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The anus is about 1-1/2 inches long and 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. These include:
- 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.
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.
Why come to MD Anderson for anal cancer care?
MD Anderson’s Colorectal Center treats more patients with anal cancer than most other cancer centers in the nation. This depth of experience enables us to offer you the most accurate diagnosis methods and the latest 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.
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.
Accept your diagnosis. Reach deep into your soul to make peace with it. Look past your daily reality and imagine a future without cancer.
I’m really blessed that I found out about my anal cancer diagnosis early on. That’s a big part of the reason why I’m living without any evidence of disease today.
A friend of mine who’d been diagnosed with late-stage rectal cancer told me he experienced bleeding for months before he finally went to a doctor. So when I started exhibiting the same symptom in October 2015, I remembered his cautionary tale and immediately scheduled an appointment with a gastroenterologist. That led to the discovery of my tumor.
Even though I lived in Florida, I came to MD Anderson because all of my research -- and even my doctors – pointed me in that direction. As soon as I met my radiation oncologist Dr. Cullen Taniguchi, I felt really safe. He has an incredible way of explaining things. There’s lots of hugging whenever my daughter and I go see him.
This has certainly been an interesting journey. Here’s my advice for coping with anal cancer treatment.
Learn to laugh through awkwardness
If you get anal cancer, you better have a sense of humor. If you can’t laugh, then you better learn how before treatment starts.
Radiation therapy for anal cancer is … awkward. Not only are you usually sitting in an uncomfortable position, but female patients also use a vaginal dilator to push away delicate tissue and protect their cervix from radiation. The method, which is unique to MD Anderson, is actually a great idea because it reduces scarring and prevents complications with future Pap tests. But to get past the reality of the moment, I made light of the situation. I asked the radiation therapists to play Elvis songs for me and whenever something embarrassing happened, I’d quip, “Houston, we have a problem!”
And the side effects were horrific -- though Dr. Taniguchi says my reaction to treatment was worse than any patient he’s ever had. I developed nausea and diverticulosis, or inflammation of my digestive track. I also suffered from severe diarrhea. I couldn’t go anywhere without several changes of clothes and baby wipes. My daughter and I joked our way through my many accidents because we knew that laughing through my misery kept me in a fighting spirit. Thankfully, MD Anderson’s pelvic wall therapy eventually helped me strengthen my sphincter and regain control of my bowel movements.
Ask many questions and bring someone with you
A lot of people hide from cancer and don’t really want to talk about it. But learning more about your disease and knowing what to expect during treatment is crucial to your overall health and safety.
Whenever my daughter Stacy and I met with Dr. Taniguchi and Dr. Cathy Eng, we brought a list of questions. Stacy jotted down notes during our appointments, and we referred back to them regularly.
I also quickly learned that it doesn’t matter how strong you are, you need an advocate with you to listen. When you’re diagnosed with a potentially fatal disease, you get easily overwhelmed, and you’re just not going to catch everything your doctor says. Having that second set of ears can help you avoid unnecessary complications.
Make peace with your disease
Many people have a hard time wrapping their heads around my anal cancer diagnosis. When I tell people I have anal cancer, they often think I misspoke and meant colon or rectal cancer. Once I reiterate that I have anal cancer, I hear, “Oh, I didn’t know you could get cancer there,” or they think my cancer stemmed from promiscuity. But I still openly talk about it because it’s up to us anal cancer survivors to move others past that stigma. No one minds saying, “I have breast cancer,” so we have to talk about it like it is breast cancer.
So, accept your diagnosis. Reach deep into your soul to make peace with it. Look past your daily reality and imagine a future without cancer. Soon enough, you’ll reach the light at the end of the tunnel.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
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