Health

Nobody wants to talk about anal cancer: Here’s why you should

Syed Husain, MBBS

Colorectal Surgeon, Clinical Associate Professor
Ohio State's Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute

October 31, 2022

Man talking to his doctor at his annual checkup

While still rare, the number of anal cancer cases is on the rise, a statistic that's very much of concern.

However, with more screenings, education and discussions about a part of the body and type of sex that many people — even some physicians — are uncomfortable talking about, we can reduce the number of anal cancer diagnoses and catch the disease in the early stages, when it's less invasive and easier to treat.

What is anal cancer?

Anal cancer is a cancer of the anus, which is located at the very end of the intestines. There's a misconception that it's the same thing as rectal cancer, but it's a distinct and different form of cancer. There are about 9,440 new anal cancer cases diagnosed in the U.S. each year, a number that's almost doubled during the past three decades.

What are the risk factors for anal cancer?

About 90% of all anal cancer diagnoses are a result of a human papillomavirus (HPV) infection. Women who've been diagnosed with a cervical or vaginal HPV infection are especially at risk, as are women and men who engage in anal intercourse.

Other factors that increase risk include:

Having HIV
Having a weakened immune system, such as a patient who’s had an organ transplant and is on immune-suppressing medications
Engaging in anal sex, especially between two men
Smoking

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Dr. Husain explains anal cancer symptoms and prevention.

Can anal cancer be prevented?

There's an effective HPV vaccination. While we're still waiting for the results of multiple studies, I'm optimistic that reducing the number of people infected with HPV will, in turn, reduce the number of anal cancer cases.

What are the symptoms of anal cancer?

The most common symptoms are:

Pain or pressure in the area surrounding the anus
Bleeding from the anus or rectum
A lump or growth in and around the anus
Itching or discharge from the anus

Because these symptoms are very similar to the symptoms of hemorrhoids, people often delay seeking treatment. The overwhelming majority of the anal cancer patients I see tell me they ignored one or more of these symptoms because they thought it was a hemorrhoid and would go away on its own and/or wasn’t that serious.

How is anal cancer treated?

Advances in radiation treatment and chemotherapy are very effective and have greatly reduced the number of patients who undergo surgery. However, surgery is necessary for patients who don't respond to this first line of treatment, or who have a recurrence. Surgery involves the complete removal of the anus and rectum and the use of a colostomy bag. About 10% of the patients we see undergo this surgical procedure. Screening and early detection could reduce this number even further.

Can you be screened for anal cancer?

Yes. A simple, noninvasive anal Pap smear test is offered to screen for anal cancer. This is different from the cervical Pap smear test collected to screen for cervical cancer. During an anal Pap smear, cells are collected from the anus to be examined for signs of pre-cancerous cells or actual cancer cells. Because we have a comprehensive anal cancer screening clinic, if we detect precancerous cells, we can remove them immediately and prevent a cancer from forming. This is similar to the way in which pre-cancerous cells are removed during a colonoscopy.

Separate the myths from the facts about preventive cancer screenings.

The OSUCCC – James offers the only comprehensive anal cancer screening center in Ohio and we see patients from all over the United States. The next closest center is in Chicago, and there are only a handful of similar centers in the country. Because we're a screening center and part of a large, comprehensive cancer center, we see more anal cancer cases than most cancer hospitals, have a team of experienced experts and offer a wide range of treatment options and clinical trials.