1. Women suffering from the HPV infection type that can increase their chances of having cervical cancer are considered to be at higher risk of developing anal cancer. This has been proved in a medical study conducted on squamous cell carcinoma patients of Sweden and Denmark. Another medical study has revealed that the HPV type that causes majority (84%) of the anal cancer cases is HPV-16. Estimations by modern day scientists suggest that overall 90% of the anal cancer cases occur due to HPV infections.
2. People having sexual relationships with multiple partners have higher risk of getting exposed to HPV virus, which also increases their chances of developing anal cancer.
3. The current smokers also have much higher chances of developing anal cancer than the nonsmokers. In a recent research conducted under the Janet Daling, an epidemiologist it was found that smoking can play a vital role in development of anal cancers, which are independent of the other common risk factors of the disease like abnormal sexual activities. During the research, it was found that over 50% of the patients studied, smoked when they were diagnosed with anal cancer. The smoking rate in the control group on the other hand was around 23%. Daling as a conclusion to the study stated that a person smoking currently is 4 times higher risk of developing anal cancer; the chances are equal for female and male smokers. The study could not reveal anything about the mechanism through which smoking increases one’s risk of having anal cancer. The speculation of the researchers however, suggest that smoking impairs a procedure known as apoptosis, which in turn abnormal cell growth in our body eventually resulting in cancer.
4. Immunosuppression is another strong risk factor of anal cancer.

Anal cancer is a cancer type related to infection caused by human papillomavirus or HPV. Majority of the anal cancer patient get the disease due to HPV. However, having HPV infection does not mean that you’ll inevitably suffer from anal cancer and vice versa. Besides this common cause of anal cancer, there are certain risk factors of the disease:

• Age: Majority of the patients diagnosed with anal cancer are above the age of 50 years.
• Multiple sexual partners: If you have multiple sexual partners, you are at higher risk of getting the disease. This risk factor stands true for both women and men.
• Smoking: The habit of smoking cigarettes increase the chance of getting several cancer types and anal cancer is one of them. Even former smokers have slightly greater risk of getting the disease.
• Intake of immunosuppressive drugs: Individuals who are treated with immunosuppressive drugs are extremely susceptible towards developing anal cancer. Such drugs are prescribed primarily to people undergoing organ transplants; so, a large number of patients having such surgeries become victims of anal cancer. Intake of corticosteroids (these medications are prescribed for controlling autoimmune disorders) for prolonged period of time is also known to augment risk of getting this cancer type.

Cervical dysplasia (the presence of pre-cancerous alterations in cells making up internal cervical lining) is a condition which over and over again has been observed to herald cervical cancer – & is additionally caused due to an HPV infection. Researches have shown that when one has cervical dysplasia, one is at a greater risk and this crucial fact is not known by many. Anal cancer is fairly remediable when detected in the earlier stages.

The analogous kinds of HPV (16, 18) which have been incriminated in cervical cancer are additionally associated to anal cancer. In the concluding month of 2010, the FDA did an expansion of the consented usage of the HPV vaccination Gardasil for including prevention of anal cancer & pre-malignant lesion formations.

Awareness needs to be raised among people regarding the association amid HPV, an exceedingly prevalent STD & an entire listing of cancers, each one affecting a comparatively smallish number of individuals, however when examined as a whole, afflicts several thousand people. Apart from anal cancer, HPV infections are even associated with several gynaecologic cancers such as cancers of the vagina & vulva, particular cancers of the penis among males & some head & neck cancers.

The paradox is that anal cancer patients oftentimes do not tell anyone about the type of cancer they have, mostly due to sense of shame about their condition. A common supposition harboured by majority of the individuals is that in case a Mr/ Miss X has anal cancer then he/ she has engaged in anal sexual intercourse, which is untrue. Even males who are heterosexuals would be having HPV presence in their anal region due to its prevalence.

It is highly crucial to accentuate that the avg. individual is actually a woman in her later part of her fifties, initial part of her sixties. The ex-Charlie’s Angels starlet Farrah Fawcett who did a documentation of her fight with anal cancer on print, was quite characteristic; she was in her sixties when losing to anal cancer during 2009. Individuals mostly link anal cancer generally with MSM (males having sex with males) that are HIV-infected – this isn’t the case.

Even though MSM are at an augmented risk for getting anal cancer, the condition tends to strike females in greater numbers as compared to males. In the U.S., anal cancer cases were identified in two thousand males & 3260 females annually. The condition is rising quickly, with newer diagnosis augmenting by two per cent yearly across genders, as per national cancer figures. Yearly 720 deaths due to anal cancer take place.

Some of the risk factors entail those who have a past of cervical cancer or some gynaecologic malignancy, people with compromised immune system, an uncharacteristic Pap smear & have tested affirmative for HPV 16, 18. People who have several sex mates, those with a past of STDs & have been a receipt to anal sex, despite no total penetrations, likewise augment risk.

Preliminary symptoms such as bloody feces or a sense of pressure could often be wrongly believed to be hemorrhoids. A crucial pointer is that in case hemorrhoids are not improving then people must promptly visit their physician. There is absence of any lucid medical agreement on anal cancer screening. Options entail a digital anal examination or DRE (digital rectal examination) carried out as part of physical or gynaecologic check-ups or anal Pap testing. A screening method known as high resolution anoscopy might have particularly high sensitivity though it isn’t broadly obtainable.

In case a female has had a history of cervical cancer, she is apparently at augmented risk for anal cancer though physicians are aware of the link since long but individuals failed in paying close heed till lately.

Another crucial goal is de-stigmatization of anal cancer & ending seclusion several patients might sense.

In some cases this disease presents no outward symptoms in individuals that have developed it. In cases where symptoms are present one of the first symptoms that may be experienced is unexplained bleeding of the rectum. Some other symptoms to be aware of include lumps that have formed near the anal area, unusual anal discharge or pain and pressure located in the anal area and changes in bowel movements. Additional symptoms may include itching and swollen lymph nodes in the anal or groin areas.

The first thing to do if you suspect you may be afflicted with anal cancer is to schedule an appointment with your health care provider to receive a digital rectal exam. During this exam your doctor will insert a finger into your anus to determine if there is anything unusual present. This exam is recommended on a yearly basis for men over the age of 50 as part of the process for screening for early detection of prostate cancer. It is also important for woman to undergo this process in conjunction with their yearly gynecological examinations. It is also recommended that an anal pap smear be performed at this time for individuals that are considered to be at high risk of contracting anal cancer. When this is done the doctor will swab the lining of the anus and test it for abnormalities. If this is found to be positive a biopsy will then be performed.

Now that we know some of the symptoms of anal cancer and how it is diagnosed let’s look at what some of the causes of it are and ways of preventing it.

One thing that may put you at a higher risk of developing anal cancer is if you are at a high risk for what is referred to as anal intraepithelial neoplasia. This is defined as a precancerous change in the mucus of the anus. Other factors that increase the risk of anal cancer include homosexuality, history of cervical or vulvar cancer, recipients of transplants and individuals inflicted with the HIV virus. If you are part of any of these categories tell your doctor to determine your risk level and the need to undergo testing for this disease.

Utilizing safe sex practices in an effort to limit exposure to sexually transmitted diseases will reduce your chances of developing anal cancer. Other considerations that may reduce your risk include quitting smoking and regular checkups with your doctor.

If you experience any of the symptoms of anal cancer it is important to notify your physician promptly. Early detection is important for successful treatment.

It was previously though that anal cancer may be caused by the recurring irritation of the skin around the anus that is related to cracks or fissures as well as hemorrhoids or fistulae which is defined as an abnormal passage. However these beliefs are no longer as common as in times past. In more recent times it is becoming more widely suggested that this type of cancer may be caused by other things.

One factor that is believed to have a large role among the causes of anal cancer is the presence of viruses such as HIV or human immunodeficiency virus and HPV also known as human papillomavirus.  Both of those are typically sexually transmitted diseases that can travel from one sexual partner to another although in some cases they can be contracted in other ways as well.

HIV generally attacks the immune system making it difficult for the body to fight off infections. HPV is known to cause genital warts as well as cervical cancer. Although there is now a vaccine that can be given to women in an effort to lower the risk of cervical cancer this vaccine is not available for use in the prevention of anal cancer.

Other risk factors that have been considered to be possible causes of anal cancer include a history of cervical or vulvar cancer, recipients of transplants, and homosexuality. Another factor that may increase the risk of anal cancer is thought to be individual that are at a risk for another disease called AIN or anal intraepithelial neoplasa. This is a precancerous change in the mucus of the anus and individuals with it or at high risk for getting it are thought to be at a higher risk of developing anal cancer. Recurring warts or hemorrhoids are also thought to elevate the risk of contracting anal cancer.
Although not all cases of anal cancer produce symptoms some of the signs to watch for include itching and bleeding of the rectum or anal area. In addition to these symptoms if you experience any of these or other symptoms such as pain or pressure in the anal area or any kind of unusual anal discharge you should seek prompt medical attention.

Most cases of this disease are generally found in individuals between the ages of 50 and 80. When cases of this cancer are found in those under the age of 50 it is more prevalent in men than women, whereas after age 50, women seem to be slightly more affected.

One thing that is considered to be a major risk factor in developing this type of cancer is the development of HPV or human papillomavirus which is a virus that is transmitted between sexual partners. Although there is currently a vaccine to prevent cases of cervical cancer related to this virus it is not currently used to in cases of prevention related to anal cancer. Some other risk factors that may be associated with the development of anal cancer include reception of anal sex, multiple sexual partners, being over the age of 50 years, recurring soreness and redness of the anus, smoking and low immune system.

Although some lesions or tumors that may develop in the anal area are not cancerous even these can turn into cancerous tumors over extended periods of time.

Hopefully this has answered the common question of what is anal cancer. Now that it has been determined what it is there is some additional vital information that individuals need to know regarding this disease.

In many cases there are no symptoms experienced by individuals that have developed anal cancer however some simple signs that may be associated with this disease include anal bleeding, itching, pain or pressure, unusual discharge, changes in bowel habits and the formation of lumps close to the anus.

There are ways of detecting anal cancer such as a digital rectal examination or during procedures such as the removal of what may be thought to be hemorrhoids. Other more complicated procedures such as anoscopy, proctoscopy or endorectal ultrasound may also used for the detection of this disease. In the event that there is evidence that an individual may have anal cancer a biopsy is usually performed and examined by a specialist.

In addition to this information it is important to know what the treatment options for this disease is. The standard treatments available for individuals diagnosed with anal cancer include surgery, chemotherapy and radiation. Of the available treatments the two that are the most common are radiation and chemotherapy. In most cases successful treatment plans include the use of two or more types of treatment.

Now that you know the answer to the question what is anal cancer it is important to remember that if you suspect that you may have developed this disease you should immediately seek the advice of your family doctor.

Anal Cancer is a disease wherein cancerous or malignant cells start developing in the tissues of the anus.

Examinations & Tests:

Tests for examining the rectal and anal area are employed for detection and diagnosis of anal cancer. The below stated tests and procedures could be conducted:

• Physical Examination
  A physical exam of the body is done for checking the general health signs inclusive of watching out for any indications of disease like lumpy appearance or anything abnormal. The patient’s history in regards to health habits, previous sickness and treatments would additionally be analysed.
• Digital Rectal Examination or DRE
  During the DRE examination, the lower portion of the anus and rectum are checked by inserting a finger covered by glove made slippery with a lubricant for palpating any lumpy or abnormal formations.
• Anoscopy
  With the assistance of a short, illuminated tube known as an anoscope the anus and the lower part of the rectum is examined.
• Proctoscopy
  The rectum is examined with the help of short, illuminated tube known as a proctoscope.
• Endo- anal or endorectal ultrasound
  During the procedure, a probe or ultrasound transducer is passed inside the anus or rectum and employed for bouncing high-power sound waves or ultrasound off the surfaces of the internal tissues or organs, thus producing echoes. These echoes produce an image of the body tissues known as a sonogram.
• Biopsy
  The cells or tissues are extracted from the dubious site to be microscopically analysed by a pathologist for searching for any indications of cancer. In case any unusual area is spotted in the course of the anoscopy procedure, a biopsy could be conducted during that time.

Particular Factors affecting Prognosis or likelihood of recovery

The prognosis or likelihood of recovery is dependent on the below stated aspects:

• The tumor size.
• The location of the tumor in the anus.
• Has the cancer metastasized to the lymph nodes.

The treatment choices would be offered on the basis of the following conditions:

• The cancer staging.
• Placing of the tumor in the anus.
• The presence of HIV or human immunodeficiency virus in the patient.
• Whether the cancer was remnant subsequent to initial treatment or has it relapsed.

Subsequent to the cancer being detected, tests are undertaken for checking whether the cancer cells have metastasized within the anus or to the other areas of the body.

Through the process of staging, the extent of spread of the cancer is determined to plan the further course of treatment. The following tests could be carried out during the staging process:

• CAT or CT scan
  In-depth images from varying angles of the interior areas of the body are captured and rendered to an X-ray device via an inter-connected computer. A dye that is either intravenously administered or ingested assists in getting a clearer picture of the internal organs and tissues. This procedure is known as either computed or computerized or computerized axial tomography. In case of anal cancer, CAT scan of the pelvic and abdominal region could be conducted.
• Chest X-Rays
  X-rays are form of energy beams that could penetrate through the body capturing images of the internal organs and bones and reproducing the pictures of the interiors of the body.
• Endo-anal or endorectal ultrasound
  A probe or ultrasound transducer is introduced within the anus or rectum and used for rebounding high-power sound waves off the surfaces of the internally placed organs or tissues and generating echoes that in turn produce images of the body tissues known as sonogram.

In majority of the patients, invasive anal cancer can be cured, especially in case of early diagnosis and the tumors are small-sized. The treatment for anal cancers generally involves a combination of chemotherapy and radiation that leads to complete regression of the tumors in eighty to ninety percent of the cases.

Surgical intervention might become necessary in some forms of cancers not responding to chemotherapy and radiation or in those cases when a relapse has occurred following treatment with chemotherapy and radiation.

Chemotherapy

Chemotherapy employs the use of drugs for obliterating the cancer cells. Chemotherapy could be taken in either pill form or an intravenous administration of the drugs. Chemotherapy is known as systemic therapy as the drugs after gaining entry into the bloodstream, move throughout the body killing cancer cells on their route. Some of the drugs used in chemotherapy make the cancer cells more responsive to radiation therapy.

Radiation Therapy

Radiation therapy employs the use of X-rays or other high-power beams for killing the cancer cells and shrivelling tumors. Radiation is emitted via a machine located outside the body also known as external radiation therapy. Alternatively during internal radiation therapy, radiation-emitting materials or radioisotopes are passed via fine plastic tubes to the location of cancerous growth. Radiation could be carried out alone or alongside other treatments.

Side Effects

Those undergoing chemotherapy and radiation therapy experience snowballing side effects that have a tendency to deteriorate as the therapy prolongs. Immediately occurring side effects comprise of:

• Skin rashes with reddishness in the area around the anus.
• Skin inflammation.
• Sporadic open sores or ulcerous growths.
• GI or gastrointestinal tract gets inflamed leading to diarrhea that might be accompanied by the appearance of oral sores.
• Tenderness, pain, discomfort and inflammation experienced in the rectum.
• Recurrent sensation of pressure or the need to defecate.
• Depleted blood counts with likely sepsis.

Tardy side effects could comprise of:

• Skin rashes with accompanying formation of scar tissue.
• Deep-seated anal ulcers.
• Anal tissue death and at times stenosis might occur.
• Constriction of the anus that might require colostomy among 6-12% of patients.
• Infertility and sexual dysfunction.
• A slight risk element of developing treated-associated leukemia, generally considered to be linked to the therapy, mitomycin.

Surgery

Some of the small-sized anal tumors that have not metastasized to other areas may be removed by a surgical procedure known as local excision. Surgical intervention procedure involves the removal of tumor from the anus along with some adjacent normal tissue. The sphincter muscle is spared during surgery so that control could be gained over bowel movements following surgery.

In other situations where the tumor is not responding to chemotherapy and radiation or in cases where in the tumor relapses subsequent to a noticeable preliminary response, an operative procedure known as abdominoperineal resection might be needed. During this surgical procedure, a slit is made in the abdomen through which the cancerous growths present in the anus, rectum, section of the colon and any lymph nodes are taken out. The tip of the colon is then brought to the abdominal surface for creating an artificial aperture, known as a colostomy. The colostomy acts as a replacement to the anus that allows the faeces to pass directly from the colon into a bag that is disposable in nature, placed outside the body. The patient would be taught means to managing and incorporating colostomy into their lifestyle.

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.