Anorectal Cancer

Digestive Diseases

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Anorectal cancer (anal cancer) is characterized by the growth of cancerous cells in the tissues of the anus. It is rare – about 5,000 Americans are diagnosed with this cancer each year.

Symptoms of Anorectal Cancer

Symptoms of anal cancer include bleeding from the rectum or anus, pain or pressure in the region surrounding the anus, an itching or discharge from the anus, a lump in the region, and a change in bowel habits may indicate anal cancer. Other conditions may also cause these symptoms, so it is important to check with your physician if you have any of these symptoms.

Risk Factors for Anorectal Cancer

Individuals infected with human papillomavirus (HPV) and anal or genital warts are at an increased risk of developing anal cancer. Chronic suppression of the immune system from infection of HIV/AIDS or the use of transplantation drugs such as cyclosporine for kidney transplant; anal intercourse or multiple sex partners also increase the risk. Tobacco use is a strong risk factor for anal cancer, as is being over age 50. Frequent anal soreness, redness, and inflammation, or having anal fissures increases the risk as well.

Diagnosis of Anorectal Cancer

Your physician will perform a physical examination and take a full medical history. He or she will do a digital rectal examination to check for lumps or anything unusual by inserting a lubricated, gloved finger into the lower part of the rectum. Your physician may also use an anoscope or proctoscope – both are short, lighted tubes – to examine the anus and lower rectum, and perform an endoanal or endorectal ultrasound. This test uses sound waves emitted by a probe, or transducer, which is inserted into the rectum and bounces sound waves off tissues to produce an image on a screen. A colonoscopy may be performed to evaluate the rest of the colon. Finally, your doctor may take a biopsy to check for cancer if an area appears abnormal.

Treatment for Anorectal Cancer

The treatment for anorectal cancer will depend on the stage of cancer, and may involve radiation therapy, chemotherapy, and/or surgery. Chemotherapy and radiation are generally the first line of treatment for anal cancers.

Radiation may be administered externally, or internally using radioactive seeds or catheters placed in or near the cancer.
Chemotherapy is often administered with radiation.
Surgery for small, contained cancer or cancer in the lower part of the bowel is usually done as a local resection, in which diseased tissue is removed along with some surrounding healthy tissue. This procedure can preserve sphincter muscles.

For more extensive cancer, a resection is performed, in which the anus, rectum, part of the lower colon, and lymph nodes are removed through an incision made in the abdomen. The surgeon then attaches the end of the intestine to an opening, called a stoma, which he or she makes in the abdomen, where stool collects in a bag attached to the outside of the abdomen.

Research for Anorectal Cancer

We are currently evaluating the role of increased magnification in laparoscopic treatment of anal cancer to help identify nerves in order to preserve sexual and bladder function.