Colorectal cancer is all too common and not something we talk about amongst friends. But it needs to be on people’s radar.
The rectum is the lower part of the colon, and the anus is between the rectum and the skin of the buttocks. The reason I bring up that word is that anal cancer is on the rise and needs to be addressed.
As an OB-GYN doctor in practice for many years, I only rarely heard of women being affected by anal cancer. I routinely performed rectal exams and occasionally diagnosed a patient with a polyp, but only two times in 25 years did one of my patients have a polyp that turned out to be precancerous.
Now that I am fortunate to work with women who are affected by all types of cancer, I see several women each week who have anal cancer. Thankfully, we have good treatments available and most women will survive anal cancer, but the earlier it is caught, the better.
Anal cancer is relatively rare. Last year 5,530 women were diagnosed, as compared to 2,770 men. There are risk factors for anal cancer: being positive for HPV as 80 to 90 percent of all anal cancers are positive for HPV; smoking cigarettes; prior pre-cancer or cancer of the cervix, vaginal or vulva; or having a suppressed immune system such as with transplant, chemotherapy for other cancer, or HIV.
This cancer can be prevented by getting the HPV vaccine, and because of the many young people who have been vaccinated, we expect the rates to go down in the future.
A surprise diagnosis
A patient I’ll call Janice is 39. She came to see me because she had been diagnosed with anal cancer. When I first saw her, she had been referred to me prior to treatment starting.
She remembered having some itching and discomfort, which she thought was hemorrhoids, and used over the counter creams for a while. The symptoms got a bit better, and she did not want to take the time to get checked as she was not too bothered.
She felt some pressure, and called her doctor and was prescribed a prescription cream. It still did not get better, and then she saw some blood on the toilet paper. She called and made an appointment. Thank goodness her physician assistant did a rectal exam, and felt a tumor the size of a grape.
That’s when things started to happen and she was able to get into the surgeon soon for a biopsy, which revealed anal cancer.
The diagnosis took Janice by surprise. She had an abnormal Pap smear years ago with HPV, but it cleared on repeat pap smears and never had to have anything done. She did not smoke, and had a healthy immune system.
While preparing for chemotherapy and radiation therapy, she learned the treatments could put her into menopause and make intercourse difficult in the future.
Years ago, the treatment was surgery and a permanent colostomy bag, and the current treatment makes it possible to avoid a bag. I was so glad to reassure her the treatment would not be easy, but she would get through and be OK.
We planned for what to do when menopause symptoms started, what lifestyle habits mattered to help avoid the symptoms, and to use vaginal dilators soon after radiation treatment. None of these subjects were easy for her to talk about at first, but she felt relief.
During treatment, I saw Janice again and she was doing well. She had prepared with a healthy lifestyle of water, vitamins, a healthy diet without sugar, stretching, sleep and practiced her gratitude. She felt tired and sick from chemotherapy, but was grateful her cancer had been diagnosed before it spread, and that she was prepared for the after-effects of cancer treatment.
The sad thing was that she felt alone. It felt good to reassure her she was not alone, and we would do what we could to tell women about this cancer to help raise awareness so others would not have to suffer like her.
Takeaway points
Ladies, it’s important we get our annual pelvic and rectal exams. While it’s certainly not pleasant, these checkups can be lifesaving.
Don’t be afraid to ask questions.
Expect a rectal exam at your annual physical, and if not, specifically ask for one if you have any risk factors or symptoms.
Here are some symptoms of anal cancer: rectal itching, pressure, change in bowel movements, bright red blood in stool, mass coming out of rectum, and pain.
Be aware, and share your knowledge with others.
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