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Anal cancer is a type of cancer which arises from the anus, the distal orifice of the gastrointestinal tract. It is a distinct entity from the more common colorectal cancer. The etiology, risk factors, clinical progression, staging, and treatment are all different. Anal cancer is typically a squamous cell carcinoma that arises near the squamocolumnar junction.
[edit] PrevalenceThe American Cancer Society estimates that in 2009 about 5,290 new cases of anal cancer will be diagnosed in the United States (about 3,000 in women and 2,000 in men).[1] It is typically found in adults, average age early 60s.[1] In the United States, an estimated 710 people died of anal cancer in 2009.[1] [edit] SymptomsSymptoms of anal cancer include bloating and change in bowel habits, a lump near the anus, rectal bleeding, itching or discharge.[2] Women may experience lower back pain due to pressure the tumor exerts on the vagina, and vaginal dryness. [edit] Risk factors
[edit] PreventionSince many, if not most, anal cancers derive from human papillomavirus infections, and since the HPV vaccine prevents infection by some strains of the virus and has been shown to reduce the incidence of potentially precancerous lesions,[10] scientists surmise that HPV vaccination may reduce the incidence of anal cancer.[11] [edit] ScreeningAnal Pap smears similar to those used in cervical cancer screening have been studied for early detection of anal cancer in high-risk individuals.[12][13] [edit] Treatment[edit] Localised diseaseAnal cancer is most effectively treated with surgery, and in early stage disease (i.e., localised cancer of the anus without metastasis to the inguinal lymph nodes), surgery is often curative. The difficulty with surgery has been the necessity of removing the anal sphincter, with concomitant fecal incontinence. For this reason, many patients with anal cancer have required permanent colostomies. In more recent years, physicians have employed a combination strategy including chemotherapy and radiation treatments to reduce the necessity of debilitating surgery. This "combined modality" approach has led to the increased preservation of an intact anal sphincter, and therefore improved quality of life after definitive treatment. Survival and cure rates are excellent, and many patients are left with a functional sphincter. Some patients have fecal incontinence after combined chemotherapy and radiation. Biopsies to document disease regression after chemotherapy and radiation were commonly advised, but are not as frequent any longer. Current chemotherapy active in anal cancer includes cisplatin and 5-FU. Mitomycin has also been used, but is associated with increased toxicity. [edit] Metastatic or recurrent diseaseUp to 10% of patients treated for anal cancer will develop distant metastatic disease. Metastatic or recurrent anal cancer is difficult to treat, and usually requires chemotherapy. Radiation is also employed to palliate specific locations of disease that may be causing symptoms. Chemotherapy commonly used is similar to other squamous cell epithelial neoplasms, such as platinum analogues, anthracyclines such as doxorubicin, and antimetabolites such as 5-FU and capecitabine. J.D. Hainsworth developed a protocol that includes Taxol and Carboplatinum along with 5-FU. [edit] PrognosisBased on series of 270 patients, the five year survival by stage was:[citation needed]
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