We often hear about colorectal cancer (cancer that develops in the colon and/or rectum) and the primary screening test to diagnose it, the colonoscopy. Colorectal cancer is relatively common — occurring in about 200,000 Americans per year.
By contrast, anal cancer is much less common, with roughly 9,000 new cases diagnosed this year, according to the American Cancer Society estimates. Still, the number of people diagnosed with anal cancer and dying from the disease is increasing year after year. It is typically found in older adults, with the average age in the early 60s. Anal cancer is also more common in white women and black men.
Signs and Symptoms
Sometimes people have no symptoms, so they are unaware that they have it. Other times, anal cancer produces symptoms that can be in the rectal or anal area that include:
- Rectal bleeding
- Pain or feeling of fullness
- Changes in bowel habits
- A lump in or near the anus
- Swollen lymph nodes near the area
The symptoms of anal cancer mimic those of hemorrhoids, which can complicate diagnosing the condition and getting patients the help they need. As a result, anal cancer often goes undiagnosed in the early stages when it is easier to treat.
Early detection is key, so it’s important to note the risk factors that make someone more likely to develop anal cancer in the first place. While colorectal cancer risk factors are closely linked to genetics and lifestyle (diet and exercise), anal cancer is very different, notes Robert Akbari, MD, colorectal surgeon at Doylestown Health Colorectal Specialists.
Anal cancer is largely associated with environmental factors. Those risk factors include being infected with the human papillomavirus (HPV), being immunocompromised as a result of HIV (human immunodeficiency virus) or having to take drugs that suppress the immune system, engaging in anal-receptive sexual activity as well as smoking.
The majority of anal cancer cases occur in people with HPV. This is the same group of viruses that cause cervical cancer and other kinds of cancer.
How it’s Diagnosed
Much like how gynecologists use the Pap smear to screen and diagnose early stages of cervical cancer, a Pap smear can be used to diagnose anal cancer in high-risk groups. For an anal Pap test, primary care physicians, gynecologists, gastroenterologists or colorectal surgeons can swab the anal lining, and cells that come off on the swab are looked at closely in the lab. The test takes only minutes to perform, is painless and no bowel preparation is needed.
If a Pap comes back abnormal or positive for anal dysplasia (cells that could indicate cancer), the next step is high-resolution anoscopy (HRA). But the HRA is a procedure that few providers offered until now. Doylestown Health Colorectal Specialists recently acquired the device; the physicians became trained in HRA and are now offering this screening to their patients.
Performed on an outpatient basis, the HRA uses an anoscope to magnify the area. It allows the colorectal surgeons to take a closer, more precise look at the cells and perform a biopsy immediately, if necessary. Then they can send the sample off to the lab for further examination.
“I think we’re ahead of the curve with this device,” says Dr. Akbari. He clarified that the HRA device can screen for anal dysplasia (precancer) in addition to existing anal cancer.
In fact, he mentioned a related, major, national study called the Anal Cancer/HSIL Outcomes Research (ANCHOR) was recently halted for its striking findings. The researchers found that anal cancer can be prevented by identifying and removing precancerous cells using the HRA procedure.
“The technology allows us to find the dysplasia more accurately and treat it, so we can prevent anal cancer from forming,” Dr. Akbari says.
- For more information on the HRA procedure offered at Doylestown Health Colorectal Specialists, call 215.863.8287.
About Doylestown Health Colorectal
Doylestown Health Colorectal Specialists provide expert assessment, diagnosis, and treatment for a wide range of disorders of the colon, rectum, anus and small intestine. Our board-certified physicians offer compassionate, personalized care, continuing patient education and state-of-the-art technology, using advanced colon and rectal surgery and minimally invasive robotic surgery techniques.