Anal cancer

"The goal of treatment will depend on the stage at which it is diagnosed. The aim should be to preserve anal function with the best possible quality of life".

DR. LUCÍA CENICEROS PAREDES
COORDINATOR. DIGESTIVE TRACT TUMOURS AREA

The anal canal is the terminal portion of the large intestine, and corresponds to a 3-4 cm tubular structure that extends from the perianal skin to the end of the rectum.

It is lined in its upper portion by rectal-type mucosa, in its middle zone (coinciding with the pectineal interface line) by transitional mucosa and, in its lower section, by mucosa with stratified squamous epithelium.

Tumors of the anal canal are rare. They represent 5% of all anorectal neoplasms and 1.5% of gastrointestinal tumors.

Carcinomas of this region are classified as squamoid and epidermoid type, and those with a line of differentiation towards adenocarcinoma (although within the carcinomas of the anal canal, it is a rare entity).

Due to the surgical complexity of this pathology, it is essential to go to specialized centers. The Clínica Universidad de Navarra has a medical-surgical team highly qualified in the diagnosis and treatment of patients with anal cancer.

In addition, we perform a follow-up by the nursing service that helps to better control symptoms, surgical sequelae and promote the rapid recovery of our patients. 

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What are the symptoms of anal cancer?

Twenty percent of patients are asymptomatic.

Some of the symptoms they present are:

  • Bleeding: this is the most frequent, appearing in 45% of cases.
  • It is sometimes accompanied by pain, tenesmus or sensation of mass.
  • Other non-specific symptoms may be pruritus or peritoneal irritation. 

Do you have any of these symptoms?

You may have anal cancer

What are the causes?

Multiple risk factors for the development of anal canal tumors have been proposed, such as HPV and HIV, smoking and immunosuppression.

The presence of chronic perianal fistulas, whether or not associated with Crohn's disease, is an important risk factor, especially when they become chronic and last more than 10 years.

Lymphogranuloma venereum (LGV) can cause strictures and perianal fistulas and is also associated with an increased risk of developing a tumor of the anal canal.

What is the prognosis?

Anal canal tumors are generally a curable disease if diagnosed at an early stage.

The most important prognostic factors, in relation to the tumor, are size and lymph node involvement. 

The overall 5-year survival rate for T1 and T2 tumors is 86%, which decreases to 45% when the tumor is in more advanced stages.

How is anal cancer diagnosed?

<p>&nbsp;Colonoscopia</p>

Diagnosis requires an evaluation by a medical specialist. If there is suspicion, a digital rectal examination should be performed to detect abnormalities in size, shape or texture.

The study should be completed by performing an anuscopy to see the inside of the anus and rectum and thus be able to perform a biopsy of the lesion. Sometimes due to inflammation or infiltration of the lesion this test can be painful so it is performed under anesthesia.

Once the diagnosis is confirmed, the study will be completed by performing a CT scan and pelvic MRI.

Diagnosis requires an evaluation by a medical specialist. If there is suspicion, a digital rectal examination should be performed to detect abnormalities in size, shape or texture.

The study should be completed by performing an anuscopy to see the inside of the anus and rectum and thus be able to perform a biopsy of the lesion. Sometimes due to inflammation or infiltration of the lesion this test can be painful so it is performed under anesthesia.

Once the diagnosis is confirmed, the study will be completed by performing a CT scan and pelvic MRI.

How is anal cancer treated?

Efforts should be made to preserve anal function with the best possible quality of life.

Radiotherapy treatment with concurrent chemotherapy is the curative treatment for most patients with locally advanced anal canal cancer.

The combination of external beam irradiation techniques with brachytherapy in selected cases achieves complete response and cure rates of more than 70%. 

Also, for selected cases, treatment with proton therapy can reduce side effects and improve tolerance to treatment.

Chemotherapy is the medical treatment that consists of the application of chemical substances to the organism.

Chemotherapy can mainly be administered intravenously or orally, although there are other forms of administration.

Sometimes, for intravenous administration, it is necessary to place a device called a port-a-cath. This subcutaneous reservoir consists of a silicone membrane and a catheter which is introduced through the subclavian vein until it reaches the superior vena cava.

The treatment is administered according to a specific schedule depending on the chosen regimen. Prior to the administration of the treatment, a patient assessment and an analytical determination must be made.

Each administration is called a cycle. There are treatments in which each cycle is divided into several sessions. All this depends on the therapeutic scheme used

Surgery is not used as initial treatment because of the risk of requiring removal of the anal sphincter and conditioning the patient to a permanent colostomy. 

However, if the tumor does not respond to the therapies used, abdomino-perineal resection may be performed. In this procedure the lower part of the colon, rectum and anus are removed. 

Due to the surgical complexity of this pathology, it is essential to go to specialized centers. The Clínica Universidad de Navarra has a highly qualified medical-surgical team to perform this procedure.

In addition, we perform a follow-up by the nursing service that helps to better control symptoms, surgical sequelae and promote the rapid recovery of our patients. 

Colostomy
Colostomy is the surgical act where one end of the large intestine is removed through an opening in the abdominal wall (stoma). Stool passes through the stoma into the pouch attached to the abdomen.

From the first moment, the colostomy requires a series of specific cares that will be explained in detail by the nursing team specialized in this type of surgical sequelae.

Where do we treat it?

IN NAVARRE AND MADRID

The Digestive Tract Tumors Department
of the Clínica Universidad de Navarra

The Digestive Tube Tumors Area is composed of a multidisciplinary team of experts in the diagnosis and treatment of diseases of the digestive tract.

It includes specialists in the digestive system, radiology, pathological anatomy, surgery and medical and radiotherapeutic oncology and nursing support.

What diseases do we treat?

Imagen de la fachada de consultas de la sede en Pamplona de la Clínica Universidad de Navarra

Why at the Clinica?

  • Integral evaluation of the patient.
  • Cutting edge technology.
  • Expert professionals who are a national reference.

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