Anal Cancer – Diagnostic Procedures

Anal Cancer diagnosis is conducted with the doctor firstly recording the patient’s medical history that would take into account the general health condition, immune status, any form of medications being taken, whether one is HIV positive, the existing viral load and CD4+ lymphocyte count.

The doctor would additionally ask about any previous occurrence of anal warts, dysplasia or other anal problems. The doctor would also enquire regarding the presence of any heart valve irregularity that is acute enough to necessitate the need of consuming antibiotics during a dental cleanup procedure in order to avert any form of heart valve infections. In case this condition holds true, then an antibiotics course would be prescribed prior to conducting any biopsies that would be part of the cancer diagnosis procedure.

The doctor would enquire about the presence of any symptoms that may include anal prickliness, pain, discomfort, irritation, bothersome bowel movements or any kind of problems occurring during anal sex, if pertinent.

In order to conduct a definite analysis of anal cancer, the doctor would also suggest undergoing the following tests:

• Digital rectal examination (DRE)
  During the test, the doctor or the nurse would insert a finger covered with a lubricated glove into the rectum to palpate any kind of irregularities like mass, thickening, any area of hardness, lumpy formations, any spot of localized soreness or an ulcerous growth. In spite of patients being asymptomatic, often some form of abnormality is generally noted during the DRE test. In such situations, the patient would be referred to a specialist doctor exclusively handling anorectal problems for an evaluation and biopsy of the dubious areas.
• High Resolution Anoscopy (HRA)
  This test comprises of probing the anus via a microscope that is introduced into the anus for spotting any irregularities like ulcerous growths, areas of thickening and lacerations containing anomalous vessels. During an HRA examination, assessment and biopsies are then conducted on these dubious areas.
• Proctoscopy (sigmoidoscopy)
  A rectal examination procedure employing a short, illuminated tube known as proctoscope.
• Endo-anal ultrasound
  A specialised form of ultrasound that employs high-power sound waves for producing detailed images of the insides of the body.
• Rectal biopsy
  Biopsy is conducted for definitive identification of anal cancer in symptomatic patients that have been diagnosed with irregularities in the DRE or HRA tests. During biopsy, a small amount of tissue sample is removed from the rectum to be sent for pathological analysis to make an irrefutable diagnosis.

Once the diagnosis has been confirmed, the stage or extent of the spread of the disease would be evaluated. Staging is a meticulous effort at finding if the cancer has metastasized and to which areas of the body. This data would additionally better assist the doctor to conclude on the most viable treatment plan for that stage of cancer. Further tests might be conducted to aid in determining the stage.

The several stages of anal cancer comprise of:

• Stage IS
  The cancer is in its nascent stages and is present solely in the inmost anal lining.
• Stage I
  The tumor has grown to 2 cms or less in size.
• Stage II
  The tumor growth is more than 2 cms in size.
• Stage IIIA
  The tumor (irrespective of size) has metastasized to close by organs like vagina, urethra, bladder or has reached the lymph nodes near the rectum.
• Stage IIIB
  The tumor (irrespective of size) has metastasized to close by organs like vagina, urethra, bladder and has reached the lymph nodes near the rectum.
• The tumor (irrespective of size) may have extended to adjacent organs, and also metastasized to the lymph nodes on one of the pelvis. The tumor may or may not have spread to the groin region.
• The tumor (irrespective of size) might have metastasized to the adjacent organs, and additionally spread to the lymph nodes close to the rectum and in the groin. The lymph nodes located on both sides of the pelvis may or may not be affected and might at times spread to the groin.
• Stage IV
  Any cancer that has metastasized to other remote areas of the body like liver, lungs or brain.
• Recurrent
  Recurrent cancer is that cancer which has relapsed subsequent to treatment. The disease might reappear in the anal region or any other part of the body.