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. This is not to be confused with a colonoscopy which is often suggested and is basically useless when it comes to examining the anal canal. The purpose of a colonoscopy is to examine the rectum and large intestine not the anal canal.
Similar to a colposcopy done for women, various solutions are applied to the area and the doctor will look for changes in the tissue referred to as acetowhitening -- a condition in which the affected tissue will actually turn white. This is a clear indication that further investigation and removal of this abnormal area is necessary along with biopsy.
Unfortunately there is no standardized screening program for anal cancer. However, Dr. Joel Palefsky of the University of California San Francisco and incoming President of the International Papillomavirus Society does extensive research regarding anal cancer and HPV.
Dr. Palefsky recently met with the NIH (National Institute of Health) in September, with a proposal for the development of just such a screening program and has already received $50,000 in private grant funding to begin this study. It is time that the NIH recognizes the need for such a program and agrees to fund the remainder of this program.
While the American Society for Colon and Rectal Surgeons refers to anal Paps and anoscopy on their website under patient information for anal cancer, there is obviously a severe disconnect when it comes to informing their members that they indeed should be prepared and knowledgeable in the performance of these procedures.
In the meantime, I continue to be subjected to the financial burden of flying to New York to receive care which could be provided in the state in which I live. If only the colorectal surgeons and the societies who represent them would do a better job of educating and recommending such protocols be put in place in all such offices, there is no doubt that many more anal cancer patients would receive earlier diagnoses and treatment and potentially save many more lives in the process.
"110 Anal Cancer Blogs." Online Community of Cancer Survivors. N.p., n.d. Web. 28 Dec. 2011.
"Anal Cancer Can be Misdiagnosed as Hemorrhoids | Noorali Bharwani Professional Corporation." Noorali Bharwani Professional Corporation. N.p., n.d. Web. 28 Dec. 2011.
"ASCRS: Anal Cancer." ASCRS: American Society of Colon and Rectal Surgeons. N.p., n.d. Web. 28 Dec. 2011. http://www.fascrs.org/patients/conditions/anal_cancer
Reviewed December 28, 2011
by Michele Blacksberg RN
Edited by Jody Smith