Anal Cancer

Experts at the UofL Brown Cancer Center treat more patients with anal cancer than most other cancer centers in the region.

Overview

Experts from our Multidisciplinary Gastrointestinal Cancer Clinic team treat more patients with anal cancer than most other cancer centers in the region.  Our depth of experience enables us to offer you the most accurate diagnostic methods and the latest in anal cancer treatments.

Our high level of experience in minimally invasive and sphincter-sparing surgeries and other innovative techniques can help many people with anal cancer.  We offer the most advanced therapies for every type of anal cancer, including in people with HIV and AIDS.

Because we know quality of life is important, we make every effort to preserve the sphincter, without affecting control of bowel movements.

At the UofL Brown Cancer Center you are surrounded by the strength of one of the region’s largest and most experienced comprehensive cancer centers.  We have all the support services needed to treat the whole person, not just the disease.

Understanding a disease is the first step toward finding the right care. Get the facts about anal cancer, including the different types, how it starts and who’s at risk.

According to the American Cancer Society, more than 5,000 people are diagnosed with anal cancer in the United States each year.  Unfortunately, this figure is increasing.  The average age of people diagnosed with anal cancer is the early 60s.  It occurs slightly more often in women than men because more women have human papilloma virus (HPV), which is a risk factor for anal cancer. Anal cancer often can be treated successfully if it is found early.

The anus, which is about 1-1/2 inches long, connects the rectum (lower part of the large intestine) to the outside of the body.  It allows solid waste (also called stool or feces) to pass from the body. The sphincter is two muscles that open and close the anus to let waste pass.  The anus is lined with squamous cells, which also are found in the bladder, cervix, vagina, urethra and other places in the body.

Anal cancer types

Several types of tumors may be found in the anus.  While some of them are malignant (cancer), others are benign (not cancer) or precancerous (may develop into cancer).  The main types of anal cancer are:

Carcinoma in situ is early cancer or precancerous cells. They are only on the surface cells of the anal canal. This also may be called Bowen’s disease.

Squamous cell cancer (carcinoma) forms in the cells that line the anus. This is the most common type of anal cancer.

Adenocarcinomas develop in the glands around the anus.

Skin cancers, including basal cell and melanoma, often are found when they are in advanced stages.

Most cancers have the same symptoms as other, less serious conditions. Still, it’s important to know the signs.

Anal cancer often does not have symptoms.  When it does have symptoms, they vary from person to person.  If you have anal cancer symptoms, they may include:

  • Anal or rectal bleeding
  • Pain or pressure around the anus
  • Change in bowel habits
  • Narrower stool than usual
  • A lump close to the anus
  • Swollen lymph nodes in the anal or groin area
  • Anal discharge

These symptoms do not always mean you have anal cancer. However, it is important to discuss any symptoms that last more than two weeks with your doctor, since they may signal other health problems.

Blood tests, imaging exams and even surgical procedures are used to check for cancer.

If you have symptoms that may signal anal cancer, your doctor will examine you and ask you questions about your health, your lifestyle, including smoking and drinking habits, and your family history.

One or more of the following tests may be used to find out if you have anal cancer and if it has spread.  These tests also may be used to find out if treatment is working.

  • Anoscopy:  A short tube with a camera is inserted into the anus and lower rectum. The doctor examines the anus and can biopsy tissue.
  • Proctoscopy:  A short tube with a camera is inserted into the anus to the rectum. The doctor examines the anus and can biopsy tissue.
  • Double contrast barium enema (DCBE):  Barium is a chemical that allows the bowel lining to show up on an X-ray. You will be given an enema with a barium solution, and then X-rays will be taken.
  • Colonoscopy
  • Virtual colonoscopy or CT (computed tomography) colonoscopy
  • CT (computed tomography) scans; also called CAT scans
  • MRI (magnetic resonance imaging) scans
  • PET/CT (positron emission tomography) scans
  • Endo-anal or endorectal ultrasound: An endoscope is inserted into the anus. A probe at the end of the endoscope bounces high-energy sound waves (ultrasound) off organs to make an image (sonogram).  Also called endosonography.
  • Chest X-Ray
  • Fine-needle aspiration biopsy: Anal cancer may spread through the lymph system, and sometimes it is found in lymph nodes. A tiny needle is placed into a lymph node, and cells are removed and looked at with a microscope. A positive lymph node biopsy may help the doctor decide what areas to treat with radiation therapy.

Anal Cancer Staging

If you are diagnosed with anal caner, your doctor will determine the stage of the disease. Staging is a way of talking about how much disease is in the body and where it has spread. This information helps the doctor treat the cancer.

Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

  • Stage I: Cancer has formed. The tumor is 2 centimeters or smaller.
  • Stage II: Tumor is larger than 2 centimeters but not greater than or equal to 5 centimeters
  • Stage IIIA: Tumor is 5 centimeters or greater and/or has spread to either:
    • Lymph nodes near the rectum
    • Nearby organs, such as the vagina, urethra or bladder
  • Stage IIIB: Tumor is 5 centimeters or greater and/or may be any size and has spread to:
    • Nearby organs and lymph nodes near the rectum
    • Lymph nodes on one side of the pelvis and/or groin and may have spread to nearby organs
    • Lymph nodes near the rectum and in the groin and/or lymph nodes on both sides of the pelvis and/or groin and may have spread to nearby organs
  • Stage IV: Tumor may be any size and may have spread to lymph nodes or nearby organs and has spread to distant parts of the body.

Common cancer treatments include chemotherapy, radiation treatment and surgery. Doctors select the treatment for anal cancer based on your diagnosis and disease stage.

We make every effort to preserve the sphincter without affecting control of bowel movements, and we use all means possible to decrease the risk of a colostomy. However, if a colostomy is needed, highly qualified nurses help you make the transition and maintain your quality of life.

Our anal cancer treatments

Anal cancer often can be treated successfully with chemotherapy combined with radiation therapy. If the cancer has spread (metastasized), a combination of therapies including surgery as well as participation in a clinical trial may be suggested.

The team of specialists focusing on your care will discuss with you the best options to treat it. This depends on several factors, including:

  • The stage of anal cancer
  • Location of the tumor in the anus
  • If you have human immunodeficiency virus (HIV) or other immunosuppressed condition
  • If the cancer has just been diagnosed or if it has returned after being treated
  • Your age and general health

Your treatment for anal cancer will be customized to your particular needs. Treatments for anal cancer, which may be used to fight the cancer or help relieve symptoms, may include:

Surgery

Anal cancer surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure. UofL Brown Cancer Center surgeons perform a large number of surgeries for anal cancer each year, using the most advanced techniques.

If surgery is needed to treat anal cancer, your surgeon may use one of the following procedures:

Local resection: The tumor, along with some of the tissue around it, is surgically removed.

Abdominoperineal resection (APR): The anus, the rectum and part of the colon are removed through an incision in the abdomen. The end of the intestine is attached to an opening (stoma) in the abdomen.  Body waste leaves this opening and is collected in a plastic bag outside the body. This also is called a colostomy.

Chemotherapy

The UofL Brown Cancer Center offers the most up-to-date and effective chemotherapy options to treat anal cancer.

Radiation therapy

New radiation therapy techniques allow UofL Brown Cancer Center doctors to target anal cancer tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

Some anal cancers can be treated with intensity modulated radiation therapy (IMRT). This technique precisely targets the cancer and causes less damage to healthy tissue.

Our doctors at UofL Brown Cancer Center are proudly part of UofL Physicians and the UofL School of Medicine.

We believe knowledge comes from questioning the status quo, discovering more about disease and using that knowledge to improve the health of our community. Our physicians are the teachers and researchers at the UofL School of Medicine, involved in the research and development of new treatments and cures for cancer. This means you receive the most advanced and appropriate treatment, even for complex or rare conditions. 

To learn more about the physicians who make the academic difference in anal cancer treatment, visit the UofL Physicians web site here.