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Anal canal cancer diagnosis

If you have symptoms of anal cancer, your doctor will examine you and ask you questions about your health, your lifestyle, including smoking and drinking habits, and your family history. Many cases of anal cancer have been linked to human papillomavirus (HPV) infection, so your doctor may ask if you have been exposed to HPV or received the HPV vaccine. These and other factors may increase your risk of colorectal and anal cancer. When you get screened for cancer, your doctor needs to know your risk factors.

Diagnosis of anal cancer

Your doctor will first perform one or more of the following tests to determine if you have anal cancer. These tests can include:

Digital rectal test: Your doctor will insert a gloved, lube finger into your anus and check for abnormalities.

Endoscopy: A short tube with a camera inserted into the anal canal and the lower part of the rectum. This allows the doctor to check the anus for any obvious abnormalities. In addition, the doctor may remove a small tissue sample (biopsy) from the anus for further examination.

Proctoscopy Hard sigmoidoscopy: A hollow tube, called a proctoscope, is inserted into your anal canal into your rectum. Proctoscopy tends to be longer than anoscopy. The proctoscope is fitted with a lamp and a camera that allows visual examination of the anus and rectum. Proctoscopy can also be used for anal tissue biopsy.

Colonoscopy: A long, flexible tube, called a colonoscope, is inserted into the rectum. A colonoscope is equipped with lights and cameras that allow the doctor to examine any part of your colon (large intestine). In addition, colonoscopy can be used for tissue biopsy.

Biopsy: If your doctor finds any abnormalities in your anus or rectum, he or she can remove a small tissue sample (biopsy) in the lab for further testing. Looking at the tissue under a microscope allows your doctor to determine if cancer cells are present. Often, devices used in the examination, such as a mirrorless, proctoscope, or colonoscope, can collect these tissue samples from your anus.

In some cases, an anal biopsy may find abnormal cells that are not cancer. This is called anal intraepithelial neoplasia, and it means that abnormal cells line your anus. Although these cells are not cancer cells, they may eventually develop into cancer and should therefore be monitored regularly.

Double contrast barium enema (DCBE): Barium is a chemical that causes the intestinal wall to show up on an X-ray. You will have an enema with a barium solution followed by an X-ray.

Intra-anal or rectal ultrasound (endoscopic ultrasound) : An endoscope is inserted into the anus. A probe at the end of the endoscope reflects high-energy sound waves (ultrasound) on the organ to form an image (sonogram). Doctors can use this image to look at abnormalities in the anus and rectum.

Virtual colonoscopy or CT (computed Tomography) colonoscopy: A virtual colonoscopy involves using a CT scanner to create 3D images of your abdominal organs. This allows the doctor to see your large intestine and rectum without having to insert a colonoscope.

You may have to be prepared in advance to take these tests. For example, your doctor may ask you to change your diet before the exam, or you may take laxatives or enemas before the exam. Talk to your doctor about what tests are best for you and how to prepare.

Determine if your cancer has spread

If you have been diagnosed with anal cancer, you may need to undergo additional tests to determine if your cancer has spread (metastasized). A metastatic tumor is a cancerous tumor that has spread from its original location to other parts of the body. In particular, anal cancer can spread to nearby lymph nodes, blood vessels, or through surrounding healthy tissue. Whether and how far the cancer has spread determines what treatment is right for you.

There are several different tests to determine if your cancer has spread:

Computed Tomography scans (also known as CAT scans) : CT scanners can produce detailed cross-sectional images of various parts of the body. The doctor will examine these images to see if the cancer has spread to the lymph nodes or other organs.

Mri scans: MRI uses powerful magnets and radio waves to create a detailed image of the body. Your doctor can look at this image to see if you have swollen lymph nodes, which may indicate that the cancer has spread.

Positron emission computed Tomography (Positron emission Tomography) scan: This test can help your doctor find cancerous tumor cells. During the exam, you'll be injected with a safe radioactive sugar. Malignant tumor cells grow quickly and require a lot of energy, so these cells take up more radioactive sugars. You will then undergo a PET scan, which will create a picture of the body where radioactive glucose is being used. Bright spots on the image indicate areas with high sugar uptake and can indicate the location of malignant tumors.

Machines used for PET scans can often also perform CT scans. A CT scan is more detailed. Doctors can compare the results of the two scans and get a clearer picture of what's going on in your body.

Chest X-ray: Your doctor may order a standard chest X-ray to look at the organs and bones in your chest. If the cancer has spread to the lungs, it can be seen on an X-ray.

Pelvic exam: Your doctor may perform a pelvic exam to see if cancer has spread to your vagina, cervix, uterus, or ovaries. Usually, the doctor will use a small metal tool he or she can also take a pap smear, which is a procedure used to detect cancer cells in the cervix and upper vagina.

Fine needle aspiration biopsy: A fine needle is inserted into the lymph node, the cells are removed and viewed with a microscope. A positive lymph node biopsy indicates that the cancer has spread to your lymph nodes. This helps the doctor decide which areas need radiotherapy.

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