Anal cancer
"The goal of treatment will depend on the stage at which it is diagnosed. The aim should be to preserve anal function with the best possible quality of life".
DR. LUCÍA CENICEROS PAREDES
SPECIALIST. GASTROINTESTINAL CANCER AREA
What is anal cancer?
Anal cancer or anal cancer is a rare type of tumour. It accounts for 5% of all anorectal neoplasms and 1.5% of gastrointestinal tumours.
The anal canal is the terminal portion of the large intestine, and corresponds to a 3-4 cm tubular structure extending from the perianal skin to the end of the rectum. It is lined in its upper portion by rectal-type mucosa, in its middle zone (coinciding with the pectineal interface line) by transitional mucosa and, in its lower section, by mucosa with stratified squamous epithelium.
Tumours that develop in this region are classified into squamoid and epidermoid tumours, and those with a line of differentiation towards adenocarcinoma (although this is a rare entity among carcinomas of the anal canal).
Due to the surgical complexity of this pathology, it is essential to go to specialised centres. The Clínica Universidad de Navarra has a medical-surgical team that is highly qualified in the diagnosis and treatment of patients with anal cancer.
In addition, our nursing service provides follow-up care to help improve symptomatic control, surgical sequelae and promote the rapid recovery of our patients.
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What are the symptoms of anal cancer?
20% of anal cancer patients are asymptomatic. However, here are some of
the main symptoms that may be associated with anal cancer.
Anal bleeding
This is the most common symptom and is often one of the first signs of anal cancer. It occurs in 45% of cases.
Pain or a feeling of pressure in the anus
Some people experience persistent pain or discomfort in the anal area. This may intensify when sitting or during bowel movements.
Anal itching or itching
An itching sensation in the anal region, although it may seem a minor symptom, could be related to changes in the anal tissue.
Lumps or masses in the anal area
The appearance of lumps, bumps or a mass around the anus is a symptom that should never be ignored. These lumps may be visible or palpable and could indicate abnormal tissue growth.
Changes in bowel movements
Changes in bowel habits, such as diarrhoea, persistent constipation or change in the shape of the stool.
Abnormal discharge
Some people may experience abnormal discharge in the anal region, this may be associated with anal tumours.
Swollen lymph nodes
In some cases, lymph nodes near the anus or in the groin may become swollen or enlarged, which may be a sign that the cancer has spread.
Do you have any of these symptoms?
If you suspect that you have any of the above symptoms,
you should consult a medical specialist for a diagnosis.
What are the causes?
Multiple risk factors for the development of tumours in the anal canal have been identified. These include infections by certain viruses, such as Human Papilloma Virus (HPV) and Human Immunodeficiency Virus (HIV).
Another important factor is tobacco use, as the carcinogenic substances present in tobacco smoke can promote abnormal changes in anal tissue.
The presence of chronic perianal fistulas, whether or not associated with Crohn's disease, is an important risk factor, especially when they become chronic and last more than 10 years.
On the other hand, lymphogranuloma venereum (LGV), a sexually transmitted infection, is also associated with the development of strictures and perianal fistulas, conditions that can complicate anal health. The presence of these conditions contributes to a risk of developing tumours in the anal canal.
What is the prognosis?
Generally speaking, tumours of the anal canal represent a curable disease, especially when diagnosed at an early stage. Early detection allows treatment to be initiated before the disease progresses, improving the patient's chances of recovery and survival.
Prognostic factors that influence tumour progression include tumour size and lymph node involvement. These factors are often directly related to the prognosis and aggressiveness of the cancer.
Five-year survival statistics also vary according to the stage at diagnosis. For stage T1 and T2 tumours, detected at early stages, the overall five-year survival is 86%. However, in advanced stages, this rate decreases to 45%, reinforcing the importance of early detection and timely treatment.
How is anal cancer anal cancer?
Diagnosis requires an evaluation by a medical specialist. If there is suspicion, a digital rectal examination should be performed to detect abnormalities in size, shape or texture.
The examination should be completed by performing an anuscopy (a medical procedure that allows the doctor to look into the anal canal and lower rectum) to see the inside of the anus and rectum so that a biopsy of the lesion can be performed. Sometimes, due to inflammation or infiltration of the lesion, this test can be painful and will be performed under anaesthesia.
Once the diagnosis has been confirmed, the study will be completed by performing a CT (Computerised Axial Tomography) and pelvic MRI (Magnetic Resonance Imaging).
How is anal cancer treated?
Efforts should be made to preserve anal function with the best possible quality of life.
Radiotherapy treatment with concurrent chemotherapy is the curative treatment for most patients with locally advanced anal canal cancer.
The combination of external beam irradiation techniques with brachytherapy in selected cases achieves complete response and cure rates of more than 70%.
Also, for selected cases, treatment with proton therapy can reduce side effects and improve tolerance to treatment.
Chemotherapy is the medical treatment that consists of the application of chemical substances to the organism.
Chemotherapy can mainly be administered intravenously or orally, although there are other forms of administration.
Sometimes, for intravenous administration, it is necessary to place a device called a port-a-cath. This subcutaneous reservoir consists of a silicone membrane and a catheter which is introduced through the subclavian vein until it reaches the superior vena cava.
The treatment is administered according to a specific schedule depending on the chosen regimen. Prior to the administration of the treatment, a patient assessment and an analytical determination must be made.
Each administration is called a cycle. There are treatments in which each cycle is divided into several sessions. All this depends on the therapeutic scheme used
Surgery is not used as initial treatment because of the risk of requiring removal of the anal sphincter and conditioning the patient to a permanent colostomy.
However, if the tumor does not respond to the therapies used, abdomino-perineal resection may be performed. In this procedure the lower part of the colon, rectum and anus are removed.
Due to the surgical complexity of this pathology, it is essential to go to specialized centers. The Clínica Universidad de Navarra has a highly qualified medical-surgical team to perform this procedure.
In addition, we perform a follow-up by the nursing service that helps to better control symptoms, surgical sequelae and promote the rapid recovery of our patients.
Colostomy
Colostomy is the surgical act where one end of the large intestine is removed through an opening in the abdominal wall (stoma). Stool passes through the stoma into the pouch attached to the abdomen.
From the first moment, the colostomy requires a series of specific cares that will be explained in detail by the nursing team specialized in this type of surgical sequelae.
Where do we treat it?
IN NAVARRE AND MADRID
The Gastrointestinal Cancer Area
of the Cancer Center Clínica Universidad de Navarra
The Gastrointestinal Cancer Area is composed of a multidisciplinary team of experts in the diagnosis and treatment of diseases of the digestive tract.
It includes specialists in the digestive system, radiology, pathological anatomy, surgery and medical and radiotherapeutic oncology and nursing support.
What diseases do we treat?
Why at the Clinica?
- Integral evaluation of the patient.
- Cutting edge technology.
- Expert professionals who are a national reference.
Where do we treat it?
Specialists with expertise in treating anal cancer
