definition

A Anal cancer is a Cancer of Anus. It is a malignant tumorwhich in most cases can be treated well. If left untreated, however, it can too Incontinence (Loss of control over stool elimination) and even death.

The disease is rare and benign tumors on the anus are much more common. Symptoms include complaints such as Pain during bowel movements, foreign body sensation and bleeding at the anus are possible.

If, on the basis of the doctor's examination, there is a suspicion that anal cancer is present, the diagnosis is made by an Sampling secured or excluded.

The chance of survival and the therapy options depend on the size and spread of the cancer.

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causes

Clear causes of one Anal cancer are not certain, but it has been shown that different Risk factors are associated with the disease. In over 80% of those affected, a infection with certain viruses (HPV = human papilomavirus) can be demonstrated as triggers of various Cancers be valid. These viruses are transmitted through unprotected sex. The use of condoms offers protection against infection with the viruses.

Other risk factors that favor anal cancer are STDs, a high number of sex partners (over 10) as well passive anal intercourseespecially in men.

Overall, however, women are more likely to be affected by anal cancer.

Also a weakened immune system like one AIDS disease or after an organ transplant increases the risk. In addition, is at Smokers the risk of getting sick increases.

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diagnosis

To diagnose anal cancer are the physical examination and the medical conversation (anamnese) most importantly. If you go to the doctor because of symptoms such as swelling at the anus or problems with bowel movements, the doctor will ask various questions about the symptoms and possible other diseases. A complete anamnesis also includes an interview with Sexual behavior. These very intimate questions can be very important for the doctor to assess.

Through a targeted examination of the anal region including the Palpation of the rectum The doctor can often make a diagnosis with his finger.

In order to confirm or disprove this, a Tissue sample taken and examined. In the case of anal cancer, this can also determine what type of cancer cells and what degree of degeneration is present.

Once the diagnosis has been made, various tests are carried out to determine whether the cancer has spread to other parts of the body. In addition to the Palpation of the lymph node regions usually a Ultrasonic of the anal canal, one Rectoscopy as well as a Computed Tomography (Cross-sectional method with X-rays in the "tube") of the abdominal cavity and chest.

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Tumor markers

Tumor markers can occur in the blood of patients with anal cancer Check-ups be determined after therapy, as they are in a increase a hint for a Recurrence the disease can be.

They are not suitable for making a diagnosis, as an increase does not necessarily have to be caused by cancer. In addition, the values ​​can also be inconspicuous in sick people.

TNM classification

The TNM classification is used to classify cancers. It is an abbreviation for the three criteria tumor, Nodus and Metastases. Tumor stands for the size and Spread of anal carcinoma from T1 (smaller than 2 cm) to T3 (larger than 5 cm). Stage T4 is independent of its size when the tumor grows into neighboring organs such as the bladder or vagina.

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The classification from N0 to N3 is based on the lymph nodes that may be affected by cancer cells (N for Latin: Nodus lypmhoidus= Lymph nodes) performed.

In M1, the tumor has already spread to other organs (metastasized), with M0 there are no metastases.

The individually determinable TNM classification can on the one hand help determine the appropriate therapy and on the other hand be helpful in assessing the prognosis.

Concomitant symptoms

Anal carcinoma can make itself felt through various accompanying symptoms, which are, however, quite unspecific and can therefore also occur in various harmless diseases Initial stage However, the disease can also without symptoms run away.

Later it often becomes hard palpable and painless Skin changes at the anus. Are typical and alarming Bleeding. Even if often harmless diseases like hemorrhoids or Anal eczema If there is blood on the anus or in the stool, a doctor should be consulted for an examination.

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Other possible accompanying complaints with anal cancer can be a Feeling of pressure or foreignness such as Painthat occur especially during bowel movements.

Another symptom that you may experience is itching. Usually only at an advanced stage of the disease can it lead to one Fecal incontinence (= uncontrolled excretion of stool).

Pain

Pain are a very unspecific symptom and the extent to which these occur in anal cancer varies from case to case. That is often the case Initial stage the disease completely pain-free and symptom-free. Sudden severe pain is more likely to speak against you malignant disease and can for example through a infection to be triggered.

As the disease progresses, due to the constricting growth of the tumor, pain often initially only occurs during or after a bowel movement. However, anal cancer is very rarely the cause of painful bowel movements. Here are also benign complaints such as constipation much more often. However, a medical clarification should always be carried out.

Persistent pain Anal cancer usually only occurs at a very late stage, when the tumor has become very large.

therapy

Various therapy options are available for anal cancer. The options for treatment depend mainly on the size and the Spread of the tumor. But also other factors such as Age and Comorbidities and especially the Patient's request are crucial.

Smaller tumors that have not grown deep into the tissue and do not affect the sphincter muscle are usually found operational away.

For larger tumors, a combined treatment of radiation and chemotherapy has proven to be the treatment with the best chance of success. Both forms of therapy have a particular effect on rapidly dividing cells and thus primarily on cancer cells. However, healthy cells are also damaged and there are often side effects, such as urination problems and diarrhea, which subside after a few weeks.

With the combined therapy, however, the patients are spared side effects, such as the creation of an artificial intestinal outlet or a usually radical surgical removal of larger tumors.

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surgery

Surgical removal is the treatment of choice for limited anal carcinomas that have not grown deep into the tissue. The canker sore becomes one of them Safety distance cut out and usually doesn't have to be artificial anus be placed.

It is different with larger tumors, or those that have grown deeper into the tissue and therefore cannot be easily cut out. This is usually a treatment with Irradiation and chemotherapy preferred over surgery.

Only if this treatment is unsuccessful or if tumor tissue grows back does a radical operation removal of the rectum and all tissue affected by the tumor should be considered. During the operation a artificial anus be placed. However, such a drastic measure is avoidable in most cases.

Aftercare

After the therapy of an anal cancer, as with all cancer diseases, a regular one Follow-up check This is important in order to be able to recognize and treat any new tumor growth in good time physical exam a reflection of the rectum. For this purpose, a tube is pushed a few centimeters over the anus and the intestinal mucosa can be assessed using a camera.

In the first 2 years after anal cancer therapy, these checks should be carried out every 3 months. If these remain without abnormal findings, a six-monthly examination is sufficient.

In addition, the so-called Tumor markers determined in the blood. If these are increased, this can indicate a renewed growth of cancer cells. However, an increase can also have other causes and the values ​​must therefore always be viewed together with the other findings.

Irradiation

The Irradiation represents an important part of the therapy for anal cancer. It is usually combined with a chemotherapy, that is, treatment with a cell poison that is administered through the blood and in particular kills cancer cells. This combination has the best chance of success and a cure can often be achieved.

Radiation and chemotherapy should also be carried out in the case of very advanced tumors, as any subsequent surgery that may be required is made easier. One then speaks of a so-called neoadjuvant therapy.

Radiation alone was often performed in the past, but should no longer be used due to the significantly poorer chances of success. Side effects of radiation are common Diarrhea and Discomfort when urinatingwhich, however, usually subside after a few weeks.

Metastases

Metastases, that is, the tumor spreads, are most likely to grow in anal cancer in the Lymph nodes pelvis or groin. In most cases, however, the disease manifests itself earlier through symptoms such as Bleeding or Pain noticeable when defecating.

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Metastases in other organs such as the lungs are very rare in anal cancer and usually only develop very far advanced stageif no treatment is given.

Nevertheless, in people with anal cancer, a complete diagnosis should be made prior to therapy imaging examination from the abdominal cavity and chest. Usually a Computertompgrahie (CT) or alternatively a Magnetic resonance imaging (MRI) carried out.

Chances of recovery / prognosis

In the case of anal cancer, if treated in good time, the chances of recovery are very good compared to many other cancers. The prognosis for anal cancer depends on the size of the tumor and how far it has grown into the tissue. If the sphincter (Sphincter) is not infected, the chances of survival are very good and in almost all cases a surgery or a combined treatment Irradiation and chemotherapy can be achieved Sphincter infected by the tumor, the survival rate of all affected patients decreases, but a cure can still be achieved in the majority.

The prognosis is poor in people with anal cancer who already have tumor cells in the Lymph nodes have spread.

In any case, after successful therapy they are regular Follow-up examinations important. This includes one carried out every three months reflection of the rectum in the first two years after treatment. Thereafter, if the findings are normal, a six-monthly check is sufficient.

Life rate / chance of survival

The survival rate for tumor diseases is usually called 5 year survival rate stated, that is what percentage of people with a comparably advanced disease are still alive after 5 years.

With a very small anal cancer that has not spread and has not grown into neighboring organs, this rate is below surgical removal of the tumor in almost 100%. Larger tumors often respond well to the combined therapy of radiation and chemotherapy.

With more advanced tumors that have already grown into the sphincter, 50% to 70% of those affected are still alive after 5 years.

The worst chance of survival is a very advanced tumor that has already spread to the lymph nodes. The 5-year survival rate drops to below 40%.

However, since anal cancer usually becomes noticeable early on, stages that are so advanced are rarer. It is therefore very important to consult a doctor in good time if you experience any symptoms.


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