Last Updated: 11 December 2018
Anal cancer is a rare type 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.
Anal cancer is a rare type 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.
Symptoms
of anal cancer
The symptoms of anal cancer are often similar to
more common and less serious conditions affecting the anus, such as piles (haemorrhoids) and anal fissures (small tears or sores). Symptoms of anal cancer can include:
- 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 don't have
any symptoms. you must see your doctor/ GP 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 doctor will usually ask about your symptoms and
carry out some examinations. They may feel your tummy and carry out a rectal examination. This involves your
doctor inserting a gloved finger into your bottom so they can feel
any abnormalities. Your GP will refer you to hospital if they think
further tests are necessary.
The National Institute for Health and Care
Excellence (NICE) recommends in its 2015 guidelines that GPs should
consider referring someone with an unexplained anal lump or anal
ulcer. The person should receive an appointment within two weeks.
If you are referred to hospital, a number of
different tests may be carried out 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 inserted into your
bottom to check for any abnormalities
- proctoscopy – where
the inside of your rectum is examined 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 have some scans to check whether the cancer has spread. Once these are
complete, 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
cared for by a multidisciplinary team. This is a team of different specialists
who work together to provide 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 cases where the cancer has spread and can't be
cured, chemotherapy alone may be considered to help relieve symptoms. This is
known as palliative care. The main treatments are described in more detail
below.
Chemoradiation
Chemoradiation is a treatment that combines
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 need to stay in hospital when you're having chemoradiation.
Chemotherapy for anal cancer is usually given 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 delivered through a small
tube called a peripherally inserted central catheter (PICC) in your arm, which
can stay in place until your treatment has finished.
The tube means you don't need 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 offer tablet chemotherapy for
anal cancer, which avoids the need for the pump and PICC.
Radiotherapy is usually given 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 required.
Both chemotherapy and radiotherapy often cause
significant side effects, including:
- tiredness
- sore
skin around the anus
- sore
skin around the penis and scrotum in men or vulva in women
- hair loss – limited hair loss
from the head, but total loss from the pubic area
- feeling
sick
- diarrhoea
These side effects are usually temporary, but
there's also a risk of longer-term problems, such as infertility. If you're concerned 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 dysfunction
- 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 develop any of these
symptoms so they can be investigated and treated.
Surgery
Surgery is a less common treatment option for
anal cancer. It's usually 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, carried out under general anaesthetic, that usually only
requires a stay in hospital of a few days.
If chemoradiation has been unsuccessful or the
cancer has returned after treatment, a more complex operation called an
abdominoperineal resection may be recommended. As with a local excision, this
operation is carried out 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 reduce the risk of the cancer returning. You'll
usually need 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 called a stoma. The stoma is
attached to a special pouch that will collect your stools after the operation.
Before and after the operation, you'll 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 challenging, but
most people become accustomed to it over time.
Follow-up
After your course of treatment ends, you'll 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 unknown, although
a number of factors can increase your risk of developing the condition. These
include:
- infection
with human papilloma virus (HPV) –
a common and usually harmless group of viruses spread through sexual
contact, which can affect the moist membranes lining your body
- having
anal sex or lots of sexual partners – possibly because
this increases your risk of developing HPV
- having
a history of cervical, vaginal or 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.
Outlook
The outlook for anal cancer depends on how advanced
the condition is when it's diagnosed. The earlier it's diagnosed, the better
the outlook. Compared with many other types of cancer, the
outlook for anal cancer is generally better because treatment is often
very effective.
Around 66 out of 100 people (66%) with anal cancer will
live at least five years after diagnosis, and many will live much longer than
this. There are about 300 deaths from anal cancer each year in the UK.
Further
information about anal cancer
- Cancer
Research UK: anal cancer
- Macmillan: anal cancer.
Screening for anal cancer
There isn't a screening programme in England for
anal cancer. This is because there isn't currently enough evidence to show
the benefits of offering screening would outweigh the risks.
Source: NHS Choices