Experts Explain the Symptoms and Treatments of Anal Cancer
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Reviewed By Louise Chang, MD
April 6, 2008 -- Former "Charlie's Angel" Farrah Fawcett remained hospitalized in Los Angeles Monday, the latest setback in her three-year fight against anal cancer.
In an interview with WebMD, her doctor denied media reports that the 62-year-old actress was unconscious and in critical condition.
"She is not unconscious and has never been unconscious," says Los Angeles cancer specialist Lawrence Piro, MD. "She is doing quite well and if things continue as we hope, we expect to release her later in the week."
Piro says the actress's hospitalization was due to a blood clot that formed following cancer treatment she received in Germany.
In an interview Monday with the Associated Press, Craig Nevius, a producer who has worked with Fawcett, said the actress's cancer has spread to her liver.
Piro would not confirm this and he would not reveal the specifics of the treatment the actress had in Germany.
But he did say that Fawcett's latest treatment did not involve experimental stem cell therapy or shark cartilage, as has been reported.
Fawcett has not revealed details of her cancer or her treatment.
WebMD spoke to the American Cancer Association's Debbie Saslow, PhD, on Monday about anal cancer.
What Is Anal Cancer?
Anal cancer is a rare malignancy that starts in the anus -- the opening at the end of the rectum.
The American Cancer Society estimates that just 5,070 new cases of anal cancer occurred last year in the U.S. and just 680 people in the U.S died from the disease.
By way of contrast, more than 40,700 new cases of rectal cancer were projected.
About half of all anal cancers are diagnosed before the malignancy has spread beyond the primary site, while about a third are diagnosed after the cancer has spread to the lymph nodes only and 10% are diagnosed after the cancer has spread to distant organs.
When it is found early, anal cancer is highly treatable.
According to the American Cancer Society, the overall five-year survival rate following diagnosis of anal cancer is 60% for men and 71% for women.
When the cancer is diagnosed in its earliest stage, five-year survival is 82%. If it has spread to surrounding lymph nodes, five-year survival drops to 60%. And when it has spread to distant organs, about one in five patients lives for five years or more.
Saslow says if the reports that Fawcett's cancer has spread to her liver are true, the actress would have stage IV cancer, which has a five-year survival rate of 19%.
Who Gets Anal Cancer?
Most anal cancers are diagnosed in people who are between 50 and 80. Before age 50, anal cancer is more common in men, but after age 50 it is slightly more common in women, Saslow says.
Anal infection with human papillomavirus (HPV) is a major risk factor for the cancer.
According to the American Cancer Society, 85% of anal cancers are associated with persistent infection with the sexually transmitted virus.
Although an HPV vaccine is now in use for the prevention of cervical cancer, it is not being given to prevent anal cancer.
"We have some promising data suggesting that the vaccine can prevent anal cancers, but this hasn't been proven," Saslow says.
According to both the American Cancer Society and National Cancer Institute, other risk factors for anal cancer include being over 50 years old, having many sexual partners, having receptive anal intercourse, having a weakened immune system, frequent anal redness and soreness, and being a smoker.
Some tumors that develop in the anus are noncancerous. Others start off as benign but develop into cancer over time.
What Are the Symptoms of Anal Cancer?
In some cases, there are no symptoms associated with anal cancer, but in about half of patients bleeding occurs and is often the first sign of the disease, according to the American Cancer Society.
"Any time people have symptoms, they need to get it checked out even if they think they know what it is," Saslow says. "Anal cancer is rare, so it is not on many people's radar screens."
Other signs and symptoms of anal cancer can include:
- Pain or pressure in the anal area
- Unusual discharges from the anus
- Lump near the anus
- Change in bowel habits
How Is Anal Cancer Diagnosed?
Anal cancer can be detected during a routine digital rectal exam or during a minor procedure, such as removal of what is believed to be a hemorrhoid.
The cancer may also be found with more invasive procedures such as an anoscopy, proctoscopy, or endorectal ultrasound.
If cancer is suspected, a biopsy will be done and will be examined by a pathologist.
How Is Anal Cancer Treated?
Standard treatments for anal cancer include surgery, chemotherapy, and radiation.
According to the American Cancer Society, treatment usually involves two or more of these treatment strategies.
Nevius told the Associated Press that Fawcett was originally treated with chemotherapy and radiation, but not surgery.
Chemotherapy and radiation therapy is currently the most widely used approach to initial treatment.
He added that the actress's doctors considered her cancer in remission early in 2007, but within three months of declaring her free of cancer, testing revealed that the cancer had metastasized to her liver.
Nevius declined to provide details about the treatment that the actress had in Germany.
SOURCES: American Cancer Society web site: "Detailed Guide: Anal Cancer," "What is Anal Cancer." Debbie Saslow, PhD, director of breast and gynecological cancer, American Cancer Society, Atlanta. Associated Press. Lawrence Piro, MD, oncologist, Los Angeles. National Cancer Institute: "Anal Cancer Treatment."
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