Anal Cancer Diagnosis

Sometimes anal cancer does not have any symptoms. However, anal cancers form in a part of your body that the doctor can see and reach easily. A rectal exam can find many anal cancers. In this exam, your doctor will insert a gloved finger into the anus. He or she will be checking for lumps or growths.

Rectal exams are not always a part of standard exams. They are used to check the prostate in men and sometimes as part of the pelvic exam in women.

Your doctor may also do an anal Pap test. This is similar to the Pap smear done to check for cervical cancer in women. In the anal Pap, your doctor swabs the lining of the anus. Then he or she looks at the cells under the microscope. This test is often done routinely for people who are high risk for anal cancer.

If you experience changes in bowel patterns or consistency of stool or blood in stool, these could be concerning. Please tell your doctor as soon as possible.

Additional Testing for Anal Cancer:

Urine, stool, and blood tests: You and/or your healthcare team will collect samples of each to be tested in a lab.

X-rays: Images of various parts of the body, including lungs, bladder, kidneys, lymph nodes

CT scan: This type of scan produces detailed pictures of your body. Instead of taking one picture, like a regular X-ray does, a CT scanner takes many pictures. It does this by rotating around you while you lie on a table. Then a computer combines all these images to produce a 3-dimensional image.

Before any images are taken, you may have to drink 1 to 2 pints of a liquid. It is called oral contrast. This fluid helps outline your intestine. This helps the doctor identify tumors. You may also receive an IV (intravenous line) in a vein, such as one in your arm or hand. A different type of contrast dye can be injected through the IV. Its purpose is also to outline structures in your body.

Ultrasonography: In this procedure, sound waves are bounced off body tissues. The echoes create a picture so your doctor can check for tumors.

MRI: An MRI provides detailed pictures like CT scans. The difference is that MRI scans use radio waves and strong magnets instead of X-rays. The energy from the radio waves produces patterns. A computer takes these and turns them into detailed images of specific part of your body.

MRI scans are often a little more uncomfortable than CT scans. For one thing, an MRI takes up to an hour. You may be placed inside a narrow tub. This can feel confining. Let your healthcare team know if you are claustrophobic.

PET scan: This scan requires a special radioactive sugar to be injected in your vein though an IV.

The cancerous tissues then take up the sugar. That enables a scanner to easily see those areas. PET scans are useful for finding cancer that has spread.

If your doctor finds something suspicious, you may need to have a biopsy.

A biopsy allows your doctor to remove a tissue sample be sent to a pathologist for examination. Before you can have a biopsy, you’ll have to “cleanse” yourself. This is usually done by taking an enema or laxatives the day before the procedure. In the procedure, the doctor will insert an endoscope or sigmoidoscope—a flexible tube with a light and small camera on the end. Your doctor will anesthetize (numb) the area where the sample will be collected. This will minimize your pain. You will probably feel mild discomfort and have some mild bleeding after the procedure.

In order to make a cancer diagnosis, a doctor needs to collect a sample of the tumor cells to be tested and examined in a lab by a pathologist.  A pathologist is a doctor who identifies cancer and other diseases by studying cells under a microscope. After the pathologist studies a sample, he or she prepares a pathology report that explains the findings. Doctors use these reports to diagnosis and stage cancer.

What will be in the pathology report?

The pathology report provides all the pathologist’s findings. Your pathology report may include some or all of the following:

  • Your identification information
  • Your important medical history
  • Details on how the sample or biopsy was taken
  • Description of how the sample looked under the microscope
  • Size, color, grade, margins, node status, etc.
  • Special tests or markers
  • A written summary of the full report

What do the words in my pathology report mean?

Here is a vocabulary list to help you through your pathology report:

Abnormal cells: cells that do not look or behave like healthy cells

Adenocarcinoma: cancer that develops in gland cells. Gland cells are found in the lining of some organs and create mucus, digestive juices, and other fluids.

Aggressive: fast growing

Angliolymphatic: means cancer has spread to the lymph nodes

Antibody: a protein produced by the immune system to fight foreign substances

Atypia: an abnormal cellular structure

Benign: not cancerous

Biopsy: a procedure to take a small sample of tissue

Cell Density: the number of cells in a single sample

Clean/ clear/ negative margins: the outer edge of the tissue sample does not contain cancer cells

Cytology: the study of a single cell or a small group of cells Differentiation: how close the cells look to normal cells

Dysplasia: the presence of abnormal cells

Florescence In Situ Hybridization (FISH): a test used to find genetic mutations

Gastrointestinal Stromal Tumors (GIST): a type of tumor that usually begins in cells in the wall of the gastrointestinal tract.

Grade: how abnormal the cells look and how quickly the tumor is likely to grow

Granulomas: inflammation of the tissue, often from infection Histology: the way the cells look under a microscope

Hyperplasia: increased cell production

Inconclusive: with the current sample and tests, it cannot be determined if cancer is present

Invasive: the cancer has spread to surrounding tissues

In Situ: abnormal cells have not spread; the abnormal cells are only where they started

Lymph node: lymph nodes filter lymphatic fluid and store white blood cells.

Malignant: cancerous

Metastasis: cancer that has spread to other parts of the body

Necrosis: cell death

Neoplasm: a growth made up of abnormal cells

Pathologist: a doctor who identifies diseases by studying cells and tissues under a microscope

Pleomorphic: able to change shape

Positive margins: the outer edge of the tissue sample does contain cancer cells

Stage: how advanced the cancer is

Stains: used to color the tissues and cells so the pathologist can see them better

Squamous cell carcinoma: cancer that begins in squamous cells. Squamous cells are found in the skin and the lining of the repertory and the digestive tracts.

Tissue Block: the sample of tissue removed during a biopsy or surgery

Vascular invasion: cancer cells are in the blood vessels

What Are Stages?

Once anal cancer has been diagnosed, it’s important to know the stage of the cancer. The stage indicates how serious it is. The stage of anal cancer depends on the size of the cancer, lymph node involvement, and if there is any distant spread of the tumor. Knowing the stage helps the doctor plan the right course of treatment. A pathologist determines the stage by looking at the cells that are collected during the biopsy process.

The TNM staging system is used for all types of cancer, not just anal cancer. The letters TNM describe the amount and spread of cancer in the body. For anal cancer,

  • T: indicates how far the tumor penetrates into the anal wall
  • N: indicates whether the cancer has spread to surrounding lymph nodes
  • M: indicates metastasis, which means that cancer has spread to other body parts

Stage I- The tumor is 2 centimeters or smaller

Stage II- The tumor is larger than 2 centimeters

Stage IIIA- The tumor has spread to nearby lymph nodes or nearby organs

Stage IIIB- The tumor has spread to nearby lymph nodes and organs or to lymph nodes in the groin

Stage IV- The cancer has spread to other, distant parts of the body

How Anal Cancer Spreads

There are three main ways that cancer spreads in the body. It can spread through:

  • Tissue. Cancer invades nearby normal tissue.
  • Lymph system. Cancer invades the lymph system and travels through the lymph vessels to other parts of the body.
  • Blood. Cancer invades veins and capillaries and travels through the bloodstream to other parts of the body.

The original tumor is called the primary tumor. When cancer cells break away from it and travel to other places in the body, a secondary tumor can form. The name for this spreading process is metastasis.

The secondary tumor is the same kind of cancer as the primary tumor. For instance, if the cancer cells from the anus or rectum travel to the liver, it is called metastatic anal cancer. It is not liver cancer.

The first step on the anal cancer treatment journey is to find an oncologist (medical or surgical) who inspires trust. Most anal cancer patients begin treatment with surgery so consider contacting a surgical oncologist first. Start with referrals from your primary care physician, specialist, or insurance carrier. Talk to family and friends who may have recommendations.

Here are some things to consider when choosing an oncologist:

  • Is the oncologist board certified?
  • How much experience does he or she have in treating anal cancer?
  • Do you feel comfortable talking with this doctor? Does he or she listen well?
  • Is the staff compassionate? Is the environment a good one or do you feel rushed?
  • What hospital(s) does this oncologist see patients in?
  • What are the office hours?
  • What if you have an emergency? Can you call?
  • Can this doctor be contacted after hours?

You will be spending a lot of time with the oncologist and staff nurses and technicians, so it’s important to feel comfortable with them.

If you’ve just been diagnosed with cancer, you may be confused and overwhelmed. You probably want answers, but you may not even know what questions to ask. As a cancer patient, being able to talk openly and honestly with your healthcare team is very important.

When you first meet with your doctor, it can be helpful to bring someone else with you. That way, there’s someone else to hear what is said and to ask questions or take notes. Here are some other tips for talking with your doctor:

  • Write out your questions ahead of time.
  • Write down the answers your doctor gives you.
  • If you don’t understand something, ask your doctor to say it in a different way. It’s important that you understand, and you have a right to know.

Use these must-ask questions as a guide to start talking with your healthcare team.

What is my diagnosis?

This question may seem like a no-brainer, but in the rush of appointments, you may not receive a clear answer.  If you are unsure of your diagnosis, ask your oncologist. Sometimes more specific tests are needed to make an exact diagnosis. Take notes. Don’t be afraid to ask your doctor to write down your diagnosis and stage to avoid any confusion.

What is my prognosis? What stage is my cancer?

Knowing your prognosis can help you better prepare for the future and select your best treatment plan. In order to know the stage of your cancer, your doctor will need to do tests. These may include scans, genetic testing, and/or a biopsy. The answer to these questions may be difficult to hear. You may consider having a family member or friend with you at this appointment.

What are my treatment options? What would you recommend?

Ask your oncologist to explain all your treatment options, including possible side effects and cost. Ask your oncologist which treatment he or she recommends. Also, ask your doctor what the goal of your treatment is—palliative or curative. If you are unsatisfied with your options, do not be afraid to seek a second opinion.

Am I eligible for a clinical trial?

Clinical trials help improve the standard of care for all cancer patients. Based on your situation, a clinical trial may also be your best treatment option. Each trial has its own eligibility requirements.

What are the possible short-term and long-term side effects of treatment? How will these affect my normal activities?

Always ask about short-term and long-term side effects before beginning treatment so you are prepared. You should also consider short-term and long-term side effects when deciding which treatment plan is best for you.

How can I manage these side effects?

Some side effects can be easily managed through diet, exercise, or over-the-counter medication. Other side effects may require prescription medication, occupational therapy, or physical therapy which your oncologist can prescribe as needed.

Will my ability to have children be affected? Is there anything I can do to preserve my fertility?

Some cancers and cancer treatments can affect your fertility, but you do have options. Before treatment, you may be able to freeze eggs or bank sperm. There may be steps you can take during treatment to protect your reproductive system as well. For more information, visit Fertile Hope at http://www.fertilehope.org/.

Where can I find help with financial concerns?

Evaluate your financial situation as soon as possible. You will not want to deal with financial stress in the middle of treatment when you may not feel well. For help finding financial assistance, contact CancerCare at (800) 813-HOPE or call 211 to reach your local United Way resource hotline.

Where can I find help with lodging or transportation?

When beginning cancer treatment, planning ahead is key. Some treatment centers have lodging coordinators or social workers to help you with the logistics of treatment. Ask your nurse navigator for assistance if you are having trouble finding lodging or transportation.

What will my follow-up care plan include?

After you finish treatment, make sure you and your oncologist create a follow-up care plan. You may need to check for recurrence. You may also need follow-up care for long term side effects.

When can I call myself a survivor?

According to the National Cancer Institute’s definition of a cancer survivor, “a person is considered to be a survivor from the time of diagnosis until the end of life.”