Anal cancer is often fairly easy to diagnose because it is in a fairly easy-to-reach area. Although some cases of anal cancer in people at high risk for that disease are diagnosed by screening tests, such as the digital rectal exam and/or anal Pap test, most people are diagnosed after their cancer starts to cause symptoms.

Signs and Symptoms of Anal Cancer

Some cases of anal cancer cause no symptoms at all. But bleeding occurs in more than half of patients and is usually the first sign of the disease. Often the bleeding is minor. At first, most people assume that hemorrhoids are the cause of their bleeding. Itching can also be a symptom. This is more often a sign of AIN, which should also be treated. Important symptoms of anal cancer include:

• rectal bleeding
• rectal itching
• pain in the anal area
• change in the diameter of stool
• abnormal discharge from the anus
• swollen lymph nodes in the anal or groin areas

There are a number of benign conditions, such as hemorrhoids, fissures, or anal warts that can cause similar symptoms. But if any of the signs or symptoms of anal cancer are present, discuss them with your doctor without delay. Remember, the sooner you receive a correct diagnosis, the sooner you can start treatment, and the more effective your treatment will be.

Procedures Used To Diagnose Anal Cancer

Sometimes a doctor will detect anal cancer during a routine physical exam or during a minor procedure, such as removing a hemorrhoid. Treatment of cancers found in this way is often very effective because the tumors are found early in the course of the disease.

An unusual growth may also be found on a digital rectal exam. But since doctors cannot see what they feel, other steps may be needed if you have symptoms or if your doctor suspects you have anal cancer.

Endoscopy

Endoscopy is the use of a tube with a lens or video camera on the end to examine an inner part of the body. Several types of endoscopy may be used to look for the cause of anal symptoms. For these tests you either lie on your side on top of an examining table, with your knees bent up to your chest, or you bend forward over the table. Types of endoscopy include:

Anoscopy: Anoscopy uses a short, hollow tube (an anoscope), which is 3 to 4 inches long and about 1 inch in diameter, and may have a light on the end of it. The doctor coats the anoscope with a lubricant and then gently pushes it into the anus and rectum. By shining a light into this tube, the doctor has a clear view of the lining of the lower rectum and anus. This is usually not painful.

Rigid proctosigmoidoscopy: The rigid proctosigmoidoscope is similar to an anoscope, except that the proctoscope is 10 inches long, so it allows the doctor to view the rectum as well as the lower part of the sigmoid colon. This test usually requires that you take laxatives or have an enema beforehand to make sure the bowels are empty.

Biopsy

If a suspicious growth is found, your doctor will do a biopsy. In this procedure, a small piece of the tissue is cut out and sent to a lab. This can often be done through the scope itself. You may get a local anesthetic before a biopsy is taken in this area.

A pathologist (a doctor specializing in lab diagnosis of diseases) will look at the sample under a microscope. If cancer is present, the pathologist will send back a report describing the cell type and extent of the cancer.

If the tumor is very small and has not grown below the surface of the anus into other tissues, your doctor may attempt to remove the entire tumor during the biopsy.

Fine-needle aspiration biopsy: There is a risk that anal cancers, like other forms of cancer, can spread through the lymphatic system. Lymph nodes are bean-sized collections of immune system cells. Swollen lymph nodes in the groin are sometimes a sign of spreading anal cancer. These can also be a reaction to infection. To distinguish between an infection or a cancer, your doctor may use a thin needle to withdraw a small sample of fluid and tissue from the lymph node. The lab will study this fluid to look for the presence of cancer cells. This procedure is called a fine-needle aspiration biopsy. In some cases, an operation to remove the lymph nodes may then be done.

Sentinel node biopsy: This test is sometimes used to help determine if cancer that has already been diagnosed has spread to the lymph nodes. In this test a low-level radioactive tracer material is injected around the tumor. Often a blue dye is injected into the tumor at the same time. The groin lymph nodes are scanned to see where the radioactive material has traveled. The doctor then makes a small incision over the radioactive area to remove the underlying lymph nodes, especially any blue-stained lymph nodes. A pathologist then looks at the nodes for evidence of cancer cells. This helps tell how far the cancer may have spread, because these nodes would be the ones that any cancer cells leaving the tumor would have spread to first. While this test has been shown to be useful for some other cancers, it's not yet clear how helpful it is for anal cancer.

Imaging Studies

If cancer is found, you may have certain tests to determine the stage (extent) of the disease. Some of these tests are used more often than others.

Ultrasound: An ultrasound can show how far a cancer has invaded nearby tissues. Ultrasound uses sound waves and their echoes to produce a picture of internal organs or masses. A small microphone-like instrument, called a transducer, emits high-frequency sound waves. These sound waves pass into the area of the body being studied and are echoed back. The echoes are picked up by the transducer and converted by a computer into an image on a screen. Normally, ultrasound is a very easy procedure that uses no radiation.

To look for anal cancer, the transducer is inserted directly into the rectum. This is known as transrectal or endorectal ultrasound. The test can be slightly uncomfortable, but it usually is not painful.

Computed tomography (CT): The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these into images that represent slices of the part of your body that is being studied. Often after the first set of pictures is taken, you will get an intravenous (IV) injection of a "dye" or radiocontrast agent that helps better outline structures in your body. A second set of pictures is then taken.

CT scans can help tell whether the anal cancer has spread into the liver or other organs. They can also be used to guide a biopsy needle precisely into a suspected area of cancer spread. For a CT-guided needle biopsy, the patient remains on the CT scanning table, while a doctor advances a biopsy needle in the body toward the location of the mass. CT scans are repeated until the doctor is confident that the needle is within the mass. A fine-needle biopsy sample (tiny fragment of tissue) or a core-needle biopsy sample (a thin cylinder of tissue about ½ inch long and less than 1/8 inch in diameter) is then removed and looked at under a microscope.

CT scans take longer than regular x-rays. You usually need to lie still on a table for 15 to 30 minutes while they are being done. But they are getting faster, and your stay might be shorter. You might feel a bit confined by the equipment while the pictures are being taken.

You may need an IV line through which the contrast "dye" is injected. The injection can sometimes cause flushing. Some people are allergic and get hives or rarely more serious reactions, such as trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays. You may also be asked to drink 1 to 2 pints of a contrast solution. This helps outline the intestine so that it is not mistaken for tumors.

Magnetic resonance imaging (MRI): MRI scans use radio waves and strong magnets instead of x-rays to make images of the body. The energy from the radio waves is absorbed by the body and then released in a specific pattern formed by the type of tissue and by certain diseases. A computer translates the pattern into a detailed image of parts of the body. Like a CT scanner, this produces cross-sectional slices of the body. An MRI can produce slices that are parallel with the length of your body. As with a CT scan, a contrast material might be used, but it is not needed as often.

MRI scans are a little more uncomfortable than CT scans. They take longer -- often up to an hour. You have to be placed inside tube-like equipment, which is confining and can upset people that suffer from claustrophobia (a fear of enclosed spaces). Newer, "open" MRI machines are less confining and more comfortable for such people. The MRI machine makes a buzzing noise that some people may find disturbing. Some places will provide headphones with music to block this sound.

Chest x-ray: This test may be done to determine whether anal cancer has spread to the lungs.

Positron emission tomography (PET): PET scans use glucose (a form of sugar) that contains a low-level radioactive atom. Because they are very active, cancer cells in the body absorb larger amounts of the sugar than normal cells and display more radioactivity. A special camera can be used to detect this radioactivity. PET is useful when your doctor thinks the cancer has spread, but doesn't know where. PET scans can be used instead of several different x-rays because it scans your whole body.