Anal cancer is a disease in which malignant (cancer) cells form in the tissues of the anus.
The anus is the end of the large intestine, below the rectum, through which stool (solid waste) leaves the body. The anus is formed partly from the outer, skin layers of the body and partly from the intestine. Two ring-like muscles, called sphincter muscles, open and close the anal opening to let stool pass out of the body. The anal canal, the part of the anus between the rectum and the anal opening, is about 1½ inches long.
Risk factors include the following:
- Being older than 50 years.
- Being infected with human papillomavirus (HPV).
- Having many sexual partners.
- Having receptive anal intercourse (anal sex).
- Frequent anal redness, swelling, and soreness.
- Having anal fistulas (abnormal openings).
- Smoking cigarettes.
These and other signs and symptoms may be caused by anal cancer or by other conditions. Check with your doctor if you have any of the following:
- Bleeding from the anus or rectum.
- Pain or pressure in the area around the anus.
- Itching or discharge from the anus.
- A lump near the anus.
- A change in bowel habits.
Tests that examine the rectum and anus are used to detect (find) and diagnose anal cancer.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Digital rectal examination (DRE): An exam of the anus and rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual.
- Anoscopy: An exam of the anus and lower rectum using a short, lighted tube called an anoscope.
- Proctoscopy: An exam of the rectum using a short, lighted tube called a proctoscope.
- Endo-anal or endorectal ultrasound: A procedure in which an ultrasound transducer (probe) is inserted into the anus or rectum and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If an abnormal area is seen during the anoscopy, a biopsy may be done at that time.
After anal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the anus or to other parts of the body.
The process used to find out if cancer has spread within the anus or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests may be used in the staging process:
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen or chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. For anal cancer, a CT scan of the pelvis and abdomen may be done.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
There are three ways that cancer spreads in the body.
Cancer can spread through tissue, the lymph system, and the blood:
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Cancer may spread from where it began to other parts of the body.
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if anal cancer spreads to the lung, the cancer cells in the lung are actually anal cancer cells. The disease is metastatic anal cancer, not lung cancer.
The following stages are used for anal cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the innermost lining of the anus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
In stage I, cancer has formed and the tumor is 2 centimeters or smaller.
In stage II, the tumor is larger than 2 centimeters.
In stage IIIA, the tumor may be any size and has spread to either:
- lymph nodes near the rectum; or
- nearby organs, such as the vagina, urethra, and bladder.
In stage IIIB, the tumor may be any size and has spread:
- to nearby organs and to lymph nodes near the rectum; or
- to lymph nodes on one side of the pelvis and/or groin, and may have spread to nearby organs; or
- to lymph nodes near the rectum and in the groin, and/or to lymph nodes on both sides of the pelvis and/or groin, and may have spread to nearby organs.
In stage IV, the tumor may be any size and cancer may have spread to lymph nodes or nearby organs and has spread to distant parts of the body.
At Huntsman Cancer Institute, anal cancer is treated by a team of specialists, including gastroenterologists (doctors who specialize in treating problems of the digestive organs), surgeons, medical oncologists (doctors who treat cancer with medicine), radiation oncologists (doctors who treat cancer with radiation), nurses, dietitians, and social workers.
Different types of treatments are available for patients with anal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Three types of standard treatment are used:
New types of treatment are being tested in clinical trials.
Having HIV can affect treatment of anal cancer. Cancer therapy can further damage the already weakened immune systems of patients who have the virus. For this reason, patients who have anal cancer and HIV are usually treated with lower doses of anticancer drugs and radiation than patients who do not have HIV.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.. Learn more about this treatment in our introduction to chemotherapy video.
- Local resection: A surgical procedure in which the tumor is cut from the anus along with some of the healthy tissue around it. Local resection may be used if the cancer is small and has not spread. This procedure may save the sphincter muscles so the patient can still control bowel movements. Tumors that form in the lower part of the anus can often be removed with local resection.
- Abdominoperineal resection: A surgical procedure in which the anus, the rectum, and part of the sigmoid colon are removed through an incision made in the abdomen. The doctor sews the end of the intestine to an opening, called a stoma, made in the surface of the abdomen so body waste can be collected in a disposable bag outside of the body. This is called a colostomy. Lymph nodes that contain cancer may also be removed during this operation.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. For more information, visit HCI's clinical trials website.
When you or someone you love is diagnosed with cancer, concerns about treatments and side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, work, or normal daily life.
There are several places you can go for support:
- Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
- The G. Mitchell Morris Cancer Learning Center has hundreds of free brochures and over 3,000 books, DVDs, and CDs available for checkout.You can browse the library, perform Internet research, or talk with a cancer information specialist.
- Our Patient and Family Support Services offer emotional support and resources for coping with cancer and its impact on daily life to HCI patients and their families.
- The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers many programs to increase the quality of life and well-being of HCI patients and their families.
Adapted from the National Cancer Institute's Physician Data Query (PDQ®) Cancer Information Summaries
This information last updated on HCI website December 2013
*If you are interested in a trial that is currently marked *Not Open, please contact the Patient Education team at 1-888-424-2100 or email@example.com for other trial options. Enrollment is updated daily.
Forte Research Systems in partnership with Huntsman Cancer Institute
Ignacio Garrido-Laguna, M.D., Ph.D.Locations
|Huntsman Cancer Hospital||(801) 213-4266|
|Huntsman Cancer Hospital||(801) 585-0193|
Specialties: Biliary Cancer, Colon Cancer, Medical Oncology, Oncology, Pancreatic Cancer
Robert E. Glasgow, M.D.Locations
|Huntsman Cancer Hospital||(801) 585-6035|
|University Hospital||(801) 585-6035|
Specialties: Acute Care Surgery, Barrett's Esophagus, Colorectal Surgery, Endocrine Surgery (Adrenal, Thyroid, Parathyroid), Esophageal Diseases, Esophageal Surgery, GI Motility, Gastric/Esophageal Surgery, Gastroesophageal Reflux Disease (GERD), Hepatopancreatobiliary (Liver/Pancreas/Biliary) Surgery, Hernia Surgery (open and laparoscopic), Minimally Invasive Gastrointestinal Surgery, Minimally Invasive Lung & Esophageal Surgery, Soft Tissue Sarcoma Surgery, Surgery, General, Therapeutic Endoscopy, Upper Gastrointestinal Tract Surgery
William J. Peche, M.S.P.H., M.D.
Specialties: Colon Cancer, Colorectal Surgery, Endoscopy, Inflammatory Bowel Disease/Crohn's/Ulcerative Colitis, Surgery, General
N. Jewel Samadder, M.Sc., M.D.Locations
|Huntsman Cancer Hospital||(801) 213-9797|
|South Jordan Health Center||(801) 213-9797|
Specialties: Clinical Genetics, Colon Cancer, Gastroenterology, Gastrointestinal Cancers, Pancreatic Cancer
Mark Savarise, M.D.Locations
|South Jordan Health Center||(801) 213-4500|
Specialties: Breast Cancer, Breast Surgery, Colorectal Surgery, Endoscopy, Gastroesophageal Reflux Disease (GERD), Hernia Surgery (open and laparoscopic), Sclerotherapy, Spider Veins, Surgery, General, Therapeutic Endoscopy
Courtney L. Scaife, M.D.Locations
|Huntsman Cancer Institute||(801) 585-6911|
Specialties: Colorectal Surgery, Esophageal Surgery, Gastric/Esophageal Surgery, Gastrointestinal Stromal Tumors, Hepatopancreatobiliary (Liver/Pancreas/Biliary) Surgery, Minimally Invasive Gastrointestinal Surgery, Oncology Surgery, Pancreatic Cancer, Sarcoma, Soft Tissue Sarcoma Surgery, Surgery, General, Upper Gastrointestinal Tract Surgery
Sunil Sharma, M.B.A., M.D., FACPLocations
|Huntsman Cancer Hospital||(801) 213-4266|
Specialties: Clinical Scientist, Colon Cancer, Liver Cancer, Oncology, Pancreatic Cancer
John R. Weis, M.D.Locations
|Huntsman Cancer Institute||(801) 585-0262|
Specialties: Colon Cancer, Oncology, Pancreatic Cancer
- Am I At Risk for Anal Cancer?
- Do What You Can to Ease Side Effects of Treatment for Anal Cancer
- How Does My Doctor Know I Have Anal Cancer?
- Statistics About Anal Cancer
- Types of Anal Tumors
- Types of Treatment for Anal Cancer
- Understanding Your Stage of Anal Cancer
- What Are the Symptoms of Anal Cancer?
- Can I Get Checked for Anal Cancer Before I Have Symptoms?
- How Can I Prevent Anal Cancer?
- What to Know About Chemotherapy for Anal Cancer
- What to Know About Radiation Therapy for Anal Cancer