Anal Cancer – Diagnosis Procedures And Staging

What is Anal Cancer?

Anal Cancer is a condition that develops in the tissues present in the anus. Anus is the small tubular structure connecting the lower section of the large intestine called the rectum to outside the body. The anus functions by controlling the excretion of unwanted body waste through bowel movements.

Diagnosis & Tests:

The general practitioner would carry out a detailed examination of the patient subsequent to which, the patient would be referred to a professional in bowel conditions –the gastroenterologist. In the hospital, the doctor would query the patient regarding general health conditions and any past medical conditions. The patient would be examined by the doctor and blood sample would be drawn for checking the general health and the functioning of the liver. A series of tests would be conducted for confirming the presence of anal cancer.

• Rectal Exam
  At times also called the PR exam wherein the doctor would conduct an examination of the back route with a lubricated gloved finger.
• Biopsy
  A small amount of cell sample is drawn from the tumour for microscopic analysis. Generally, this employs the use of either a specialised biopsy piece of equipment called the punch biopsy or a small section of the tumour would be incised by the doctor – called the incisional biopsy. Both of these biopsies are conducted under the influence of local or general anaesthesia. In case the tests reveal an affirmative outcome, then additional tests would be carried out to analyse the metastasis of the cancer.
• X-Rays
  These are taken for assessing whether the cancer has metastasized.
• Ultrasound Scan
  This simple scanning procedure employs sound waves for capturing images of the interior of the abdominal region that are conducted in the hospital scanning section. On lying down on a flat surface, a gel is applied all over the abdomen subsequent to which a small hand-held device is moved all over it. The sound waves produced are transformed into images employing a computer. The pain-free procedure lasts for nearly twenty minutes. At times an ultrasound scan procedure called as endoanal ultrasound could be performed wherein a tiny, slender probe is introduced into the back route (rectum) that provides images of the size and spread of the tumour.
• CT or Computerised Tomography Scan
  A CT scan captures a sequence of x-rays that are passed via computer to reproduce 3-D pictures of the inner areas of the body. The pain-free procedure lasts for ten to thirty minutes. CT scans employ miniscule amounts of radiation that are not harmful to either the patient or those coming in contact with the patient. The patient would be requested not to ingest liquids or solids for nearly four hours prior to the scan. Majority of the individuals undergoing the scan are offered a drink or administered a shot for allowing certain areas to be seen more lucidly. Prior to getting the injection or the drink it is imperative to inform the individual conducting the test whether one is allergic to iodine or asthmatic. Following the scan, one could return home.
• MRI or Magnetic Resonance Imaging Scan
  This test procedure is analogous to a CT scan, however this employs magnetic fields rather than x-rays. During the course of the scan, the person would be requested to lie totally motionless on a couch inside a metallic cylindrical enclosure which is a potent magnet. Hence, prior to entering inside the room, one must remove any kind of metallic items in one’s possession. The doctor also must be informed in case one has previously worked with metals or were employed in the metal industry or whether one has any metal present in the body (for instance, a heart monitor, a pacemaker, surgical clips or bone pins). In case these might be present in the body, then a MRI would not be performed on that person due to the magnetic fields. An injection would be administered for allowing greater picture clarity of the interiors of the body. The test procedure would last for nearly thirty minutes and is totally painless, though the MRI machine could sound loud. Earplugs or headphones would be offered for this reason. In case, one is apprehensive of closed spaces, one might find the feeling of being inside the machine quite suffocating or stifling. A 2-way intercom facilitates easy communication with the person operating the scanner.
• Staging and Grading
  The staging of cancer depicts the size and the extent of metastasis past the initial location of occurrence. Gaining knowledge of the specific type and the staging of the cancer assists doctors in deciding upon the best line of treatment. Cancer could proliferate in the body through either the bloodstream or via the lymphatic system. The lymphatic system is a component of the body’s protection mechanism from infection and ailments and comprises of a system of lymph glands or lymph nodes that are connected by fine ducts that contain lymph fluid. The doctor would generally examine the close by lymph nodes while staging the cancer.
• Stage 1
  The cancer is observed to affect the anus and has a size of lesser than two centimetres or 3/4th inch. It has not yet metastasized to the sphincter muscle.
• Stage 2
  The cancer is more than two centimetres in size, however has not reached into the close by lymph nodes or to other body parts.
• Stage 3A
  The cancer has metastasized to the lymph nodes near the rectum, or to the closely situated organs like the bladder or vagina.
• Stage 3B
  The cancer has metastasized to either the lymph nodes in the groin region, pelvis or to the lymph nodes near the anus, along with the closely placed organs like the bladder or vagina.
• Stage 4
  The cancer has metastasized to lymph nodes in the abdominal region or other organs of the body like the liver.At times, a different staging system known as the TNM staging system is employed in place of the number system specified above.
  • T
    Depicts the tumour size and if it has spread to the close by organs.
  • N
    Depicts if the cancer has metastasized to the lymph nodes.
  • M
    Depicts whether the cancer has metastasized to another body organ like the liver (secondary or metastatic cancer).

Though this system is more multifarious, it could offer more accurate data regarding the tumour staging.

In case the cancer relapses subsequent to original treatment, then it is called as recurrent cancer.

Grading

Grading refers to the microscopic appearance of the cancerous cells and provides insight about how rapidly the cancer could develop. Low-grade would mean that the cancer cells appear quite alike normal cells. They generally have a slow growth and are less prone to proliferating. Among high-grade tumours, the cells appear quite anomalous and have a likelihood of swifter growth and spread.