When Bibi Philippou complained to her family doctor two years ago about hemorrhoids and rectal bleeding, the doctor scheduled a colonoscopy.
“The test showed a few noncancerous polyps, but nothing else,” says Bibi, a real estate property manager from Las Cruces, New Mexico. “I got the ‘all clear.’”
Bibi visited her doctor two more times in the next six months before finally consulting a colorectal specialist who diagnosed her not with hemorrhoids, but with anal cancer.
“I knew something was wrong all along,” says Bibi, 63. “A week before my diagnosis, I attended my niece’s wedding in Mexico. The ceremony and reception were beautiful, but I couldn’t enjoy the festivities as I had hoped. I was worried and declining physically. For me, there was a cloud over the event.”
Increase in anal cancer cases linked to HPV
Anal cancer forms in the anal canal – the short passageway at the end of the rectum where solid waste leaves the body. Though it’s fairly rare, anal cancer cases are on the rise. The reason: the human papillomavirus (HPV), which is linked to several types of cancer, including anal cancer, as well as cervical, head and neck, vaginal, vulvar and penile cancers.
The Centers for Disease Control and Prevention estimates that more than 90% of anal cancers are linked to human papillomavirus (HPV) infection.
HPV is so common that most people will get it at some point. Most people exposed to HPV will never develop cancer. Their bodies will clear the virus within two years, and they’ll never realize they were infected. But in a small number of people, the virus remains undetected in the body for 15 to 20 years or longer, causing changes to cells that decades later will lead to cancer.
“Anal cancer often develops decades after the initial exposure to HPV,” says anal cancer specialist Van Morris, M.D. “This is why anal cancer is more common in adults age 60 and older. The vaccine that prevents HPV didn’t exist when they were younger.”
Anal cancer diagnosis and treatment
Bibi sought treatment at MD Anderson, where tests showed her cancer was stage III.
Morris, who is Bibi’s medical oncologist at MD Anderson, prescribed six weeks of radiation therapy, plus the chemotherapy drugs mitomycin and 5FU.
Bibi finished treatment just in time to return home to New Mexico on Dec. 24, 2019.
“My kids weren’t expecting me,” she says. “I was their Christmas present.”
A follow-up appointment to MD Anderson this January brought good news: her tumor had disappeared. She showed no evidence of cancer.
Immunotherapy clinical trial for anal cancer
With the standard treatment behind her, Morris invited Bibi to participate in a national clinical trial testing the immunotherapy drug nivolumab in anal cancer survivors who have completed radiation and chemotherapy. The drug works by blocking a protein that prevents the immune system from attacking cancer cells. The clinical trial’s goal is to evaluate whether nivolumab improves long-term, disease-free survival in anal cancer survivors whose disease has not spread to other organs in the body.
Bibi was, as she says, “thrilled” to participate in the clinical trial. Once a month for six months, she made the 12-hour drive from New Mexico to Houston, where MD Anderson nurses infused nivolumab into her veins.
“Normally I would fly, but COVID-19 put a stop to that,” she says.
Bibi completed the trial this August, and she’ll return to MD Anderson for three years of follow-up appointments.
Changing the guidelines for metastatic anal cancer treatment
Prior to Bibi’s trial, Morris helped develop a National Cancer Institute-led clinical trial with Jim Allison, Ph.D., and Pam Sharma, M.D., Ph.D., that showed nivolumab worked well in some people whose anal cancer had spread to other parts of the body.
“Because of that trial, the national guidelines for metastatic anal cancer treatment were updated in 2019 to include nivolumab as a recommended option for these patients,” Morris says.
Since then, MD Anderson has conducted a number of clinical trials testing immunotherapy in combination with other drugs.
“Only a small number of anal cancers spread, but when they do, the disease is difficult to treat,” Morris says. “We owe these patients treatments that offer hope.”
Words of wisdom from an anal cancer survivor
Bibi wishes every patient could have her results.
She continues to show no signs of cancer, and is building her strength with Pilates classes and running up and down outdoor staircases at buildings in her neighborhood.
She offers this advice:
If you have a hemorrhoid that doesn’t go away, it may not be a hemorrhoid. Go to a doctor; don’t self-diagnose or wait.
You know your body better than anyone. If something seems “off,” such as a change in bowel habits or continuous fatigue, consult your doctor.
Make sure your children and grandchildren get the HPV vaccine.
“And if you have cancer, go directly to MD Anderson,” she says. “Your first chance is your best chance.”