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Patterns of recurrence in anal cancer

Patterns of recurrence in anal cancer

Anal cancer is the type of cancer that affects the anal canal of your body. It happens when there is an abnormal growth of cells in the anal canal. It is not a very common cancer but the data show that the number of cases of this cancer is on the rise. 

What is anal cancer?

Anal cancer occurs when the cells present in the anal canal undergo uncontrolled growth and multiplication. The anal canal is the part of the digestive tract that connects your anus and rectum and this passage is about one to two centimetres in length. It is the organ involved in the waste disposal of the body and helps to excrete solid waste or feces. The most common type of anal cancer is squamous cell carcinoma.

Signs and symptoms

It is important to note that you might not have any symptoms of this disease. Nearly one-fourth of the people don’t seem to have any signs or symptoms. But the symptoms can be rectal bleeding during bowel movements, a lump at the opening of the anus, pain, and itching, change in the frequency or consistency of the bowel movements, leakage, and an urge to have a bowel movement all the time.

Treatments available

The treatment prescribed depends on the stage of cancer diagnosed and the age of the patient. You may be given a combination of the treatment to get the desired result. Treatments can be chemotherapy, surgery, radiation, or a combination of them. Chemotherapy involves drugs administered to kill cancer cells or prevent them from proliferating. Surgery can be used to remove the mass or tumour. It works well if the tumour has a well-defined boundary. Radiation therapy uses X-ray to kill cancer cells. It is non-invasive in nature but may kill the surrounding healthy cells.

Risk factors

It is believed that HPV(Human papillomavirus) might cause this cancer. Although, people who have HPV might not have anal cancer. Several other factors pose a risk. These are the use of immunosuppressants, engaging in anal sex, age(above 55), smoking, having a weak immune system, presence of anus fistula, etc.

Recurrence

When anal cancer comes back even after its disappearance after treatment then it is called recurrent anal cancer. It may come back in the place where it had happened earlier or a place nearby to the older site, or it can spread to other places or organs like the liver, bones, etc. There can be three types of recurrence. A local recurrence or LR is the kind of recurrence when cancer comes back in the same place. When it comes back to the area nearby then it is called regional recurrence(RR). A distant recurrence(DR) happens when tumour comes back in an area different from the earlier occurrence.

Identifying the possible patterns of recurrence

In the case of squamous cell carcinoma type, the usual treatment is CRT or chemoradiotherapy. It is considered an effective treatment but patients who undergo this treatment have to bear many side effects which means a reduced quality of life. 

A study conducted on the patients who received the radiotherapy treatment suggests that the occurrence of out-of-field LR and isolated RR is not very frequent and happens not so often. Also, the patients whose lymph nodes also got affected had a high chance of recurrence. The highest chance of recurrence was for the DR. In fact, LR is very rare compared to DR. Also, those who have lymph node involvement might be at risk of having tumour cells in the CI/PA lymph nodes.

Another study identified the recurrence based on the geometry of the tumour unlike the origin or occurrence area of the tumour. This study suggests that the roundness of the tumour could be a clue to know how likely the tumour is going to come back. The rounder is the tumour more likely it is expected to come back. On the other hand, a decrease in the roundness means the tumour has a lower risk of recurrence. 

So, measuring the roundness can help to predict if the recurrence will happen or not. Using imaging tools and devices, the image of the tumour can be taken and analysed to know the roundness and other geometrical aspects that may help to identify the recurrence.

Prevention 

We are still not sure about the exact reason for anal cancer as it can happen due to a lot of reasons. But we can at least reduce the risk of getting this cancer. Some of these ways can be:

  1. Practicing safe sex helps prevent HPV and HIV, two sexually transmitted infection viruses that can increase your risk of anal cancer. If you decide to have anal sex, use a condom. 
  2. Get vaccinated against HPV. Vaccines are available to prevent HPV infection. It is recommended for adolescents, including boys and girls, but can also be given to adults.
  3. Smoking increases the risk of anal cancer. Do not start smoking. If you are currently smoking, you probably should quit.
  4. Try to incorporate a healthy lifestyle by eating healthily and staying active. You can do exercise and do yoga or meditation. Avoid stress and manage your emotional well-being by practising mindfulness techniques and keeping a positive outlook.

Summing up

In order to find the pattern of recurrence in anal cancer, more research needs to be carried out in a more systematic and comprehensive manner. There might be several other patterns and factors related to recurrence which can only be revealed if given sufficient clinical trials and extensive research. What we can do is incorporate a healthy lifestyle and keep care of a few things to get the upper hand to reduce the chances of recurrence and lead a normal life after recovery. 

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