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Anal Cancer Expertise
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.
As one of the world’s largest cancer research centers, MD Anderson is leading the investigation into new methods of anal cancer diagnosis and treatment. You benefit from the most advanced research and a range of clinical trials of new agents.
And, at MD Anderson you’re surrounded by the strength of one of the nation’s largest and most experienced comprehensive cancer centers. We have all the support and wellness services needed to treat the whole person – not just the disease.
I am anything but ashamed of my anal cancer, but stigma is hard to shake.
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.
Anal Cancer Risk Factors
Anything that increases your chance of getting anal cancer is a risk factor.
- Age: Squamous cell carcinoma of the anus most often is found in people older than 50
- Human papillomavirus (HPV) infection
- Human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)
- Having more than 10 sexual partners
- Anal intercourse
- Frequent anal redness, swelling and soreness
- Tobacco use
- Immunosuppression, including taking immune-suppressing drugs after an organ transplant
Not everyone with risk factors gets anal cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.
Anal Cancer Prevention
Certain lifestyle choices can help prevent anal cancer. One of the most important is to avoid HPV infection. Some ways you can lower your chances of getting HPV include:
- Wait until you are older to have sex and limit your number of sexual partners
- Use condoms during sex
- Avoid sex with people with sexually transmitted diseases (STD) or who have had multiple sexual partners
- Don’t smoke or use other types of tobacco
- Get an HPV vaccine. Gardasil® and Cervarix® help protect against certain types of HPV. But if you have HPV, they do not cure it.
Visit our Prevention site to learn more about preventing anal cancer.
did you know?
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.
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.
Imaging tests, which may include:
- 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.
- 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.
Anal Cancer Stages
(source: National Cancer Institute)
Stage 1: Cancer has formed. The tumor is 2 centimeters or smaller.
Stage 2: Tumor is larger than 2 centimeters but not greater than or equal to 5 centimeters
Stage 3A: 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 3B: 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 4: Tumor may be any size and may have spread to lymph nodes or nearby organs and has spread to distant parts of the body.
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.
If you have anal cancer that has spread and/or have HIV or AIDS, we offer the most advanced treatments, as well as clinical trials of new agents.
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:
Anal cancer surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure. MD Anderson 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.
MD Anderson offers the most up-to-date and effective chemotherapy options to treat anal cancer.
New radiation therapy techniques allow MD Anderson 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.
MD Anderson is leading into the future of cancer treatment by developing innovative targeted therapies. These agents are specially designed to treat each cancer’s specific genetic/molecular profile to help your body fight the disease. Many of the doctors who treat cancer at MD Anderson are dedicated researchers who have pioneered and actively lead national and international clinical trials with novel targeted agents.
HPV-Related Cancers Moon Shot
Almost all cases of anal cancer are caused by human papillomavirus (HPV) infection, for which a safe and effective vaccine currently exists. MD Anderson’s HPV-Related Cancers Moon Shot™ aims to improve outcomes for anal cancer patients through prevention initiatives and new treatments.Learn more
Some people get married. Some have children. Some get divorced. Some get cancer. Nelda Blair believes that while these are all life-changing moments, none of them should become a person’s entire identity. She’s felt this way ever since she found out she had HPV-related anal cancer in February 2011.
“I’m a take-charge person, and this diagnosis was not going to rule my life or alter my life for any period of time,” she says. “My attitude was: we’ll take care of this.”
Coming to MD Anderson for a second opinion
Nelda’s anal cancer was discovered during her first colonoscopy, which she’d put off until age 53. A local oncologist removed the tumor, but after researching her diagnosis some more, she came to MD Anderson to seek a second opinion from Cathy Eng, M.D.
“Dr. Eng came walking into the room and took charge,” she says. “She answered my questions, looked me in the eye and there was no messing around. She gave me the truth and nothing but the truth, and I very much appreciated that.”
Because Nelda was in otherwise great physical health, Eng wanted her to undergo three months of daily radiation and chemotherapy simultaneously. Nelda was OK with that plan, as long as she could do it at MD Anderson in The Woodlands, where she leads a busy life.
Balancing life and anal cancer treatment
A successful real estate lawyer, Nelda also operates a local education foundation, runs a private real estate investment company, served as chairwoman of The Woodlands Convention & Visitors Bureau, and is heavily involved in economic development and politics. And she didn’t want to give any of it up during her anal cancer treatment.
“Dr. Eng supported me in that. When I said, ‘This is not going to stop me from my law practice and the other things that I do,’ she was behind me. She wasn’t saying, ‘Oh, no, no, no. You have to go to bed and be sick,’” Nelda recalls.
So every weekday morning, Nelda drove just down the road to MD Anderson in The Woodlands for radiation therapy with Pamela Schlembach, M.D. On Mondays through Thursdays, she also received intravenous chemotherapy, which she stowed in custom-made fanny packs as she went about her day. On Fridays, she went to the clinic to have daylong infusions of a second chemotherapy drug.
“I didn’t miss a day of work, I didn’t lose my hair. I got fewer things done, but I still had good energy,” she says. The biggest changes were that she couldn’t do her regular exercise routine, and had to change her diet and eat very soft and bland foods that wouldn’t upset her stomach.
Looking at cancer through a different lens
Nelda finished her anal cancer treatment in April 2011 and has been in remission ever since then. She attributes the energy she had throughout treatment to her healthy lifestyle habits and positive outlook.
“I really think that the attitudes of the patient and the doctor make the difference,” she says. “If the patient is determined that cancer is not going to alter her lifestyle or be the main focus of life, then it won’t be.”
She’s had to adjust to post-treatment changes in her body, like menopause, a weakened sense of taste and a more sensitive colon. But just like any life-altering event, she’s learned to find a new normal and carry on.
“Cancer doesn’t have to define you. It’s just one of the many things that can happen to you, but it’s not your life,” she says.
A call to end HPV-related cancers
Though Nelda’s anal cancer may be a thing of the past to her, the threat it poses to others is still at the forefront of her mind. Before her diagnosis, she had no idea that HPV could cause cancer. Now she advocates for the HPV vaccine and encourages her family and friends to vaccinate their children.
“I try very hard to educate them. I use my own cancer as an example of how that can happen,” says Nelda, who makes a point of telling others that her cancer was caused by HPV and that a colonoscopy and early detection saved her life. “I just don’t want others to have to go through what I have.”
Request an appointment at MD Anderson online or by calling 1-877-632-6789.