Anal cancer is a rare cancer that begins in the anus, the opening at the end of the rectum. Its appearance is usually uncommon before age 35, but it is more frequently observed in men. In most cases, a diagnosis is typically made in the early 60s of a person and is slightly more frequent in women over 50. This article delves into its causes, symptoms, and treatment options to better understand this ailment.

Causes
Anal cancer arises when cells expand uncontrollably and establish a tumor. Human papillomavirus (HPV), a sexually transmitted infection, and this condition have a close relationship. Although the precise etiology of anal cancer is unknown, researchers have identified numerous risk factors that raise a person’s chance of developing the disease-

• HPV, or human papillomavirus – The chance of developing cancers such as cervical and anal cancer is increased if a person has an HPV infection. Genital warts may also result from this.
• Multiple sexual partners – Throughout their lives, those who have multiple sexual partners are more likely to get anal cancer
• Phallic sex – Anal cancer risk is higher in those who have receptive anal intercourse.
• Old age – Most anal cancer incidences affect adults 50 and older.
• Cancer history – A higher risk of anal cancer exists in people with cervical, vulvar, or vaginal cancer.

Signs and symptoms
Anal cancer can occasionally go unnoticed. However, bleeding is frequently one of the first signs. Usually, it is not severe. Many individuals mistakenly believe hemorrhoids cause bleeding and itching because anal itching can also be a symptom of tumor growth. Significant anal cancer symptoms include:

• Bleeding from the rectum
• Itching in the rectum or nearby areas
• Mass or a lump at the anal opening
• Anal discomfort or a sensation of fullness
• Stool narrowing or other modifications to bowel motions
• An unusual anal discharge
• Stool incontinence (loss of bowel control)
• Enlarged lymph nodes in the groin or anal regions

Diagnosis

• During a routine digital rectal exam or a quick treatment like the excision of what was thought to be hemorrhoid, anal cancer may be discovered.
• More invasive procedures like an anoscopy, proctoscopy, or endorectal ultrasonography may also be used to find this cancer.
• A biopsy should be performed, and a pathologist should analyze the specimen.
• An abdomen and pelvic CT scan, a pelvic MRI scan to evaluate the pelvic lymph nodes, a chest x-ray, and liver function tests may all be part of the staging workup. PET scans are occasionally carried out.

Treatment options
Radiation and chemotherapy are the two main treatments for anal cancer. The following variables influence the available treatment options:

• The individual’s age and general health
• The size of the tumor
• The cancer grade, as high-grade tumors, can be more aggressive

Radiation and chemotherapy

• High-intensity rays are used in radiation therapy to kill cancer cells. In this treatment, a machine creates a beam of waves directed at the cancerous cells. Inserting radioactive material inside the body, which continues to release radiation, is known as internal radiation.
• Chemotherapy employs chemicals that either kill cancer cells or stop them from increasing. They could be given orally by the doctor.
• Chemotherapy and radiation therapy both have potential drawbacks. Around the anus, radiation therapy may cause discomfort and scorching. For example, a doctor may prescribe specific treatments to lessen the severity of side effects. For example, combining radiation and chemotherapy for anal cancer may also have short-term effects on the skin and digestive system.

Immunotherapy
Researchers have been studying an emerging therapy known as immunotherapy. Certain substances can strengthen the immune system’s resistance against certain cancer types. The body’s capacity to restrain itself from attacking healthy bodily cells is crucial. Immune cells have “checkpoint” proteins that must be triggered for an immune response to happen or not. These are occasionally used by cancer cells to deter immune system attacks. However, some patients with anal cancer can be treated with substances that target these checkpoints. Individuals with metastasized anal cancer whose tumor began to advance after receiving at least one kind of chemotherapy can benefit from immunotherapy.

Surgery
Surgery is usually saved for individuals who don’t respond to previous treatments. Therefore, the tumor’s size and location determine the operation type.

Resection
The surgeon removes a tiny tumor and some surrounding tissues. This is only conceivable if cancer has not spread to the muscle that controls the anal sphincter. However, the patient will still be able to urinate after this operation.

Abdominoperineal resection
The anus, rectum, and a portion of the bowel are removed during an abdominoperineal resection by the surgeon. The doctor will create a colostomy because the patient cannot urinate otherwise. A surgeon performs it by bringing the bowel’s end to the outside of the abdomen. The stools are collected outside the body and placed in a bag covering the stoma or opening.