It’s long past time for the specialty of colorectal surgeons and even gastroenterologists to come up to current standards when it comes to dealing with anal cancer.
Bleeding hemorrhoids is more often than not the simple and initial diagnosis given to patients who ultimately will have anal cancer. A prescription is usually provided for a steroid cream to reduce not only the inflammation but accompanying itching as well.
This is the wrong approach to be taking with any patient until it is clear that HPV or anal cancer has been ruled out. The application of a steroid only reduces the immune response and can potentiate the progression of HPV. This can lead to the progression of precancerous lesions and existing precancerous lesions to invasive cancer.
This scenario is far from unusual. “Blog for a Cure” is a website which contains a subsection specifically for anal cancer patients. The story described above has been reiterated on this site far too many times to be considered acceptable and the fact is, the longer it takes for a correct diagnosis, the more in jeopardy the patient is of losing their life to metastatic disease.
Anal cancer, if caught early, is treated with radiation and chemotherapy and has a very high cure rate. Obviously this only decreases if a correct diagnosis is prolonged.
Every colorectal surgeon who encounters a patient with bleeding hemorrhoids should perform an HPV test to rule out the possibility of HPV and potential anal cancer. This is not much different from the cervical Pap tests which women receive and certainly is not a drain on the office to obtain the required supplies necessary to perform the test.
A positive test can alert the physician that this patient needs close follow-up and can allow for early diagnosis should any precancerous lesions develop. As a two-time survivor of anal cancer now living in Florida, I find it quite frustrating that I must fly to New York to a colorectal surgeon who is not only familiar with the anal Pap test but also with high resolution anoscopy or HRA.
HRA is a simple in-office procedure which examines the anal canal.