Canal of the anal canal is a rare, but rather dangerous disease, which is mainly diagnosed in middle-aged and elderly women. The use of modern methods of therapy allows in many cases to normalize well-being and increase the percentage of survival.
To achieve a good result of therapy, timely diagnosis is important, which allows you to detect a tumor in the initial stages.
Disease feature
Canal of the anal canal is a neoplasm that occurs in the anus between the upper edge of the anal canal and the area of its transition into the perianal skin, which is covered with hair. This type of tumor is quite rare, but the incidence is increasing every year.
Among the wide variety of histological forms of such a neoplasm, the squamous cancer of the anal canal occupies the leading place. This tumor is often detected in women after 50 years. The risk is significantly increased if previously treated squamous cell carcinoma of the vagina or cervix.
The disease is characterized by the fact that it is almost never asymptomatic, but it is difficult to diagnose due to the presence of a large number of common symptoms similar to a number of other diseases.
Subtypes and stages of development
Canal of the anal canal (code for ICD-10 - C21.0) is considered as a result of the occurrence of sexually transmitted diseases, in particular, infection with the human papillomavirus. This mainly occurs as a result of frequently repeated anal intercourse.
Other risks of developing cancer of the anal canal (according to ICD-10 - C21.0) include a decrease in immunity due to the development of HIV infection, as well as exposure to certain medications, chronic injuries, and smoking.
There are several subtypes of this malignant neoplasm. They arise against the background of various diseases, in particular:
- Bowen pathology;
- malignant fistula;
- Verrucous cancer
- tumors of perianal skin.
Depending on the location of the neoplasm, cancer is distinguished with the involvement of the anal canal and without involvement. In patients with cancer of the anal canal, the stage of the disease is finally determined only after surgery and a thorough examination of the removed tumor. Before surgery, the stage is set only approximately based on the received MRI data.
The first stage is characterized by the fact that the neoplasm is small, and there are no metastases. It is quite difficult to detect it, since there are no pronounced signs. In the second stage, the tumor is larger. However, metastases have not yet been observed.
In the third stage of cancer of the anus, the tumor reaches a fairly large size. Metastases penetrate only adjacent lymph nodes. In the last fourth stage, the tumor reaches the largest possible size, and metastases penetrate into other organs.
Causes of occurrence
There are many causes of squamous cell carcinoma of the anal canal, but they cannot be explained. The disease can be triggered by previously existing advanced diseases, in particular such as:
- the presence of polyps;
- fistulas;
- genital warts;
- anal fissures.
The disease can also occur as a result of progressive proctitis or hemorrhoids. The causes of the pathology can be associated with sexuality, HIV infections, as well as non-traditional preferences in sex.
Risk factors for a malignant tumor are not yet fully understood, studies are still being conducted to help determine the root causes.
Main symptoms
Symptoms of cancer of the anal canal can be different, it all depends on the particular course of the disease. The main signs should include such as:
- the presence of blood in the stool;
- pain in the anus;
- visible tumor inside the anus;
- constipation, diarrhea;
- mucus secretion;
- itching in the anus.
It is difficult to determine from the photo what the cancer of the anal canal looks like. Only a specialist has the right to diagnose the disease and prescribe appropriate treatment. In some patients, an asymptomatic course of the disease is observed. The first sign of a malignant neoplasm will be itching in the anus.
Diagnostics
Photos of cancer of the anal canal are not given in the article for aesthetic reasons. This disease has similar symptoms with other pathologies, which is why complex diagnostics are required. To establish the correct diagnosis in the presence of severe symptoms is quite simple. In most cases, an ulcer, swelling, or fissure is visible immediately upon examination. In approximately 10-25% of patients, inguinal lymph nodes are additionally involved in the pathological process.
A neoplasm can be detected during examination with a rectal mirror or by finger examination. To establish the cause of the disease, microscopic examination is required. If there is a suspicion of cancer, an examination is required, which includes:
- anamnesis;
- inspection;
- identification of concomitant diseases;
- finger examination;
- sphincterometry.
After that, the oncologist performs palpation of the lymph nodes and biopsy to confirm the diagnosis. It is very important to distinguish adenocarcinoma from squamous cell carcinoma. In addition, an HIV test is performed.
To identify other diseases, an examination of the rectum by sigmoidoscopy or anoscopy is performed. Women should be examined by a gynecologist to identify diseases of the vagina and cervix.
If cancer is suspected, patients are prescribed computed tomography to examine the organs of the peritoneum and pelvis, as well as radiography of the lungs. Before the operation, a partial or complete examination of the colon is required in accordance with all screening standards. Additional studies include:
- blood analysis;
- liver examination;
- endorectal ultrasound.
Additionally, a biopsy of the inguinal lymph nodes, MRI, and CT is performed. These techniques are used in the presence of metastases.
Treatment features
Treatment of squamous cell carcinoma of the anal canal largely depends on a number of factors that determine the methods and methods of influencing the body to eliminate the disease. The effectiveness and feasibility of therapy depends largely on the size of the tumor, its location and whether the disease has affected the lymph nodes. Treatment is largely determined by such factors:
- stage of the course of the disease;
- the location of the tumor in the anus;
- the presence or absence of HIV in humans;
- cancer recurrence.
Be sure to follow a strict diet for cancer of the anal canal. It implies a rejection of fatty, fried, unhealthy foods. Drinking plenty of water is recommended, as well as consuming only those foods that are easily digested and do not cause constipation.
The main methods of therapy
Treatment of cancer of the anal canal implies the use of various techniques and techniques. In particular, the use of methods such as:
- radiation therapy;
- chemotherapy;
- operation.
Radiation therapy for cancer of the anal canal implies exposure to powerful x-rays that are directed to areas affected by the tumor to kill cancer cells. It can be external and internal. When conducting internal therapy, a radioactive substance is used, which is injected directly into the neoplasm. When external, direct rays directly to the place of spread of the disease. The purpose of the procedure and its type largely depend on the stage of the pathology.
Chemotherapy is a standard treatment technique and is used at all stages of the disease, in addition to zero. For this, chemical agents are used that interfere with the life and division of malignant cells. There are two types of chemotherapy, namely regional and systemic. When conducting systemic chemotherapy, the substance used goes directly into the patient’s blood and then spreads throughout the body. When regional preparations have a local purpose.
The operation can be of two types, namely local resection and abdominoperineal resection. In the first case, removal of the neoplasm is carried out together with a part of healthy tissue located near it. When resection, an incision is made in the lower abdomen and the anus and rectum are excised, as well as the lower part of the sigmoid colon and the affected lymph nodes. The possibility of surgery is largely influenced by the presence of HIV. The type and purpose of the intervention largely depends on the particular course and stage of the disease.
In addition to standard techniques, medications are used that lead to a change in tissue radiosensitivity. This is an additional technique that allows you to make a malignant tumor more sensitive to radiation therapy.
In some cases, lymphadenectomy is prescribed, namely the removal of lymph nodes in the presence of metastases in them. Extirpation is a radical method of intervention, and if necessary, resection of adjacent organs that are involved in the pathological process is additionally applied.
In the case of cancer of the anal edge, local excision is performed in the area of healthy tissues. With an unspecified diagnosis, a biopsy is prescribed. Palliative treatment involves the imposition of an artificial fecal fistula.
Quality of life and supervision
Proper control after completion of therapy is the key to success in the fight against malignant neoplasms. After completing a course of chemotherapy, regular examinations are required, especially in the first 2 years. The final result of complex therapy and the decision regarding further treatment is taken no earlier than after 6 months. Constant monitoring of the patient's condition will allow time to identify relapse in order to timely treat and prevent complications.
The optimal examination during the first 2 years includes examination by a doctor, MRI and ultrasound every 3 months. Radiography is also performed once a year. Canal of the anal canal is not a hereditary disease.
Data on the quality of life of patients are scarce and quite satisfactory, with the exception of only patients with significant impairment of sphincter function. The full functioning of the sphincter persists in most patients.
Forecast
About 50-70% of patients after radiation therapy can achieve complete cancer regression and get rid of the disease. However, even with the most positive outcome, the patient must be observed by an oncologist for at least 5 years, and only after that the malignant neoplasm is considered completely cured.
However, the larger the size or germination of the tumor, the less likely its complete elimination. With a mild regression after the first stage of radiation therapy, a complete excision of the rectum and anus is performed.
Prophylaxis
A malignant tumor of the anal canal refers to such diseases, the development of which is often associated with exposure to the human papillomavirus. The development of HPV can be prevented by vaccination. Basically, such a vaccine is given to adolescents aged 13-17 years. The vaccine will significantly help reduce the risk of future malignant tumors of the genitals, anal canal, head and neck.
Despite the fact that cancer of the anal canal is a rare disease, a number of patients have significantly increased risk of developing such a pathology. That is why it is very important to conduct comprehensive prevention in a timely manner. It includes the elimination of the main risk factors that trigger the onset of the disease.
Patient Reviews
According to patient reviews, cancer of the anal canal is quite treatable, especially if a tumor was detected in a timely manner. The treatment must necessarily be comprehensive, and for this, surgery, radiation therapy and chemotherapy are prescribed. In addition, in addition, you must strictly follow a strict diet, as well as lead a healthy lifestyle.
With a competent approach to the treatment process, you can achieve very good results and get rid of the disease completely. In rare cases, a relapse of a malignant neoplasm is observed, as well as the occurrence of metastases throughout the body. In this case, a longer and more complex treatment is required.
Canal of the anal canal is a rare and dangerous disease, but with a competent approach, you can achieve a very good result and get rid of the pathology.