Learn About the Signs and Symptoms of Anal Cancer

One of the cancers that receives less attention than others but is just as important to be aware of is anal cancer, which occurs in 1 in 600 adults nationwide. Survival rates are greatly affected by how early it is detected. Dr. Paula Denoya, a colorectal surgeon with a specialty in anal cancer, talks about what people need to know and what they can do right now about this disease.

What are the signs and symptoms of anal cancer?
The symptoms of the most common type of anal cancer, squamous cell carcinoma, tend to be similar to those of hemorrhoids. Because of this — and its relative low rate of occurrence in relation to other cancers — it tends to be misdiagnosed or overlooked. See your doctor if you experience any of the following:

• Anal bleeding
• A lump or mass at the anal opening
• Persistent itching and pain
• Drainage or discharge
• Swollen lymph glands in the groin area
• Changes in bowel habits

People may feel uncomfortable talking about these symptoms - what do you suggest as the best approach?
I urge people not to be embarrassed to go to the doctor. We are talking about a body part like any other. Your doctor will be very matter-of-fact with you; remember, he or she has seen it all before. Their major concern will about your health and how to best help you — and to do so in a way that makes you feel comfortable. Try to be as open as possible and to share all of your concerns because the earlier anal cancer is detected, the better the survival rates. For example, when detected in stage 1, the five-year survival rate is 70 percent. However, at stage 4, it drops to 20 percent.

Who is at risk for anal cancer?
Anal cancer occurs in both men and women, although is slightly more prevalent in women. Risk factors include:

• Age — the risk grows as you age
• Presence of the human papilloma virus (HPV) infection
• HIV infection
• Immunosuppressant therapy (for example, in transplant patients)
• Chronic inflammation of the anus
• Open wounds
• Radiation to pelvis
• Anal sex (men and women)
• Smoking

Are there any prevention measures I can take?
It is important to have regular checkups that include a digital rectal exam. Check your stool for the presence of blood, and see your doctor if you detect any. You can also protect yourself by not smoking, having safe sex and getting the HPV vaccine. People who are at high risk, such as the HIV positive population, can now get anal pap smears to screen for the precancerous cells that can develop before anal cancer.

How is anal cancer diagnosed?
If your personal physician suspects a problem, you should get referred to a colorectal surgeon who can run a number of tests. This includes a physical exam, a digital exam, a palpable groin exam, an anoscopy and a full colonoscopy. If we uncover any lesions, we can biopsy them. At Stony Brook Cancer Center, we also use CT and PET scanning for testing, as well as to evaluate if the cancer has metastasized or invaded any other structures around the anus.

What treatment options are available?
Approximately 80 percent of patients respond to chemotherapy and/or radiation therapy. At Stony Brook, we take a multidisciplinary team approach to cancer treatment. We have a highly specialized team that focuses exclusively on cancers of the colon, rectal and anus, which includes:

• Colorectal surgeons
• Gastroenterologists
• Oncologists
• Radiation oncologists
• Anesthesiologists
• Pathologists
• Nurses
• Enterostomal therapists 

Team members have the experience, knowledge and compassion to deliver expert and highly personalized care coordinated across the full spectrum, from diagnosis through discharge and beyond. Upon completion of the course of treatment, we follow the patient at regular intervals – checking though ultrasound and anoscopy for the presence of additional cancer cells. If cancer remains or recurs, we can perform what is called an abdominal perineal resection (APR) to remove the anus and surrounding tissue. 

At Stony Brook, we believe that we can offer patients what they most need: high-level cancer care close to home. Not only do we offer the type of specialized care typically only found in urban areas, but it also is comfortable and convenient for patients. Nearly all services —diagnostics, chemotherapy, radiation therapy, surgery, follow-up appointments and support groups — are located in the Cancer Center or Stony Brook University Hospital. 

For more information on anal cancer, call the Colorectal Oncology Management Team, Division of Colorectal Surgery, at (631) 444-1825.