Saanichton, BC

Dr. Miguel A. Lipka

Anal Cancer

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Anal Cancer is a form of colorectal cancer. Although rare, anal cancer is becoming more prevalent in North America. Approximately 5,300 new cases of anal cancer will be diagnosed in North America each year (about 3,000 in women and 2,000 in men). It is typically found in adults, average age early 60s.

The condition develops in the tissues of the anus, which is a short tube that connects the lower part of the large intestine, known as the rectum, to the outside of the body. The anus allows the controlled disposal of body waste during bowel movements.

Like cervix cancer, the principal cause of anal cancer is human papillomavirus (HPV), a common virus that causes changes in the skin. Anal HPV infection is most commonly acquired through anal intercourse, but it can also be acquired from other genital areas that are infected, particularly from the vulva in women, or from the penis in men. Fingers, toys, etc., can probably lead to anal HPV infection as well. Research suggests that sexually active individuals, both men and women, may be at risk for HPV. The good news is that only a fraction of people with anal HPV infection will develop a lasting case of anal intraepithelial neoplasia (AIN) -- a precursor to anal cancer -- and even fewer will develop anal cancer.

Other risk factors for anal cancer include:

  • Men and women with a history of anal intercourse
  • Men and women with a history of perianal warts, which are found outside the anus
  • Women with a history of vulvar warts, which are found outside the female genitals
  • Men and women who are chronically immunocompromised, such as those taking immunosuppressive medications, and those who are HIV positive, or have received organ transplants
  • Being over 50 years of age
  • Having many sexual partners
  • Smoking

Patients with invasive anal cancer experience a wide variety of symptoms, but at the earliest stage of cancer, patients often have no symptoms. The most common symptoms include:

  • Pain or tenderness in the area around the anus, which can be constant or occur only with bowel movements or receptive sex
  • Bleeding with bowel movements or following sex that is different from normal
  • Lump or hard area on the outside of the anal area that appears to be increasing in size
  • Itching or discharge from the anus
  • Pain and/or a sense of fullness and constant need to go to the bathroom, which may occur as tumors grow and begin to invade the sphincter muscle

If you are at risk of anal cancer and/or are experiencing symptoms, it is important to contact your doctor and be examined promptly. If cancer is detected, an early diagnosis will help improve outcomes and smaller tumors can be treated more effectively with fewer side effects.

Anal cancer is most effectively treated with surgery, and in early stage disease (i.e., localised cancer of the anus without metastasis to the inguinal lymph nodes), surgery is often curative. The difficulty with surgery has been the necessity of removing the anal sphincter, with concomitant fecal incontinence. For this reason, many patients with anal cancer have required permanent colostomies.

A combination strategy including chemotherapy and radiation treatments has been used recently to reduce the necessity of debilitating surgery. This "combined modality" approach has led to the increased preservation of an intact anal sphincter, and therefore improved quality of life after definitive treatment. Survival and cure rates are excellent, and many patients are left with a functional sphincter. Some patients have fecal incontinence after combined chemotherapy and radiation.