tract or the bowel outlet. If there are clear signs of carcinoma in the anal region, an immediate visit to the doctor is recommended. If a growth develops in a relatively short period of time, possibly even accompanied by blood discharge or sensory disturbances in the affected region, medical advice is required. This is especially true if further complaints such as severe pain or fatigue occur. In general, growths, fistulas or cysts whose cause is not clear should be medically examined and removed if necessary. Anyone who has already been affected by anal fissures, hemorrhoids or anal carcinoma should have regular check-ups. At the first sign of a recurrence of anal disease, the family physician must be consulted. Other contacts are the gastroenterologist and the coloproctologist.
Treatment and therapy
In most cases, surgical removal of the tumors is performed first. In many cases, it becomes necessary to place an artificial anus, which cannot be moved back in all cases after therapy has been completed. The operation is followed by chemotherapy in combination with radiation. A component of chemotherapy are cytostatics, i.e. drugs that prevent the growth of cells. Cytostatic drugs are cell toxins and affect, among other things, the formation of mucous membranes and blood formation. The patient therefore suffers the typical side effects – nausea, vomiting, hair loss – that chemotherapy brings. Since chemotherapy is not permanently effective in the case of anal carcinoma, radiation is also administered. Unfortunately, side effects are to be expected here as well.
Outlook and prognosis
Since anal carcinoma is a cancer, the further course of this disease depends greatly on the time of diagnosis and treatment. Generally, a positive course of the disease occurs when treatment for anal carcinoma is started early. Complications largely occur with late diagnosis, when metastases may have formed. Patients primarily suffer from bloody stools as a result of anal carcinoma. For many people, bloody bowel movements cause panic attacks or sweating. Likewise, there may be pain during defecation and itching in the anus. These complaints are very unpleasant and significantly reduce the patient’s quality of life. Likewise, bowel movements are irregular. In most cases, anal carcinoma is removed by surgery. This usually results in a positive course of the disease. Likewise, sufferers continue to rely on chemotherapy to completely limit the cancer. This usually results in various side effects. Whether there is a reduction in life expectancy due to anal carcinoma cannot generally be predicted.
Prevention
Although a direct correlation between a healthy lifestyle and the exclusion of anal carcinoma has not yet been confirmed, a healthy lifestyle, i.e., a healthy diet, plenty of sports and exercise, and avoidance of alcohol and nicotine is advisable. In addition, attention should be paid to sexual hygiene during anal intercourse. Condoms prevent the transmission of HP viruses and should therefore always be used. At the first signs that indicate anal carcinoma, a doctor should be consulted immediately.
Follow-up care
Anal carcinoma (anal cancer) is a disease whose treatment belongs in the hands of a doctor.The patient is also involved in the aftercare in consultation with the medical doctor. The doctor with whom the aftercare is discussed can be a proctologist, oncologist, the treating surgeon and also the family doctor. Aftercare is about regenerating the anal area from the effects of treatment such as surgery and radiation therapy, detecting any relapse promptly, and also restoring the patient’s physical and emotional well-being. For this purpose, there is a bundle of measures that are tailored to the patient as part of an individual aftercare concept. The follow-up appointments with the treating physicians must be consistently adhered to. Care and cleaning of the strained anal region must be closely coordinated with the physicians. In general, however, it is advisable to avoid the use of harsh surfactants or moist toilet paper. Stool regulation during aftercare is important, as both constipation and diarrhea have a negative effect on tissue regeneration. Stool regulation is often successful with adequate drinking and a high-fiber diet, which can be supplemented with psyllium husks in consultation with medical professionals. The immune system can be stabilized with a healthy diet, exercise and adequate sleep. Psychological well-being can often be significantly improved by discussions with the psychooncologist, psychologists or even friends. Self-help groups also offer valuable support.
What you can do yourself
If anal cancer is suspected, a doctor should be consulted as soon as possible. Anal cancer requires immediate treatment, not only medication and surgery, but also therapeutic measures. The patient can support the treatment by following the doctor’s instructions regarding diet, personal hygiene and physical exertion. After a surgical procedure, the patient is advised to take it easy and keep warm in bed. A change in diet can prevent the surgical wound from rupturing again due to excessively solid stool. Typically, in the first days after surgery, a gentle diet with plenty of fruits and vegetables, light food and lean meat is recommended. To stimulate the activity of the gastrointestinal tract, sufficient water should be drunk. The healing process must also be checked at regular intervals after the operation. This is accomplished by close medical monitoring. After the treatment has been completed, the annual colorectal cancer screening examinations should be taken advantage of. Especially elderly patients and patients with chronic diseases of the bowel should be examined regularly. In this way, any recurrences can be detected early and treated before metastasis occurs.
