How to recognize it? The clinical manifestations of tumors of the anus are often late and frequently involve pain and bleeding attributed by patients to the most common anorectal disorders such as hemorrhoids or fissures. Other symptoms are represented by anal itching, anal leakage, reddish mucus or fecal incontinence.
Anal cancer may look like a hemorrhoid or an anal fissure or may create a fistula in the perianal, vulvar or vaginal areas. Malignant melanoma of the anus is similar to a pigmented nevus. The diagnosis is made by the specialist in coloproctology through inspection of the perianal region, exploration of the anus and rectum to assess size, location and relative fixity of the tumor, and the anoscopy rectum sigmoidscopy as a cancer of the rectum can affect the anal canal, looking into it, and biopsy of the lesion for histological confirmation.
The fundamental consideration in assessing the degree of parietal invasion by the tumor and the relationship with the sphincter apparatus is represented through an endoanal ecography. Indeed, the gradual infiltration in the sphincter apparatus by the tumor was found to be the most significant parameter for the occurrence of local recurrence and survival of patients.
Ultrasound endoanal testing plays an important role in the follow-up after treatment to identify a recurrence before it becomes clinically evident, and therefore at a stage that can still be attacked with the treatments described. CT scanning plays an important role in the evaluation of lymph node involvement and distant spread.
What causes anal cancer? Risk factors that may subsequently cause the body to develop a cancer of the anal canal are:
-Chronic infection with human papillomavirus (HPV) causes anal cancer (may cause squamous cell carcinoma);
-HIV infection;
-Squamous infections of intraepithelial lesions;
-Pigmented nevi.
There are also elements that can simulate the development of anal cancer, although this happens rarely, as on a very frequent occasions these are benign lesions as marisca, prolapsing hemorrhoid, a chronic anal fissure or anal fistula long neglected, which however were not necessarily seen as pre-cancerous elements.
How is it treated? - Injuries limited to the submucus can be effectively treated with local excision alone. In other cases, the specialist uses a radio-chemotherapy combined treatment and possibly interstitial brachytherapy using an ultrasound guided needle piling iridium 192. These treatments involve a high percentage of complete clinical remission. Surgery is currently a redeeming therapy only for the forms that have not responded to medical therapy.
Failure to respond to curative treatment and recurrence of cancer within 5 years may reach an amount of 30% of cases. Many studies have shown that anal cancer may be caused by activities such as smoking, anal sex, lesions in the anal area that develop cancerous tissue, fissures ignored where the cells start mutating and dividing chaotically, exposure to radiations and several other, rarer, occurrences.