Anal Cancer: Exploring the Prognosis and Chances for Survival

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Prognosis is a fancy used when treating various chronic diseases.  Many individuals do not understand what a prognosis is. Prognosis is a word that you may hear your health team utilize when treating your anal cancer.  The term is used in order to describe your chances of surviving the cancer. Other times, the word prognosis is used in order to discuss the likely outcome from treatment.  It is important to understand that a prognosis is a scientifically calculated estimation. In other words, it is a guess. Many individuals want to know their prognosis, or chances of survival, when they receive a diagnosis of anal cancer.

Decisions

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Deciding whether or not to ask about your prognosis is personal.  You have to make the decision on how much information you want to receive.  Some patients are able to cope with the cancer and fight it better when they are informed about their prognosis and provided with the statistics regarding the stage of cancer they are facing and how likely treatment is to work.  Others are confused by statistics and don’t want to know their chances of survival. They find it easier to cope and fight the cancer without that information. Other patients believe that statistics aren’t useful because they are simply a generic number.

The best individual to discuss your prognosis with is the healthcare provider that is most familiar with your health.  As you discuss the statistics and the prognosis, it is important to remember that the prognosis has the ability to change.  It is difficult to predict cancer and the outcomes for treatment. A favorable prognosis can quickly change if the cancer spreads and reaches major organs or if the patient does not respond to the treatment provided.  A prognosis that is not favorable also has the potential to change if the treatment goes well and prevents the growth and spread of the cancer.

How is a prognosis made?

The healthcare provider figures out any factor that can impact the cancer or the treatment when calculating a patient’s prognosis.  They look at the estimated risks and the stage of cancer that the patient is dealing with. Estimates are based on research results from research that have been conducted over many years on individuals with the same cancer.  A favorable prognosis is one where you are likely to respond to provided treatments. An unfavorable prognosis is when the cancer is likely going to be difficult to control and/or has the chance to significantly shorten the patient’s life.  It is critical to remember that a prognosis is what is probably going to happen. It is not a definite statement of the future. When treating cancer, there are rarely any certainties.  

A prognosis typically depends on numerous factors.  It depends on the location of the cancer and the type of cancer that the individual is facing.  It depends on how quickly the cancer is spreading and growing and the stage of cancer the individual has been diagnosed with.  Age and overall health play a key role in the prognosis. The decisions that you make for treatment and how you personally respond to the treatment also affect the prognosis.  

Survival Rates

Survival rates can be a difficult topic to understand.  In general, survival rates are the length of time that individuals typically live after being diagnosed with anal cancer.  Rates are grouped based on the stage and type of cancer being experienced. Normally, statistics are used in regards to five and ten year rates of survival.  Most individuals live between five and ten years after receiving a diagnosis of anal cancer. Survival rate looks at individuals who are cured, have few symptoms of cancer, and are being treated for cancer.

Many individuals that are grouped in the five year survival rate live much longer than five years.  It is also important to remember that statistics are often based on individuals that received their diagnosis over five years ago.  Individuals that have recently diagnosed have a better prognosis due to constantly improving options for treatment.

Prognosis for Anal Cancer

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Anal cancer survival rates are based on large quantities of individuals.  Survival rates cannot predict what is definitely going to happen to an individual because no two people are exactly alike.  The way that individuals treat their cancer and respond to the treatments vary based on the individual. Anal cancer is a serious diagnosis.  Most treatments are effective, however, and many individuals are cured.  

About half of all diagnosed anal cancers are found early.  Most are diagnosed before the cancer is able to spread further than the anus.  This is known as localized cancer and has a five year survival rate of eighty percent.

There are times that cancer is not found until after it has spread to lymph nodes or other areas located around the anus.  This is referred to as locally advanced cancer and has a five year survival rate of sixty-one percent. When the cancer has spread to other locations in the body it is referred to as metastatic cancer and has a five year survival rate of around thirty percent.  The overall five year rate is sixty-six percent for anal cancer.

References:

https://www.cancer.org/cancer/anal-cancer/detection-diagnosis-staging/survival-rates.html

http://www.cancer.net/cancer-types/anal-cancer/statistics

http://www.cancerresearchuk.org/about-cancer/anal-cancer/survival

 

What are Medical Treatments Available for Anal Cancer?

The type of treatment that is used to treat your cancer is dependent on the type of cancer that you are diagnosed with, where it is located, and the extent that it has spread.  There are many different options available for treatment, and many times it is based on the stage of cancer that you are facing. It is important to understand that Anal tumors that are not located in the anal canal are occasionally treated differently from anal cancer found in the canal.  

Stage 0

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Stage 0 is the pre-cancer stage.  This is when the cancer is only located within the inner lining of your anus.  Cancer has not yet spread to the deeper layers. It is important to know that anal cancers are rarely identified during this stage.  When it is, the tumor can typically be completely removed by a surgeon and chemo is needed in rare instances.

Stage 1 and 2

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If you have been diagnosed with Stage 1 or Stage 2 anal cancer, this means that cancer has reached the anal wall but has not yet spread to the organs or lymph nodes that are nearby.  If the tumor is small enough, the tumor can typically be removed without the use of a sphincter. There are cases that chemo and/or radiation therapy are needed after to keep cancer from returning.

If the tumor is too big and there is no way that cancer can be removed without harming the anal sphincter, chemo, and radiation therapy are commonly combined to treat cancer.  When chemoradiation is used, 2 treatments are generally given within the same period. Chemo typically involves 5-FU with mitomycin C. Mitomycin is given through an IV, usually prior to radiation treatment and near the end of the treatment (around 4-6 weeks in).  5-FU is typically given through an IV over a period of 4 to 5 days and then repeated within 4-6 weeks. There are cases that internal radiation combined with external beam radiation.

There are times that cancer may not be completely gone after chemo has taken place.  If this happens, you may find that you require further treatment. You need to understand, however, that the full effects of chemo can take several months to notice.  Doctors typically keep an eye on any cancer that remains for as long as 6 months because there are times that it will continue to shrink. There are even times that it completely goes away and further treatment is not needed.

In the instance that further treatment is required, there are times that more chemo is given to attempt to shrink the remaining cancer.  5-FU and cisplatin are the drugs that are typically used in the process. Surgery is also an option for further treatment. This can remove any cancer that is remaining. An abdominoperineal resection is the most extensive operation that may be used for further treatment.  

Stages 3A and 3B

If you are diagnosed with Stage 3A or 3B, this means that cancer has reached nearby organs and/or lymph nodes but have not reached more distant parts of your body.  Most of the time, the first treatment that is tried is a combination of radiation and chemo. This means that both chemo and radiation are given over the same time. Like the process used for stages 1 and 2, 5-FU and mitomycin C are given.  Mitomycin is given in a short IV at the start and end of treatment. The 5-FU is given over a 4-5-day period and repeated at the 4 to 6 weeks mark. There are cases that internal radiation and external beam radiation may be suggested.

If cancer remains after the chemo combined with radiation process, you may find that nothing else occurs for up to 6 months to give the doctor the opportunity to see the full effects of the treatment.  However, if cancer begins to grow, further treatment will be needed. There are times that additional chemo is given and the drugs 5-FU and cisplatin. There are other times that a radiation boost (more radiation) is given.  Surgery is also an option. You can also undergo an abdominoperineal resection. When cancer spreads to the lymph nodes, you may find yourself undergoing surgery or receiving radiation therapy. Stage 3B can be a difficult stage for treatment, so this is the stage that you may find yourself looking at clinical trials as an option.

Stage 4

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If you are diagnosed with stage 4 cancer, this means that your cancer has reached either the distant tissues or organs in your body.  Anal cancer typically reaches the liver, bones, brain, and lungs first. However, it can spread anywhere in the body.

If you have stage 4 cancer, treatment is unlikely to cure cancer.  Treatment is given to control cancer if you can and relieve the symptoms.  Chemotherapy combined with radiation is the standard treatment. 5-FU and cisplatin are the drugs commonly used.  There are incidences where surgery is used. It is important, however, that you know the goal of the surgery and the risks involved before undergoing this option.  Clinical trials are often also contemplated during this stage.

 

References:

https://www.cancer.org/cancer/anal-cancer/treating.html

https://www.cancer.gov/types/anal/patient/anal-treatment-pdq

http://www.cancer.net/cancer-types/anal-cancer/treatment-options

https://www.cancer.gov/types/anal/patient/anal-treatment-pdq

http://www.mayoclinic.org/diseases-conditions/anal-cancer/diagnosis-treatment/treatment/txc-20233247

http://www.mayoclinic.org/diseases-conditions/anal-cancer/home/ovc-20233197

https://www.radiologyinfo.org/en/info.cfm?pg=anal-cancer-therapy

https://www.uabmedicine.org/patient-care/conditions/anal-cancer

 

SIGNS AND SYMPTOMS OF ANAL CANCER

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Anal cancer develops in the anus. Anal cancer is not to be mistaken for colorectal cancer which is much more common.  The anus is the end part of the large intestines which is usually about four centimeters long. This is where the solid wastes come out from the body. Anal cancer is very rare, and it occurs mostly to women than men.  Abnormal changes that occur in the anus are oftentimes harmless in the early stages but may eventually develop into cancer. 

 

Types of Anal Cancer

 

The variations of anal cancer depend on the kind of anal cells in which the cancer developed, according to cancercenter.com, and in verbatim:

 

  • Squamous cell carcinoma is located in the outer lining of the anal canal. It is the most common type of anal cancer.
  • Cloacogenic carcinoma starts between the outer part of the anus and the lower part of the rectum.
  • Adenocarcinoma occurs in the glands that produce mucous located beneath the anal lining.
  • Basal cell carcinoma is a type of skin cancer that can appear in the perianal skin, which is around the anus.
  • Melanoma starts in cells that produce pigment for the skin or anal lining

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Signs and Symptoms of Anal Cancer

 

Common symptoms of anal cancer may include:

 

  • Bloody stools
  • Random occurrence of diarrhea, constipation and thinning of stools
  • Lumps around the anus mostly mistaken for hemorrhoids
  • Mucous-like anal discharge 
  • Bloating
  • Anal itching
  • Anal pain 
  • Fecal incontinence
  • Discharge from the anus that are jelly-like
  • Lower back pain in  women (can be a sign of a tumor that creates pressure on the vagina)
  • Vaginal dryness

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Causes of Anal Cancer

 

Though experts cannot really pinpoint the causes anal cancer, there are a number of risk factors that may cause this disease.

  • HPV (human papilloma virus) – HPV are closely linked to anal cancer. Majority of patients with anal cancer are infected with HPV in the anal area.
  • Sexual partner numbers – Individuals who have had more sexual partners than others have higher risks of being infected with HPV, which is the primary risk factor for anal cancer.
  • Receptive anal intercourse – individuals who practices anal intercourse have higher risk of acquiring anal cancer. 
  • Other cancers – women and men who have had cancer in their reproductive area (vaginal or cervical cancer for women, and penile cancer for men) are more prone to developing anal cancer.
  • Age – as the case for most cancers, the older we get, the higher the risk of developing cancer.
  • Weak immune system – Individuals with HIV or AIDS and patients who have had organ transplants;  individuals who takes immunosuppressant medications are more at risk of having anal cancer.

 

If you think you are at risk of anal cancer, visit your doctor for a consultation.

Anal Cancer: What to Ask Your Doctor

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If are experiencing symptoms that make you believe you may have anal cancer, it is critical that you schedule an appointment with your doctor as soon as you can.  You are probably feeling worried and extremely scared if this is the case. Your primary doctor may have disclosed that anal cancer is a possibility. They may have even referred you to a specialist or a surgeon that treats these types of diseases.  This specialist is called a gastroenterologist. Once you have been diagnosed with anal cancer, you will typically be referred to an Oncologist. This type of specialist works with cancer patients. Appointments sometimes do not provide a lot of time to go over everything that needs to be discussed.  For this reason, you want to make sure that you are prepared when you go for your appointment. Here are some things that you can do to prepare.

What to do

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The first thing you want to do is make sure you know of any restrictions before you go to the appointment. This means that when you call and schedule, you should make sure to ask about any paperwork or any steps that you need to take prior to the appointment.  For example, ask if there is anything you need to change your diet. Covering this ground before you go for your appointment can minimize the amount of time spent on the topic during the appointment and free up time to cover other necessary topics.  

Make sure that you make a list of all your symptoms, even ones you think may be unrelated to cancer.  That way, when the doctor asks, you have the symptoms at the ready. This helps ensure nothing is missed and saves time.  Make sure that you write down personal information that is typically asked during a medical history. Include things that increase your stress level and any changes that have taken place in your life (such as income change, getting married, or having a child.)  You should also write down all the medications (over-the-counter and prescribed) that you are currently taking. Ask someone to go to the appointment with you so that you have an extra pair of ears at the appointment. These appointments can be overwhelming. Having an extra person at the appointment can help ensure that more details are remembered. 

You also want to make sure that you write up a list of questions to ask the doctor when you go for the appointment.  You are not going to have a lot of time with your doctor. Therefore, you want to list the questions from the most to the least important so that you can ask the ones that matter most before your time is up.  

What should you ask?

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The hardest part of making any list is figuring out what to put on it.  Some people are just natural list makers. We all know someone that make lists of their lists and can follow them with expertise.  However, there are much more than stare at a blank piece of paper having a hard time figuring out what to put on it. Here are some basic things you should go over with your doctor to get you started.  Remember, however, to order the questions based on what you feel is the most important. Everyone is different and everyone has different priorities. With that said, here are some things you might want to ask.

When speaking with your doctor about anal cancer, one of the most important things you are going to want to ask is what stage of cancer do you have.  This affects your overall prognosis and is important to talk about at some point during the visit. You should inquire about any further testing that is needed so that you are prepared for what you are facing.  Make sure that you ask about the different options available for treatment. This is important because what works for one doesn’t work for all. You want to ask about the doctor’s professional opinion of what treatment is best for the stage of cancer that you are facing and what research is available to back up that approach.  Evidence-based practice is normally the safest bet when it’s available. However, clinical trials have been known to work as well. Weigh the risks and benefits before you decide. This means that you need to know if you qualify for any clinical trials and make sure that you inquire about any side effects to each treatment option discussed.  Ask if the professional can recommend any one for a second opinion if you feel a second opinion is warranted. Finally, inquire about what factors determine if you need to follow-up.  

 

References:

https://www.cancer.org/cancer/anal-cancer/detection-diagnosis-staging/talking-with-your-doctor.html

http://www.cancer.net/cancer-types/anal-cancer/questions-ask-doctor

https://www.analcancerfoundation.org/living-with-anal-cancer/questions-to-ask-your-doctor/

https://www.cancercare.org/publications/322-after_a_colorectal_cancer_diagnosis_questions_to_ask_your_doctor