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Michelle King Robson and Dr. John Garvie talk about the symptoms associated with anal cancer.
Michelle King Robson:
What are the symptoms of this? Is that my colon cancer or rectal cancer, where you don’t really have the symptoms until it’s in later stage?
Dr. John Garvie:
Usually the symptom of anal cancer produces some symptoms that brings the patient to a physician and I would not call those presentations necessarily silent because there are pain fibers in the skin tissue. So something that cause some irregularity or swelling could produce some sense of symptom for the patient and bring the patient in for evaluation, whereas again, the rectal cancer patient, typically the rectal polyp patient, has no symptoms as we were talking about earlier.
So typically those patients may come in with pain with defecation or they noticed some irritation, they may have felt something around the anal area and that would usually bring them in to the doctor’s office for an initial evaluation, and I might say that in the experience that I have had personally with anal cancers, they are often misdiagnosed.
Michelle King Robson:
I was going to say, is there misdiagnosis associated with it?
Dr. John Garvie:
Yes, I think it’s an area that’s right for misdiagnosis. Primary care doctors may not be that familiar with the anal or anorectal anatomy and often times these patients are mistaken to have very common, benign problems like a hemorrhoid or fissure and the diagnosis maybe delayed for that reason.
Michelle King Robson:
Which is not good.
Dr. John Garvie:
It’s not good. We are back to the same issue of early diagnosis translates to good outcomes. I want you to know that the treatment of anal cancer is radically different from the treatment of rectal cancer.
Michelle King Robson:
I was going to ask you that.
Dr. John Garvie:
Yes, the treatment of anal cancer by and large, at least for early stage patients, is chemotherapy and radiation therapy, it’s not surgical therapy.
Michelle King Robson:
Really?
Dr. John Garvie:
Quite surprising.
Michelle King Robson:
Yeah, that is surprising because you would think that you want to remove that and then do the course of treatment with chemo and radiation.
Dr. John Garvie:
And you are exactly right. This historically, that was the way it was treated. Anal cancer was treated as advanced rectal cancer and surgery to remove the lesion was what was performed. As you can imagine, surgery to remove an anal or low rectal cancer involves removing the rectal sphincter and those patients would have a colostomy.
Michelle King Robson:
Right.
Dr. John Garvie:
So it became extremely important when it was discovered that these cancers responded and outcomes were much better with chemo radiation rather than with primary surgery. So surgery for anal cancers is reserved for very advanced stage patients or patients that fail to have responses to chemo and radiation.
Michelle King Robson:
That’s interesting that the approach is so different but I would imagine that nobody would want to have a bag if they didn’t have to, I mean that’s something that’s with you the rest of your life.
Dr. John Garvie:
Yes, that’s, it’s a major consideration when we talk to patients about the management of their anal or low rectal cancers, the issue of colostomy or no colostomy.
Watch Michelle's Story About Her Colonoscopy Experience
https://www.empowher.com/community/herstory/video-herstory-michelle-shares-her-colonoscopy-journey