Staging:

 The doctors need to know how far the cancer has spread. There are different stages of cancer. The initial stages are the easiest to deal with because then the disease has not become too perilous. When the doctors detect the stage they can determine what treatment should be done. That is the reason staging is rather important in the treatment process.

 The tests can easily diagnose the stage.  There are different ways of staging cancers.The two main ways are the TNM system and number stages.The information you get about the stage of your cancer may sound a bit confusing.  You probably won’t be as familiar with these terms as your doctor is.   If you don’t understand what stage your cancer is, and would like to know more, ask your doctor.

The stages named TNM and its description:
‘TNM’ stands for Tumor, Node, and Metastasis. 

This staging system can tell you

·                      The initial size of the tumor.  (T) 

·                      Whether there are lymph nodes containing cancer cells (N)   

·                      Whether the cancer has spread to a different part of the body (M)

The size of the tumor (T)

There are 5 stages of tumor size in the current TNM classification of anal cancer: T1 – T4 and a very early stage called Tis or carcinoma in situ.  Anal cancers are not usually found at this very early stage, as they don’t cause any symptoms when they are so small. 

Below is the exact meaning of each T stage for anal cancer

·                      Tis or carcinoma in situ - also sometimes also called AIN (anal carcinoma in situ)- is the earliest stage of anal cancer, when the cancer cells are only found inside the lining of the anus and have not spread elsewhere  

·                      T1 means the tumor measures 2cm across or less   

·                      T2 means the tumor is larger than 2cm but smaller than 5cm   

 ·                      T3 means the tumor is larger than 5cm   

·                      T4 means the cancer can be any size, but is growing into the surrounding tissues or organs, such as the urethra, the vagina or bladder

N stages of anal cancer:

The N stage refers to whether any lymph nodes are affected by the cancer.  The N stages are defined as follows

·                      N0 means that no lymph nodes contain cancer cells  

·                      N1 means there are cancer cells in the lymph nodes closest to the rectum   

·                      N2 means the lymph nodes in the pelvis (pelvic nodes) or groin (inguinal nodes) on one side of the body are affected   

·                      N3 means that either the nodes near the rectum and nodes in the groin or pelvis contain cancer cells OR the nodes in the pelvis or groin on both sides of the body contain cancer cells

M stages of anal cancer:

The M stage refers to whether there has been spread of the cancer to other organs in the body.  M stages are defined as follows

·                      M0 means there is no cancer spread to other organs.   

·                      M1 means the cancer has spread to another part of the body, such as the liver.

Determining these is necessary in order to have a clear idea for treatment purposes.

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Procedure that should be adopted: once you learn that you are suffering from anal cancer you should not take this lightly but get immediate help. There are cancer hospitals that provide treatments for all sorts of cancers. Cancer is no ordinary disease that you can ignore. You have to find a proper channel through which you get your treatment done. The very first thing that you need to do is visit a doctor for a medical examintaion.

·                     Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

 ·                     Digital rectal examination (DRE): An exam of the anus and rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual.

·                     Anoscopy: An exam of the anus and lower rectum using a short, lighted tube called an anoscope.

·                     Proctoscopy: An exam of the rectum using a short, lighted tube called a proctoscope.

·                     Endo-anal or endorectal ultrasound: A procedure in which an ultrasound transducer (probe) is inserted into the anus or rectum and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If an abnormal area is seen during the anoscopy, a biopsy may be done at that time.           

          These are a few medical examinations that you need to take. These different tests vary from normal health examinations because cancer cells are not easily detected.If they do not appear in one test then other tests have been created so that if there is cancer it is detected one way or the other. It is advised that people dont make any delay in getting themselves examined if they spot any smptoms of cancer. 

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   Like every other disease in the world there are some symptoms and signs that start to appear incase a person has been victimized by the anal cancer. These signs become apparent gradually and slowly they turn hazardous for the victim. Some of the very common signs of anal cancer are as follows:  

• ·                     Bleeding from the anus or rectum.
• ·                     Pain or pressure in the area around the anus.
• ·                     Itching or discharge from the anus.
• ·                     A lump near the anus.
• ·                     A change in bowel habits.
• ·                     Any abnormal anal discharge.

In about 50% of cases, the initial symptom of anal cancer is bleeding. Pain is somewhat less common, seen in about 30% of patients presenting with anal cancer; however, it can be quite severe. Occasionally, patients have the sensation of having a mass in the anus and can experience itching or anal discharge. Rarely, in advanced cases, anal cancers can disrupt the function of the anal muscles, resulting in loss of control of bowel movements. In general, these symptoms are vague and non-specific. As a result, in one-half to two-thirds of patients with anal cancer, a delay of up to 6 months occurs between the time when symptoms start and when a diagnosis is made.

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Anal tumors and anal cancers can have various causes of occuring. Generally anal cancer is caused by infections in the anal area. The main cause is still unknown. Most anal cancers seem to be linked to infection with the human papilloma virus (HPV). While HPV infection seems to be important in the development of anal cancer, the vast majority of people with HPV infections do not get anal cancer.The cause of anal cancer is normally unclear for any type of cancerous cell is never easy to detect till at a later stage. If there was a question raised as to a virus causing anal cancer then the answer would be that yes, there is a virus that causes anal cancer and it is called the human papilloma virus (HPV).There are many different types of HPV. Some types of HPV cause warts in the genital area but many others do not. Usually, if we are infected with HPV our body’s defense against infection, the immune system clears the virus within a few months. But, in some cases, our body fails to clear the virus. The virus can cause changes in the cells that line the anus. For a small number of people these changes may, over a number of years, lead to anal cancer.

Anal cancer is slightly more common in women than in men and is more common in gay men and in people with a higher than average number of sexual partners. HPV infection may be a factor in this. A study in the Nov. 6 issue of The New England Journal of Medicine reports there is “strong evidence” to indicate that anal cancers are sexually transmitted via the human papillomavirus. HPV is most commonly known as the virus which causes genital warts, and which can lead to cervical cancer in women. Generally speaking, cancer is not thought of as a disease that can be transmitted from one person to another. But a study by Danish and Swedish researchers found that 88 percent of 388 people with anal cancer (both men and women) also had HPV in their cancer tissue specimens. Control groups of more than 500 people who didn’t have cancer and 500 people who had rectal cancer showed no signs of HPV infection. Interestingly, while past studies have associated anal cancer with men having sex with men, only 15 percent of the men with anal cancer in this study reported having had “homosexual contact” with another man — the same percentage as women who reported having had “anal intercourse” with a man. But because no man without anal cancer reported “homosexual contact,” the researchers concluded that this evidence and a few other peculiarities (such as being unmarried, no history of hepatitis) “strongly support the idea that male homosexual contact is a risk factor for anal cancer.” (By contrast, of the women who had engaged in anal intercourse, 15 percent had anal cancer, 10 percent had no cancer and 6 percent had rectal cancer.) The investigators said they also found strong evidence to link “heterosexual promiscuity” to the likelihood of having anal cancer.  

Human body has been designed to work in a specific manner. Any kind of abnormality can cause it to malfunction and that is where humans make a mistake. All the abnormal or excessive sexual relationships especially the unsafe ones normally larger in number of cases like gays and homosexuals can cause virus to infect the human anal track. And there on the virus penetrates causing the cancer to develop.  

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General causes: 

There are approximately around millions of the anal cancer cases around the globe. Generally the number of cases has been increasing in the past 5 decades. It is much more common in the female population; however in the world about there is a possibility that both; males and females have this cancer in an equal proportion. The

In general, cancer begins with a genetic mutation that turns normal, healthy cells into abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at a set time. Abnormal cells grow and multiply out of control, and they don’t die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can separate from an initial tumor to spread elsewhere in the body (metastasize).Doctors don’t know what causes the genetic mutation that triggers the development of anal cancer. However, they have identified several factors that may increase the risk of anal cancer. 

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There are various types of tumors that can develop in the anus or around it. The skin around the anal area is called perianal area. This is the area where normally tumors develop that is related to the skin and not anal cancers. These non-cancerous tumors are called benign. These tumors are not that severe and they tend to spread in the areas around the anus. Sometimes these tumors develop into cancers if they are not cured. Cancerous cells grow slowly and these conditions are called the pre-cancerous conditions. These abnormal growths vary and changes occur in the skin cells. Eventually they become very fatal in the end and develop into cancer.

·          Polyps: Polyps are small, bumpy, or mushroom-like growths that develop in the mucosa or just under it. There are several kinds, depending on their cause and location.

·          Inflammatory: polyps arise because of inflammation from injury or infection.

·          Lymphoid: polyps develop in lymph tissue (part of the immune system). Small nodules of lymph tissue are normally present under the anal inner lining.

·          Skin: tags are benign growths of connective tissue that are covered by a layer of squamous cells. Skin tags are also called fibroepithelial polyps.

Condylomas:

Condylomas (also called warts) are growths that occur just outside the anus and in the lower anal canal below the dentate line. Occasionally condylomas can be found just above the dentate line. They are caused by infection with a human papilloma virus (HPV). People who have had condylomas are more likely to develop anal cancer (see next section, “Potentially Pre-cancerous Anal Conditions.”).

Other tumors: In rare cases, benign tumors can grow in other tissues of the anus. These include:

• adnexal tumors : usually benign growths that start in hair follicles or sweat glands of the skin just outside of the anus. These tumors stay in the perianal skin area and do not grow into the anal region. 

• leiomyomas – develop from smooth muscle cells 

• granular cell tumors –develop from nerve cells and are composed of cells that contain lots of tiny spots (granules)

• hemangiomas –start in the lining cells of blood vessels 

• lipomas - start from fat cells

•  schwannomas - develop from cells that cover nerves

Eventually they become very critical in the end and develop into cancer.These non-cancerous tumors appear if you are not careful about the proper cleanliness of the anal area. Food containing germs and virus can accumulate in the anal area and then the skin surrounding the anus gets swelled and there can also be wart development there. Anal tumors are agitating and they hinder a comfortable and smooth flow of excretion. Healthy diet and cleanliness are two key factors of avoiding anal tumors or any other type of cancer for that matter.

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 Anal Tumors and Cancers :

There is always a possibility of getting different diseases and after the virus has penetrated in the body, there is no way humans can get rid of it soon. Anal opening is a vulnerable part of the human body. Any minor scratch or bruise caused due to any reason can give birth to any severity. At times these abnormal lumps, swellings etc can cause cancerous cells to develop within that specific area.

 Many types of tumors can develop in the anus. Some of these tumors are benign (non-cancerous). Others are cancerous, which means they can grow into and damage nearby tissues and can spread to other parts of the body. There are also some growths that start off as benign but over time can develop into cancer. These are called pre-cancerous conditions. This section discusses all of these types of abnormal growths.  

Anal cancer in the simplest definition is a disease which is caused in the anus when cancer cells form in the tissues of the anus.

 Normally, cells in the body will grow and divide to replace old or damaged cells in the body. This growth is highly regulated, and once enough cells are produced to replace the old ones, normal cells will stop dividing. Tumors occur when there is an error in this regulation and cells continue to grow uncontrolled. Tumors can either be benign or malignant. Although benign tumors grow uncontrolled, then do not break off and spread beyond where they started and do not invade into surrounding tissues. Malignant tumors, however, will grow uncontrolled in such a way that they invade and damage other tissues around them. They also gain the ability to break off from where they started and spread to other parts of the body, usually through the blood stream or through the lymphatic system where the lymph nodes are located. Over time, the cells within a malignant tumor become more abnormal and appear less like normal cells. There is often a change in the development of the cells in the human body. These changes become apparent after a very long time, when they have become infected. The cancer cells are changeable and they tend to change unknowingly. These cells are hard to detect because they have the ability to merge themselves with the other cells of the body.

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The Anal opening: 

The human body has two openings as it is understood. The mouth takes in the food while the other opening known as rectum, is the opening that helps the waste to pass out from. This is also known as the anal opening. It is necessary for the extra food not needed by the human body anymore to pass out. Otherwise the abnormal holding back of waste material can lead to many diseases.     

The anal canal is about an inch and a half long. Its inner lining (called the mucosa) is made up of several different kinds of cells. Learning a little about these cells is helpful in understanding the kinds of cancer that develop in various parts of the anal canal. Glands and ducts (tubes leading from the glands) are found under the mucosa. These “anal glands” make mucus, which acts as a lubricating fluid.

 The anal canal is the tube that goes from the rectum to the anal margin (where the canal meets the outside skin at the anus). About midway down the anal canal is the dentate line, which is where most of the glands empty into the anus. Cells above the anal canal (in the rectum) are mainly shaped like tiny columns, while most of those in the upper anal canal just above the dentate line are shaped like cubes and are called transitional cells. This area is called the transitional zone. Below the dentate line are flat (squamous) cells.

The anal margin (also called the anal verge) is lined by squamous cells that merge with the skin just outside the anus (called perianal skin). The anal canal is surrounded by a sphincter, which is a circular muscle that keeps feces from coming out until it is relaxed during a bowel movement.

 The rectum and the anus are very vulnerable parts of the human body. It has to be made sure that they function properly. The timely excretion that takes about 24 hours is very important otherwise a person’s body can suffer from multiple diseases. The reason is that the stools passed out are a wastes material. The body does not require it any longer so it has to be excreted. Cancer development in this particular area is not very common. Mostly, tumors and the like that tend to form in these areas. In severe cases these tumors can turn into cancer.

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