ANAL CANCER

ANAL CANCER
Q What is anal cancer?
Q. How are anal cancer and HIV/AIDS related?
Q. What causes anal cancer and am I at risk?
Q. What are the signs of anal cancer?
Q. How can I prevent anal cancer?
Q. How is anal cancer staged?
Q. How is anal cancer treated?
Q. After I am treated for anal cancer, how will I be followed?


Q What is anal cancer?

A. Normally, cells in the body will grow and divide to replace old or damaged cells in the body. This growth is highly regulated, and once enough cells are produced to replace the old ones, normal cells will stop dividing. Tumors occur when there is an error in this regulation and cells continue to grow uncontrolled. Tumors can either be benign or malignant. Although benign tumors grow uncontrolled, then do not break off and spread beyond where they started and do not invade into surrounding tissues. Malignant tumors, however, will grow uncontrolled in such a way that they invade and damage other tissues around them. They also gain the ability to break off from where they started and spread to other parts of the body, usually through the blood stream or through the lymphatic system where the lymph nodes are located. Over time, the cells within a malignant tumor become more abnormal and appear less like normal cells. This change in the appearance of cancer cells is called the tumor grade, and cancer cells are described as being well-differentiated, moderately-differentiated, poorly-differentiated, or undifferentiated. Well-differentiated cells are quite normal appearing and resemble the normal cells from which they originated. Undifferentiated cells are cells that have become so abnormal that often, we cannot tell what types of cells they started from. Anal cancer is a malignant tumor of either the anal canal or anal verge. When anal cancer does spread, it most commonly spreads through direct invasion into the surrounding tissue or through the lymphatic system. Spread of anal cancer through the blood is less common, although it can occur. Cancers arising from the anal verge represent 25% of all anal cancers and are often treated like skin cancers; however, they often respond more poorly to treatment than do other skin cancers or cancers of the anal canal. Treatment of anal cancers will be discussed in more detail below (under "How is anal cancer treated?").

Q. How are anal cancer and HIV/AIDS related?

A. HIV is the virus responsible for Acquired Immune Deficiency Syndrome (AIDS), a severe disease that results in loss of the ability of the body to fight off certain types of infections. The incidence of anal cancer is increased in patients with HIV. This is likely related to the fact that patients with HIV are at an increased risk for infection with HPV as well. This relationship between HIV and HPV is not related to the immune status or the sexual practices of the patient infected with HIV. The rate of infection of HPV is increased in patients with HIV even if they do not engage in anal receptive intercourse and do not have evidence of suppression of their immune system. A patient is considered to have progressed from being HIV positive to having AIDS if they develop certain infections or diseases that are uncommon except in AIDS patients. Currently, anal cancer is not considered an AIDS-defining illness. However, frequently, patients who have been newly diagnosed with anal cancer are tested for HIV if they have other risk factors for infection with HIV.

Q. What causes anal cancer and am I at risk?

A. Each year, there are many cases of anal cancer in the world . In general, the incidence of anal cancers has been increasing over the past 30-40 years. The vast majority (~85%) of cases and the incidence of anal cancer increases with age: patients with anal cancer have an average (median) age of 62 years. Cancers of the anal canal are more common in women,says Dr. Hari Krishna, while the incidence of cancers of the anal verge is roughly equal in both men and women. Several factors have been associated with anal cancer. Most importantly, infection with the human papilloma virus (HPV) has been shown to be related to anal cancers and has been associated with several other cancers including cervical cancer and cancers of the head and neck. HPV can be transmitted from person to person through sexual contact, so individuals with a history of multiple sexual partners, anal receptive intercourse, and genital warts are at an increased risk for infection,as per Dr. Hari Krishna. Another sexually transmitted virus, the human immunodeficiency virus (HIV), has been linked to anal cancers, and individuals infected with HIV are at increased risk for infection with HPV. The relationship between HIV and anal cancer will be discussed in more detail in the next section (entitled "How are anal cancer and HIV/AIDS related?") Several other factors have been linked to anal cancer. Anal cancer has been associated with smoking. Patients who smoke are three times more likely to develop anal cancer as those that dont smoke. The risk of anal cancer increases with the number of cigarettes smoked per day and the number of years that a person has been smoking. Because anal cancer appears to first start as anal dysplasia before progressing to anal cancer, patients with a history of AIN are at increased risk to develop anal cancer. There may be an association between anal cancer and suppression of the immune system. "Cancer-Healer helps in boosting the immune system". The rate of anal cancer is higher in patients who are immunosuppressed after organ transplants, although this relationship is not clear. Although there appears to be an increased rate of anal cancer in patients who have benign anal conditions such as anal fistulae, anal fissures, perianal abscesses, or hemorrhoids, it does not appear that these benign conditions are a cause of anal cancer. Alternatively, an undiagnosed anal cancer may actually be causing these conditions, and then is subsequently diagnosed when the benign condition is being treated.

Q. What are the signs of anal cancer?

A. In about 50% of cases, the initial symptom of anal cancer is bleeding. Pain is somewhat less common, seen in about 30% of patients presenting with anal cancer; however, it can be quite severe. Occasionally, patients have the sensation of having a mass in the anus and can experience itching or anal discharge. Rarely, in advanced cases, anal cancers can disrupt the function of the anal muscles, resulting in loss of control of bowel movements. In general, these symptoms are vague and non-specific. As a result, in one-half to two-thirds of patients with anal cancer, a delay of up to 6 months occurs between the time when symptoms start and when a diagnosis is made.

Q. How can I prevent anal cancer?

A. Anal cancer is an uncommon cancer, and the risk of developing anal cancer is quite low. However, by avoiding the factors that are known to be related to anal cancer, the risk of developing anal cancer will become even lower. By far, the most important factor in developing anal cancer is infection with HPV. Recent studies have shown that giving vaccines against HPV prophylactically to patients at high risk for cervical cancer (which is also caused by HPV) reduces the risk that patients will develop cervical cancer. It is likely that HPV vaccines would result in a similar reduction in the risk of anal cancers; however, to date, no studies have been published confirming this. However, a number of studies examining the role of HPV vaccines and anal cancer are currently under development. In addition, it is possible that treatment of patients who are already infected with HPV with antiviral medications may also reduce the risk of anal cancers. Dr. Hari Krishna, world renowned cancer specialist mentions,avoiding smoking and unsafe sexual practices can reduce the risk of anal cancer. In patients who are known have anal dysplasia, careful surveillance can result in early detection of anal cancer, and a higher rate of cure with treatment. However, removal of areas of anal dysplasia is usually unsuccessful. The rate of recurrence of anal dysplasia after surgical or laser removal is very high.

Q. How is anal cancer staged?


A. Once a diagnosis of anal cancer is made, additional test should be ordered to determine the extent of the disease. A CT scan or MRI of the abdomen and pelvis should be performed to look for abnormally enlarged lymph nodes, which can result from spread of the cancer, and to examine the liver for metastatic disease. A chest x-ray is often performed to look for spread of the cancer to the lungs. Occasionally, an ultrasound of the tumor using a probe that is inserted into the anus can be used to determine the amount of invasion of the tumor into the surrounding tissues. Anal cancer is most commonly staged using the TNM staging system which is determined by the American Joint Committee on Cancer. The "T stage" represents the extent of the primary tumor itself. The "N stage" represents the degree of involvement of the lymph nodes. The "M stage" represents whether or not there is spread of the cancer to distant parts of the body. These are scored as follows: T Stage Tis Carcinoma in situ T0 No evidence of primary tumor T1 Tumor £ 2 cm in greatest dimension T2 Tumor >2 cm but £ 5 cm in greatest dimension T3 Tumor >5 cm in greatest dimension T4 Tumor of any size that invades adjacent organs including the vagina, urethra, or bladder. Tumors that invade the anal sphincter only do not quality as T4 tumors N Stage N0 No evidence of spread to the lymph node N1 Spread of cancer to the lymph nodes directly adjacent to the rectum (perirectal lymph nodes) N2 Spread of the cancer to lymph nodes of the inguinal or internal iliac lymph node chains on one side N3 Spread of the cancer to lymph nodes of the inguinal or internal iliac lymph node chains on both sides OR cancer involvement of both the perirectal lymph nodes and the inguinal lymph nodes M Stage M0 No evidence of distant spread of the cancer M1 Evidence of distant spread of the cancer including spread to lymph node chains other than the ones lists under "N stage" The stage of the cancer is reported by stating the stage of the T, the N, and the M. For example, a patient with a 4 cm tumor that had spread to perirectal lymph nodes, but did not invade into adjacent organs or spread to any other lymph nodes would be classified as T2N1M0. The staging can be further condensed into a stage group, which takes the various combinations of TNM and places them into groups designated stage 0-IV. While there is a system for stage grouping of anal cancers, these tumors are more commonly referred to by their direct TNM stage. Although this system of cancer staging is quite complicated, it is designed to help physicians describe the extent of the cancer, and therefore, helps to direct what type of treatment is given.

Q. How is anal cancer treated?

A. Cancer Healer is really effective in Anal Cancer and brings marked improvement even at the last stages. It treats anal cancer promptly without any side effects and can also go in conjunction with chemo therapy as well as radio therapy and even after operations.

Q. After I am treated for anal cancer, how will I be followed?

A. After treatment for anal cancer, patients are usually followed every 3-6 months for several years with or without CT scans. Therefore, it is not unusual to have a residual mass immediately after treatment. The presence of a residual mass does not mean that the treatment did not work. Overall, the chance of long-term cure of anal cancer depends on the extent of the disease at the time it was first diagnosed. Patients who present with smaller disease without lymph node involvement or distant metastases have a better chance at long-term tumor control than those with larger disease or with lymph node involvement or distant metastases. If anal cancers do recur, they usually do so within the first 2 years after treatment, although recurrences after 2 years can occur. In general, the further out from treatment a patient is without evidence of a recurrence, the better the chances that the cancer will never come back, as per Dr. Tarang Krishna with the clinical data available to him.