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Colorectal Surgeons Border on Negligence in Cases of Anal Cancer: Editorial

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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

Add a Comment4 Comments

What are the implications of your article for anal cancer followup?
Second, I regret that your sources did not provide a link to the Blog for a Cure site, where many anal cancer patients, including me, exchange information on diagnosis and treatment. It's simply that, Blog for a Cure DOT com. I hope anyone who is concerned about anal cancer would join us!

January 2, 2012 - 9:57am
(reply to Catamarca)

I'm not sure I understand your question.

As for my site in particular, the partners/trusted sources page is currently being revised and partnership with Blog for a Cure is already in place and will be included in the revised page.

January 2, 2012 - 12:10pm

There are docs scattered here and there but they are not easy to find and ALL colorectal surgeons should have this information and be prepared to treat AIN when it occurs. At present, there is no protocol in this regard however if you utilize the cervical protocol as a model, then AIN1 would be watched and further HPV test/anoscopy done at 12 months up to 24 months. However AIN2/3 needs to be treated typically with the use of laser and even a first year colorectal surgeon out of med school should know this. CIS is even worse and many equate it to AIN3 and will progress to invasive cancer if untreated. To have your doctor tell you he/she doesn't know how to treat something this early is one of the most ridiculous things I've ever heard and the reason why screening is done. And, if he doesn't know how to approach it then he needs to get off his duff and contact the experts who do such as Dr. Palefsky or Dr. Goldstone!

January 2, 2012 - 9:53am
EmpowHER Guest

Great point. How would you respond to my colo-rectal surgeon, who points out that we don't know what to do when we find something that early? What exactly can be done if AIN is found? Burn it off, cut it out? Does Palefsky specify a protocol of what to do when abnormal cells are found? I need ammo to argue my case. By the way, there are docs doing these tests in Georgia.

December 29, 2011 - 9:38am
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