Anal Cancer Treatment in Delhi and Gurgaon

Anal Canal is about 3 to 4 cm long terminal constricted part of the large intestine that lies between the rectum and the anus (outer opening for defecation). It serves as the passage for feces stored in the rectum to the outside of the body through the anus. It is lined with mucosa partly made-up of glandular epithelial cells (in the interior of the anal canal that is a continuation of rectum lining) and mainly consisting of squamous epithelial cells (that cover the interior part of the anal canal and are in continuation with the perianal skin). The junction of 2 types of cells is known as the transitional zone.

Signs and symptoms

anal-cancer-early-signs-and-symptoms

  • Per-rectal bleeding is the most common symptoms for anal cancer. This symptom may be caused by other benign pathologies like hemorrhoids (or piles), anal fissures, etc which are more common causes than anal cancer.
  • Pain and/or itching in the anal region
  • The sensation of anorectal fullness
  • Change in bowel habit
  • Swollen lymph node in groin region
  • Tenesmus
  • Formed stool narrower than usual

Risk Factors for Anal Cancer

Squamous cell carcinomas are the most commonly encountered (about 90% of all cases) anal cancers. Adenocarcinoma and other types are less common. Besides squamous cell carcinomas, many benign tumorous growths in the mucosa are frequently reported that are not cancerous. These may include polyps, skin tags, and anal warts.

Anal warts are mostly associated with the human papillomavirus (HPV) infection. Certain precancerous lesions, for example, anal intraepithelial neoplasia (AIN) (low and high grade) or carcinoma in situ (CIN) may develop in the anal canal, which may progress to anal cancer.

Similar to the screening of cervical cancer through Pap test, the screening for anal cancer can be performed using anal Pap test that can diagnose pre-cancerous changes in the anal mucosa and thus the development of invasive anal cancer can be prevented.

Anal Cancer Risk factors

HPV Virus Infection

HPV virus infection

Human papillomavirus (HPV) infection is the single most important risk factor which is associated with almost 85 to 95% of the cases of anal cancer. Although the incidence of HPV infection is very common, only a few cases progress to pre-cancerous anal lesions or invasive anal cancer. HPV is a group of about 150 DNA viruses, with high-risk subtypes including HPV-16 and HPV-18, reported in about 75% and 10% of all the cases of anal cancer, respectively. HPV consists of two proteins known as E6 and E7 which inactivate some tumor suppressor genes and lead to anal cancer.

Anal Warts

anal warts

Although anal warts are caused by different subtypes of HPV, individuals with a history of anal warts remain at high risk of developing the infection with high-risk HPV subtype, and thus, anal cancer.

HIV Infection

HIV infection

People infected with HIV are at 15 to 35 times higher risk of developing anal cancer compared to the normal population.

Weak Immune System

weak immune system

Individuals with a weak immune system that may be due to any cause, for example, infection with human immunodeficiency virus (HIV), use of medicines that suppress the immune system after an organ transplantation, an autoimmune disorder, chronic steroid therapy, etc, are more prone to HPV infection and thus development of anal cancer.

Anal Sex

anal sex

Men or women who have receptive anal intercourse remain at high risk of developing anal cancer due to a high frequency of HPV infection reported in these people.

Multiple Sexual Partners

multiple sexual partners

Individuals who have multiple sexual partners or have partners with multiple partners are considered to be at higher risk of developing anal cancer due to higher chances of sexually transmitted HPV infection.

History of cervical, vaginal or vulvar cancer

history of cervical vaginal or vulvar cancer

Women with a history of genital cancer that are mostly caused by HPV infection are also considered to be at increased risk of developing anal cancer.

Tobacco/Cigarette Smoking

tobacco smoking

Chronic tobacco chewing or cigarette smoking exposes the body to various carcinogens that suppress the immune system to fight against HPV infection and increase the risk of anal cancer.

Other Factors

Consumption of diet low in fruits and vegetables, in utero exposure to diethylstilbestrol (DES), history of a sexually transmitted disease, and chlamydial infection are other reported risk factors for anal cancer.

Apart from the above-listed risk factors, certain factors which can reduce the risk of anal cancer have also been reported. Such protective factors mainly include the use of intrauterine devices for birth control and HPV vaccination. Also quitting smoking may be helpful.

Anal Cancer Pretreatment Investigations

Anoscopy

anal cancer diagnosis by anoscopy

Anoscopy is a diagnostic technique which uses an anoscope – a cylindrical device equipped with a light source, and some special instruments for biopsy or surgery. This enables the doctors to closely examine the surface of the anal canal to determine the presence of cancerous or precancerous lesions. The physician can also collect biopsy sample{s} if an abnormal area is observed during the procedure.

Anal Biopsy

biopsy for anal tumor

Biopsy sample(s) from the anal region or the affected lymph nodes are generally collected in case an abnormal area(s) is observed during the anoscopy procedure or during the physical examination indicating enlarged lymph nodes. It can provide information such as the type of cancer, the severity of cancerous changes involved (grade of cancer), and the presence of specific defective genes or proteins.

Imaging Tests

One or more of the following investigations are required for staging and reassessment following treatment-

Transrectal Ultrasound

transrectal ultrasound by resectoscope

In normal ultrasound, a transducer is used which directs very high-frequency sound waves towards the tissue to be examined. In transrectal ultrasound, the transducer is placed directly into the rectum. This helps the doctor to examine the nearby tissue for any abnormality. This test can detect solid tumor masses (cancerous) within the anus or nearby area(s), which can be further evaluated with the help of other diagnostic tools.

  • Computed tomography (CT) scan
  • Positron emission tomography (PET) scan
  • Magnetic resonance imaging (MRI) scan

Treatment of Anal Cancer

The anal cancer treatment may depends on various factors including stage of the disease, age, performance status of the patient, patient’s preference along with other factors.

Stage 0 (Tis N0 M0)

Stage 0 is presence of pre-cancerous cells (CIS or high-grade AIN) found only in the surface layer of the anal canal. No evidence of primary tumor mass.

Stage 0 anal cancer can be treated by removal of the pre-cancerous lesion by local excision with the negative margins

Stage I and II (T1-3 N0 M0)

Stage I (T1 N0 M0)

The primary tumor is </=2 cm in size. No spread to nearby lymph nodes or distant body parts.

Stage IIA (T2 N0 M0)

The primary tumor is >2 cm but </=5 cm in size. No spread to nearby lymph nodes or distant body parts.

Stage IIB (T3 N0 M0)

The primary tumor is >5 cm in size. No spread to nearby lymph nodes or distant body parts.

In the case of Stage I to II anal cancer, chemotherapy along with radiotherapy is considered the preferred treatment.

Stage III (Any T N0-1 M0)

Stage IIIA (T1-2 N1 M0)

The primary tumor is </=5 cm in size and it has spread to nearby lymph node(s). No spread to distant body parts.

Stage IIIB (T4 N0 M0)

The primary tumor of any size that has invaded in a nearby organ, such as the vagina, prostate gland, urethra, or bladder. No spread to nearby lymph nodes or distant body parts.

Stage IIIC (T3-4 N1 M0)

The primary tumor is >5 cm in size or it has invaded in a nearby organ and it has spread to nearby lymph node(s). No spread to distant body parts.

In the case of Stage III anal cancer, chemotherapy along with radiotherapy is considered the first-line treatment.

Stage IV (Any T Any N M1)

The primary tumor has spread to the distant site(s), such as the lung, liver, peritoneum, etc.

In the case of Stage IV anal cancer, chemotherapy is the mainstay of treatment.

Surgery for Anal Cancer

surgery for anal cancer

Surgery is the first choice of treatment for early-stage anal cancer. Precancerous lesions or lesions that are present only in the superficial layer can be treated by local resection. In abdominoperineal resection (APR), the anus and rectum are surgically removed along with regional lymph nodes. An artificial opening (stoma) is created in the abdomen to collect stools in a bag attached to it.

Radiation Therapy

radiation therapy

Radiotherapy (along with chemotherapy) is commonly used as first-line treatment of many cases of anal cancer. It is also sometimes used for palliation of symptoms of the advanced-stage disease such as pain, bleeding, obstruction, etc.

Chemotherapy

role of chemotherapy

Chemotherapy (in conjunction with radiotherapy) is considered the first-line treatment for most locoregionally advanced anal cancers. Also, chemotherapy is the mainstay of treatment for the advanced-stage disease that has spread to distant body parts.

Chemotherapy drugs that are a part of anal cancer treatment regimens are-

  • 5 Fluorouracil
  • Mitomycin
  • Paclitaxel
  • Carboplatin
  • Capecitabine
  • Cisplatin

Immunotherapy

role of immunotherapy

Nivolumab and pembrolizumab target the PD-1 protein on T-cells and activate them to kill cancerous cells. The immunotherapy is generally used for the treatment of advanced-stage disease unresponsive to primary treatment.

These are the various treatment options for anal cancer that may help in improving survival. 

Best Anal Cancer Specialist in Delhi

Dr Sunny Garg is a renowned Medical Oncologist in New Delhi with an experience of around 10 years of treating anal cancer patients. He has treated anal cancer patients with Chemotherapy and Immunotherapy. He is currently practicing at Manipal Hospital, Dwarka.

Diagnostic modalities available at our hospital include Anal Biopsy, Anoscopy, Transrectal Ultrasound, Whole Body PET CT, etc. Other treatment facilities for Anal Cancer available are Local Resesction, Abdominoperineal Resection, Radiation Therapy, etc.

Call +91 9686813020 for appointment.

Leave a Reply

Your email address will not be published. Required fields are marked *