What is Anal Cancer? What Are Its Symptoms? How Is It Diagnosed and Treated?

Also known as anal cancer, this disease is a type of cancer that develops in the anal canal and has a high chance of treatment when diagnosed early. Although it is generally more common in individuals over the age of 50, it has also shown an increase at younger ages in recent years.

One of the most important causes of this disease is human papillomavirus (HPV) infection. Additionally, having multiple sexual partners is among the factors that increase the risk of developing anal cancer. Its symptoms include pain, burning, itching, bleeding, and swelling in the anal region.

In this article, we will explain what anal cancer is, its symptoms, diagnostic methods, and treatment options in a clear and understandable way. We have compiled all the essential information you need to know about the disease for you.

What is Anal (Anal) Cancer?

Anal cancer is a rare type of cancer that forms inside the anal canal and develops as a result of the uncontrolled proliferation of cells. This cancer, like other cancers in the body, occurs due to errors in the DNA of normal cells. Cells lose their normal growth pattern and begin to multiply, and over time, an abnormal tissue mass called a tumor is formed.

Structure and function of the anal canal

The anal canal is the final part of the digestive system and is shaped like a short tube connecting the rectum to the anus. Its length varies between approximately 2.5-4 cm and it is located below the level of the pelvic diaphragm. This region is situated between the right and left ischioanal fossae.

Three muscle layers surround the anal canal. While the inner two layers consist of smooth muscle tissue, the outer layer is composed of striated muscle structure that can be voluntarily controlled. The involuntary muscle rings located on the inside and the voluntarily controlled muscle rings on the outside prevent the uncontrolled passage of stool.

The anal canal assumes the task of regulating the defecation process. It controls the elimination of stool coming from the rectum out of the body. Thus, under normal conditions, you can defecate only when you wish.

Difference between anal cancer and rectal cancer

Although anal cancer and rectal cancer are frequently confused with each other, they are actually different diseases. The rectum is the section located above the anus, forming the last part of the large intestine, with a length of approximately 12-15 cm. The anus, on the other hand, is the final point of the excretory system.

Although both types of cancer are seen in the lower parts of the digestive system, the tissues where they originate, their symptoms, and treatment methods differ. Although lower rectal cancers are frequently referred to as anal cancer among the public, they differ from true anal cancers in terms of their characteristics and treatments.

Types of anal region cancer

The types of cancer seen in the anal region are classified according to where they start and their cell type. Depending on the region where they are seen, they can be examined in two main groups:

Anal canal cancer: Occurs above the anal margin, inside the anal canal.

Perianal skin cancer: Forms below the anal margin, in the region where the anal canal joins the outer skin.

According to cell type:

Squamous Cell Carcinoma: Accounts for the vast majority of anal cancers. It begins in the squamous cells that cover most of the anal canal and anal margin.

Adenocarcinoma: Forms in the cells in the upper part of the anus (close to the rectum).

Basal Cell Carcinoma: Generally develops in the perianal skin and is rare.

Melanoma: Begins in the anal lining cells and is a quite rare type.

Gastrointestinal Stromal Tumor (GIST): Is mostly seen in the stomach or small intestine, but can rarely appear in the anal region as well.

Anal cancer is a treatable disease when diagnosed early. Therefore, it is important to consult a specialist without losing time when suspicious symptoms are observed.

What Causes Anal Cancer?

Many factors play a role in the development of anal cancer. Scientists state that this disease does not have a single cause, but rather forms through the combination of various risk factors. Now let us examine these factors more closely.

HPV infection and sexually transmitted diseases

The most important cause of anal cancer is Human Papillomavirus (HPV) infection. Studies show that 93% of anal cancers are associated with HPV infection. This rate reaches 78% especially in squamous cell cancers.

There are more than 150 types of the HPV virus, but the one that causes anal cancer is mostly HPV type 16. While this type is seen in 85% of HPV-positive patients, less frequently HPV types 18 (7%), 33, 31, and 45 have also been detected.

HPV is a virus transmitted through sexual contact. This virus can lead to warts in the anal region and genitals in both women and men. However, anal cancer can also develop without the formation of warts.

Smoking and immune system suppression

Smoking significantly increases the risk of anal cancer. Harmful chemicals in cigarette smoke can damage the DNA in cells and trigger cancer development. Additionally, smoking can weaken the immune system, causing HPV infections to remain in the body for a longer period.

A weak immune system is also an important factor that increases risk. HIV/AIDS patients, those using immunosuppressive drugs after organ transplantation, or those with other diseases affecting the immune system are at higher risk.

Age, gender, and genetic factors

Anal cancer is generally seen more frequently in individuals aged 50 and over. It is encountered slightly more often in women than in men, but this difference is not very pronounced.

Genetic factors may also play a role in the development of anal cancer. Individuals with a family history of anal cancer or other types of cancer may have a slightly higher risk rate.

Anal sex and multiple partner risk

Engaging in anal sex is among the behaviors that increase the risk of anal cancer. This situation can cause the anal region to become damaged and more vulnerable to infections such as HPV.

Having multiple sexual partners also increases the risk. Individuals who have relations with a large number of partners have a higher probability of contracting HPV and other sexually transmitted diseases. Unprotected sexual intercourse in particular further increases the risk.

Conditions such as prolonged inflammation and fistulas in the anal region are also among the factors that increase the risk. Therefore, it is important not to neglect complaints in the anal region and to consult an expert physician.

What Are the Symptoms of Anal Cancer?

Noticeable recognition of anal cancer in the early period is the most important factor that increases treatment success. To ensure this, you need to recognize the signals given by your body. While anal cancer sometimes progresses silently, it most of the time manifests itself with certain symptoms.

Pain, burning, and itching in the anus

Constant pain you feel in the anal region can be one of the first signs of anal cancer. This pain generally increases during defecation. At the same time, you may also experience a burning sensation in the region. Long-term itching that does not respond to normal treatments should also be taken into consideration.

These discomforts felt in the anus become more pronounced in the advanced stages of the disease and can sometimes cause discomfort even while sitting. In the event that one or more of these symptoms are observed, it is important to consult a doctor.

Bleeding and blood in the stool

The most common and striking symptom of anal cancer is bleeding from the anus. This bleeding can manifest itself in different ways:

Fresh red or dark-colored blood in the stool

Blood stain on toilet paper

Droplet-shaped bleeding from the anus after defecation

The color of the bleeding is also an important clue. While bright red blood generally points to a problem in the anal canal or lower rectal region, dark-colored blood indicates that there may be bleeding in higher regions.

Swelling or lump sensation in the anus

A lump or swelling that you can feel in the anal region is an important symptom of anal cancer. This lump is generally noticed as a feeling of fullness in the anus. Especially a hard lump palpable around the anus may not be a simple hemorrhoid.

On the other hand, any abnormality, swelling, or hardness felt in the anal region must definitely be taken seriously and evaluated by a doctor.

Changes in bowel habits

Persistent changes in your bowel habits can be a harbinger of anal cancer. These changes may include:

Long-standing complaints such as diarrhea or constipation

Stool taking on a thin, pencil-like form

The feeling that the bowels have not completely emptied despite going to the toilet

Increased frequency of defecation

Along with this, a constant feeling of gas and bloating, and cramp-like pains in the abdominal region are also symptoms that need attention.

Symptoms that can be confused with hemorrhoids

Anal cancer symptoms are mostly confused with hemorrhoid symptoms. Both diseases can show similar symptoms such as bleeding, pain, and discomfort in the anus. However, there are important differences between them.

Hemorrhoids are formed by the swelling of veins in the anus or the lower part of the rectum and generally manifest themselves with pain and mild bleeding during defecation. Among the most important symptoms distinguishing anal cancer from hemorrhoids are a hard lump in the anus, long-term pain, unexplained weight loss, and changes in bowel habits.

If the symptoms you are experiencing have been ongoing for a long time, do not respond to habitual hemorrhoid treatments, or if new symptoms are added, you must definitely consult a specialist.

How Is Anal Cancer Diagnosed?

If you carry a suspicion of anal cancer, your doctor investigates the presence of the disease by applying various diagnostic methods. Since early diagnosis directly affects treatment success, this stage is extremely important.

Physical examination and anoscopy

The diagnostic process generally begins with a detailed physical examination performed by the doctor. In this examination, the doctor checks the anal and rectal region digitally to detect whether there is any structural change. This examination, performed using gloves and a lubricating solution, is an important step to detect lumps or abnormal growths in the anal region.

Then, the anal canal is visually examined using a lighted tube called an anoscope. This procedure is called an anoscopy and allows the doctor to evaluate abnormal tissues by directly viewing the anal canal.

Ultrasonography and colonoscopy

Ultrasonography is an imaging method performed using high-energy sound waves. In this procedure, a probe resembling a thick thermometer is placed into the anal region, and tissues in the region can be examined in detail with the help of ultrasonic waves.

Colonoscopy, on the other hand, is the examination of the anal canal, rectum, and large intestine with the help of a flexible tube having a light and a small camera at its tip. During this procedure, biopsies can be taken from areas seen as suspicious. It provides quite valuable information during the diagnostic process, especially in patients with complaints.

Definitive diagnosis with biopsy

The most definitive method in diagnosing anal cancer is a biopsy. During anoscopy or colonoscopy, a small piece of tissue is taken from the suspicious area, and this sample is examined in the laboratory. As a result of the pathological examination of the taken tissue sample, the presence of cancer cells is definitively detected.

Definitive diagnosis is made by the pathologist examining the biopsy sample taken from the patient under a microscope. This stage plays a decisive role in shaping the treatment plan.

Imaging methods such as CT, MRI, and PET-CT

After the diagnosis of anal cancer is confirmed, advanced imaging methods are resorted to in order to determine how far the disease has progressed and whether it has spread to other regions of the body.

Computed Tomography (CT) is an important test used to evaluate the spread of the disease to lymph nodes or other organs. This method helps doctors understand the scope of the disease by creating cross-sectional images of the body.

Magnetic Resonance Imaging (MRI) is preferred especially in the detailed examination of the pelvic region and soft tissues. MRI can provide more detailed information than CT in evaluating the local spread of the tumor.

Positron Emission Tomography-Computed Tomography (PET-CT) is an advanced imaging technique used especially to investigate the spread of the disease to distant organs (metastasis). This method offers doctors valuable information about the spread of the disease by showing cancerous tissues throughout the entire body according to their metabolic activities.

The combined use of these diagnostic methods for correct diagnosis carries great importance in establishing the most appropriate treatment plan according to the condition of the disease.

How Is Anal Cancer Treated?

Anal cancer treatment is planned depending on the stage of the disease and the general health status of the patient. Treatment methods are generally used together, and a special treatment plan is created for each patient.

Chemotherapy: The drug treatment process

Chemotherapy is a treatment method utilizing drugs targeting cancer cells. These drugs can be injected intravenously or taken in pill form. They generally give more effective results when applied together with radiotherapy.

During the treatment process, drugs are distributed throughout the body via the bloodstream and destroy rapidly multiplying cancer cells. However, since it can also affect healthy cells, side effects such as hair loss, nausea, and vomiting may be seen.

Radiotherapy: Radiation therapy

Radiotherapy is a treatment method ensuring the destruction of cancer cells by using high-energy rays. During this treatment, a special device sends rays to the cancerous region and damages the cells.

In anal cancer, radiotherapy generally lasts 5-6 weeks and is mostly applied together with chemotherapy. Chemotherapy, on the other hand, is given in the first and last weeks of treatment. This combination treatment ensures that cancer cells are destroyed more effectively.

Surgical intervention: Local and abdominoperineal resection

Surgical treatment is applied in early stages or when other treatments fail. There are two different surgical methods:

Local excision: In this method applied for small tumors, only the tumor and a small amount of healthy tissue around it are removed. The anal sphincter muscles are preserved, ensuring the continuation of the fecal continence function.

Abdominoperineal resection (APR): In this method applied in more advanced cases, the anal canal, rectum, and a part of the sigmoid colon are removed. At the end of the procedure, a permanent colostomy needs to be opened.

Immunotherapy and supportive treatments

Immunotherapy is a treatment method providing defense against cancer cells by strengthening the immune system. It is applied especially in advanced-stage anal cancer that does not respond to other treatments.

Supportive treatments, on the other hand, include applications aimed at increasing the quality of life, such as pain management, nutritional support, and psychological support.

Post-treatment follow-up and stoma care

Regular check-ups after treatment are important. Since there is a risk of cancer recurrence, examinations and imaging tests are performed at certain intervals.

Colostomy care is of vital importance in patients who have undergone abdominoperineal resection surgery. Stoma care nurses provide training and support for patients to adapt to their new lifestyle.

In Summary Anal Cancer

As a result, although anal cancer is rare, the probability of treatment is quite high when diagnosed early. Since its symptoms are frequently confused with more common diseases such as hemorrhoids, you need to be careful. If you notice pain, bleeding, itching, or swelling in the anus and these complaints have been ongoing for a long time, definitely consult a doctor.

HPV infection is one of the most important causes of this type of cancer. Nevertheless, smoking and a weak immune system also increase the risk. Regular health check-ups and early intervention in suspicious situations can save lives.

During the diagnostic process, your doctor will perform a physical examination, anoscopy, and, if necessary, a biopsy. Imaging methods such as CT and MRI are also used to understand how far the disease has progressed.

Treatment options include chemotherapy, radiotherapy, and surgical intervention. The combined application of these methods generally gives the best results. Additionally, regular follow-up after treatment also reduces the risk of the disease recurring.

Remember, instead of postponing your health problems, taking suspicious symptoms seriously and consulting an expert physician is of vital importance. Changes in your bowel habits, abnormal sensations in the anus, or bleeding can be harbingers of serious diseases beyond simple problems. With early diagnosis and treatment, anal cancer is a beatable disease.

Frequently Asked Questions

Is anal cancer fatal?

Anal cancer has quite high survival rates when diagnosed in early stages. According to statistics, the 5-year survival rate in patients diagnosed in early stages is approximately 90%. As the disease progresses, this rate decreases. Nowadays, thanks to advanced treatment techniques, many patients can lead a quality life for many years.

How to distinguish between hemorrhoids and anal cancer?

Both diseases show similar symptoms, but there are important differences. Hemorrhoids are formed by the swelling of veins around the anus and generally manifest themselves with bright red bleeding. Anal cancer, on the other hand, makes itself felt with harder, irregular-edged lumps and abnormal discharge. Furthermore, symptoms in anal cancer become severe over time. A physical examination is essential for definitive distinction.

Does the HPV vaccine prevent anal cancer?

Yes, the HPV vaccine can reduce the risk of anal cancer. Studies have shown that the 9-valent HPV vaccine reduces the frequency of developing high-grade anal cancer precursor lesions by 54% in sexually active individuals. It helps young people especially protect against HPV infections.

Is a lump felt in the anus always cancer?

No, every lump in the anus is not cancer. Lumps felt in this region can originate from hemorrhoids, benign tumors, or other health problems. The size and shape of the lumps can vary; some may be painless while others are painful. A specialist must definitely be consulted for a definitive diagnosis.