Anal Cancer
Cancer occurs when cells in our body multiply out of control, producing lots of abnormal cells. These abnormal cells don't function like the cell should and can invade tissues or organs and can sometimes spread to other parts of the body.
Anal cancer is cancer that is in the anus, which is the last few centimetres of the bowel and connects the bowel to the outside of the body (the last part your stool passes through the anus when you go for a poo). It isn’t a common cancer – it causes less than 1% of all cancers - but HPV (human papillomavirus) infection increases your risk of developing anal cancer.
HPV is a virus passed on through sexual intercourse. Most people will be infected with HPV infection in their lifetime and the majority will not develop anal cancer. Both HPV infection and anal cancer are more common in people who have anal sex with a lot of different partners, those who smoke, those with a lowered immune system, or those who have had cervical, vulval or vaginal cancer.
The most common symptoms of anal cancer are bleeding, pain, itching, discharge and faecal incontinence (losing the ability to control when you poo). There are many more common causes of bleeding, pain and itching symptoms that are not anal cancer, so please don’t be worried if you have symptoms but always get them checked out.
We should be clear - anal cancer is rare. More subtle signs of cancer can be unexplained tiredness or loss of weight, night sweats or pain in your bones.
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Different Stages of Cancer and What do they Mean?
When a person is diagnosed with cancer, one of the first steps is determining the stage of the disease. Staging describes how much the cancer has grown and whether it has spread. This helps doctors choose treatments and predict outcomes.
Stage 0
This is the earliest stage. The cancer is non-invasive, meaning it hasn’t spread beyond the layer of cells where it started. It’s confined and more straightforward to treat, often requiring minor surgery or localised therapies.
Stage I
At this stage, the tumour is small and localised to its origin. There’s no evidence of it spreading to nearby lymph nodes or other tissues. Treatments like surgery and localised radiation are typically very effective.
Stage II
The tumour is more significant or has begun to affect nearby lymph nodes. Though still considered localised, the cancer is more advanced than Stage I. Treatment may involve a combination of surgery, radiation, and possibly chemotherapy, depending on its location and type.
Stage III
Here, cancer has extended beyond the original site into nearby tissues, lymph nodes, or organs. It’s still regional but more challenging to treat. Aggressive therapies, often involving a combination of treatments, are typically required.
Stage IV
This is advanced cancer. The disease has spread to distant body parts, like the liver, lungs, bones, or brain. While treatment options aim to slow progression and manage symptoms, the focus shifts to maintaining quality of life.
The TNM System
The TNM staging system is often used to provide a detailed picture of cancer's progression:
- T (Tumor): Size and extent of the primary tumour.
- N (Nodes): Whether and how much cancer has spread to nearby lymph nodes.
- M (Metastasis): Presence of cancer in other parts of the body.
For instance, T3N1M0 indicates a larger tumour (T3), limited spread to nearby lymph nodes (N1), and no distant metastasis (M0).
Why Staging Matters
Cancer staging isn’t just a technical step; it’s a roadmap for treatment. It helps ensure personalised care, targeting the disease effectively while minimising unnecessary interventions. Whether it’s curative surgery in the early stages or therapies to control advanced cancer, knowing the stage informs every decision.
Each stage tells its own story and highlights a different approach to tackling the disease.
Methods of Treating Cancer
Treating cancer involves a wide range of approaches tailored to the type and stage of the disease and individual patient factors. From surgical removal to advanced therapies that target cancer at the molecular level, here are the primary treatment methods:
1. Surgery
Surgery is often the first choice when cancer is localised. If necessary, the goal is to remove the tumour and surrounding tissue to ensure no cancer cells remain.
- Examples: Removing a breast lump (lumpectomy) or a portion of the colon in colon cancer.
- Surgery may also relieve advanced-stage symptoms, such as reducing pain caused by a tumour pressing on organs.
2. Radiation Therapy
This treatment uses high-energy beams, such as X-rays or protons, to kill cancer cells.
- Radiation damages the DNA of cancer cells, preventing them from growing or dividing.
- Often used after surgery to destroy any remaining cancer cells or as a standalone treatment for certain types of cancer.
- Side effects may include skin irritation and fatigue, but modern techniques like IMRT (intensity-modulated radiation therapy) minimise damage to surrounding healthy tissue.
3. Chemotherapy
Chemotherapy involves drugs that kill fast-growing cells, including cancer cells.
- Chemotherapy is often used for cancers that have spread (metastasised) or as an adjuvant therapy to destroy residual cancer after surgery.
- It can cause side effects like nausea, hair loss, and low blood counts because it affects other rapidly dividing cells in the body, such as those in the gut and hair follicles.
4. Immunotherapy
This innovative approach helps the immune system recognise and fight cancer cells.
- Types of immunotherapy
- Checkpoint inhibitors (e.g., pembrolizumab) block proteins that stop the immune system from attacking cancer cells.
- CAR T-cell therapy modifies the patient's immune cells to target cancer.
- It is particularly effective for cancers like melanoma, lung cancer, and certain blood cancers.
5. Targeted therapy
These treatments focus on specific genetic mutations or proteins that cancer cells rely on to grow.
- Examples:
- HER2 inhibitors for breast cancer.
- EGFR inhibitors for certain lung cancers.
- By targeting only cancerous cells, this method minimises damage to healthy tissues compared to chemotherapy.
6. Hormone Therapy
Some cancers, like breast and prostate cancer, are fueled by hormones such as estrogen or testosterone. Hormone therapy blocks the body's ability to produce these hormones or stops them from interacting with cancer cells.
- Examples: Tamoxifen for estrogen-positive breast cancer or androgen-deprivation therapy for prostate cancer.
7. Stem Cell Transplants
Stem cell transplants replace damaged or destroyed bone marrow with healthy cells, often after intensive chemotherapy or radiation.
8. Complementary Therapies
Complementary methods, such as acupuncture, yoga, and meditation, can help manage side effects like pain, stress, and fatigue.
- These methods do not replace standard treatments but can improve overall well-being during treatment.
9. Clinical Trials
Participating in clinical trials gives patients access to cutting-edge treatments that are not yet widely available. Trials might involve experimental drugs, new combinations of therapies, or advanced technologies like gene editing.
Tailoring Treatment to the Patient
Cancer treatment is rarely one-size-fits-all. Doctors often combine multiple therapies to create a personalised treatment plan based on the type of cancer, its stage, and the patient's overall health. The goal is always to maximise effectiveness while minimising side effects, giving each patient the best possible outcome.
When should I see my doctor?
You should see your doctor if you have new symptoms around your bottom, or if you have unexplained general symptoms of tiredness or significant unexplained weight loss. You should book to see your doctor straight away if you notice blood in your poo, discharge or pain from your anus, you have severe pain or you develop faecal incontinence.
What will my doctor do?
The doctor will ask about your symptoms and how long you have been experiencing them, your medical history and your family's medical history. With your permission, they will examine your abdomen and your anus. They may need to put their gloved finger into your bottom to feel for any lumps. They may also do blood tests and refer you for further scans or tests.
Am I fit for work?
The ability to work will depend on your symptoms: your doctor will help to decide whether you are fit for work, or if there are any modifications that would benefit you.
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