Anal Cancer : Causes, Symptoms, and Treatments

Anal cancer is a type of cancer that occurs in the anus or anal canal. The anal canal is a channel at the end of the rectum that functions to remove faeces from the intestine. Anal cancer is generally rare. Anal cancer occurs when cells in the anal area grow uncontrolled. This condition causes these cells to turn into cancer.

Most anal cancers come from cells in the mucosal layer, especially glandular cells in the lining of the anal mucosa. The function of the gland in the anus is to produce mucus or mucus as a lubricant so that the feces more easily pass through the anus. The type of anal cancer that originates from this gland is called adenocarcinoma. In addition to adenocarcinoma, anal cancer can also include types of squamous cell carcinoma, basal cell carcinoma and melanoma. Often anal cancer spreads from one part of the anus to another so it is difficult to know the area of origin of anal cancer.

In addition to malignant tumors (cancer), in the anus can also appear benign tumors and pre-cancerous tumors, namely tumors that start from benign but on the way can turn into malignant. Dysplasia is an example of a pre-cancerous tumor. Dysplasia that occurs in the anus is known as anal intraepithelial neoplasia (AIN) and anal squamous intraepithelial lesions (SILs).

Also Read : Laryngeal Cancer : Causes, Symptoms, and Treatments

Anal Cancer Symptoms

Symptoms that can occur in anal cancer patients include:

• Bleeding from the rectum or anus.
• Itching or pain in the anal area.
• Swelling or bumps on the anus appear.
• Unusual discharge from the anus.
• Defecation (bowel movements) one of them is the difficulty of holding bowel movements.

One fifth of anal cancer patients do not show symptoms at all (asymptomatic). If the symptoms above appear, it is recommended to consult a doctor immediately.

Causes of Anal Cancer

Anal cancer is caused by a genetic mutation in the anus cell that causes normal cells to become abnormal. Abnormal anus cells grow and multiply uncontrollably and form tumors. These cancer cells can attack the surrounding tissue and spread to other parts of the body (metastasis).

Anal cancer is often associated with viral infections, namely Human Papilloma V irus (HPV). However, not everyone who has HPV infection will have anal cancer. HPV produces proteins that can deactivate tumor suppressor proteins in normal cells. When this protein is inactive, cells can turn into cancer.

Some things that can cause a person to get anus cancer more easily include:

• Age. Often anal cancer appears in the elderly.
• Do anal sex. Anal sex offenders will be more susceptible to anal cancer than people who do not have anal sex.
• Change sexual partners often. People who frequently change sexual partners are more susceptible to anal cancer than people who never change sexual partners.
• Have a history of suffering from cancer. Patients with cervical cancer , vulvar cancer, or vagina have a higher risk of developing anal cancer.
• Smoke. 
• Weak immune system conditions. A weak immune system, for example due to HIV infection or because of the use of immunosuppressant drugs such as corticosteroids , can cause a person to be more susceptible to anal cancer than people whose immune systems are in good condition. 
• Suffering from warts on the anus. Warts on the anus caused by HPV infection increase a person's risk of developing anal cancer. 
• Woman. Women are more susceptible to anal cancer than men. But for the age group below 35 years, anal cancer is more common in men than in women.

Anal Cancer Diagnosis

To determine whether a person has anal cancer or not, the following checks will be needed, including:

• Physical examination of the anus and rectum. This examination aims to check the condition of the rectum and anus, especially to find a lump in the anal tissue as a sign of cancer. Examination can be done by a digital plug and continued with the help of an anuscope device, which is a hard tube-shaped device to see abnormalities in the anus and rectum channels more clearly.
• Endoscopy. Endoscopic examination is done by inserting a thin flexible tube with a small camera at the end, into the anus. In this examination procedure, samples of anal tissue that are suspected of having cancer (anal biopsy) can also be taken. 
• Biopsy. The biopsy aims to take samples of anal tissue that are suspected of having cancer to be examined using a microscope. In addition to a direct biopsy of the anal tissue, a biopsy can also be performed using a fine needle aspiration on the lymph nodes when there is enlarged lymph nodes . 
• Transectal Ultrasound . In Transectal Ultrasound, the transducer is directly placed in the rectum. This check can see how deep the cancer has invaded the anal tissue.

In addition to these four tests, anal cancer can also be detected using the examination below, especially to determine the stage of cancer:

• MRI. This scan uses magnetic waves to get images of the condition of organs in the body, in this case the inside of the anus. MRI can be used to detect enlarged lymph nodes around the location of the cancer, which is suspected as a spread.
• CT scan. This scan can map the condition of anal cancer using X-rays. In addition to detecting cancer, CT scans can also detect if the cancer has spread, either to the lymph nodes or to other organs. 
• PET scan. This scan can describe the location of cancer and its spread throughout the body by using an analysis of the absorption of radioactive sugar by cancer cells. Generally doctors will combine PET scans with CT scans or MRIs so that the resulting images are clearer.

As a measure of the level of malignancy and spread of anal cancer, the following levels are used:

• Stage I. Anal cancer is less than or equal to 2 cm (the size of a bean or smaller).
• Stage II. Anal cancer is larger than 2 cm but has not spread to other organs. 
• Stage III A. Anal cancer has spread to lymph nodes near the anus or to other organs near the anus, such as the bladder, urinary tract (urethra), and vagina. 
• Stage III B. Anal cancer has spread to lymph nodes near the anus and organs near the anus; or anal cancer has spread to other lymph nodes in the pelvic area. 
• Stage IV. Anal cancer has spread to other parts of the body outside the pelvic area.

Anal Cancer Treatment

Treatment of anal cancer given to patients will depend on the stage of the patient's cancer. Therefore, it is important to diagnose the stage of cancer before treatment for patients. The types of treatment that can be done include:

• Radiotherapy. Radiotherapy treatment is done by firing high-powered rays such as X-rays and protons into areas that have cancer. During radiotherapy, the patient will be placed on the table, then the light is fired specifically into the anal area. Keep in mind that giving radiotherapy can also damage healthy cells around the cancer, so it can cause certain side effects. Some of the side effects that can arise include:
• Burning feeling on the skin
• Irritation and pain in the anus. 
• Diarrhea . 
• Nausea. 
• Fatigue. 
• Feel uncomfortable when defecating. Vaginal irritation in women that causes discomfort and discharge from the vagina. 

• Chemotherapy. Chemotherapy is a treatment method for killing cancer cells by using chemical drugs in the form of pills or infusion solutions. Chemotherapy can kill cells that grow quickly, such as cancer cells. Therefore, chemotherapy can also cause death in healthy cells that grow quickly such as hair and digestive tract cells that cause side effects in patients. Some of the side effects that can arise due to chemotherapy include:
• Nausea and vomiting. 
• Hair loss. 
• Sprue 
• Diarrhea. 
• Loss of appetite. 
• Decreased blood cell count.

            Chemotherapy is often given synergistically along with radiotherapy to get more effective treatment results.

• Cancer tissue surgery. Surgery is performed to remove cancerous tissue in the anus. Surgery can be done in the early stages of cancer or at an advanced stage. Early stage cancer surgery is usually done by removing cancer tissue and a little healthy tissue around it. In early stage cancer surgery, the doctor will try not to damage the anal sphincter muscle because this muscle functions to regulate bowel movements. Whereas in advanced cancer surgery, performed on cancer patients who have not responded to chemotherapy and radiotherapy. This advanced stage of cancer surgery is done by cutting the anus, rectum and part of the large intestine. The rest of the rectum and large intestine are then connected to the abdominal wall and made a hole (stoma) so that the stool can be removed through the hole. Then the stool will be accommodated in a bag ( colostomy bag ) that is connected to the intestine in the stoma, before being removed.

To improve the quality of life of patients in preventing and overcoming symptoms of diseases and side effects caused by cancer treatment, patients can be given palliative therapy or supportive therapy. The goal of palliative therapy is not to cure cancer.

Anal Cancer Prevention

Anal cancer cannot be completely prevented, but steps can be taken to reduce the likelihood of anus cancer in a person. Some steps to reduce the risk of developing anal cancer include:

• HPV Vaccination. To prevent HPV infection that can trigger anal cancer, HPV vaccination can be carried out, both in men and in women.
• Conduct safer and healthier sexual activity . For safe and healthy sexual activity, you should avoid having sexual relations with multiple partners. Avoiding anal sex is also a good step to prevent HPV infection in the anus. However, if you want to have anal sex, you should use a condom. 
• Quit smoking.

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