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Anal Adenocarcinoma - Causes, Symptoms, Diagnosis, and Treatment

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Anal adenocarcinoma is a malignant tumor of the anal canal. This is extremely rare clinically.

Written byDr. Glady Ann Thomas

Medically reviewed byDr. Abdul Aziz Khan

Published At August 9, 2023
Reviewed AtAugust 9, 2023

Introduction

Anal adenocarcinoma is a cancerous condition that is found in the anus. A long tube at the end of the rectum is called the anal canal, and the opening is called the anus. This is where stool leaves the body. It is a clinically rare condition. Adenocarcinoma of the anal canal constitutes only five percent of the neoplasms in the anorectal region and about two percent in the gastrointestinal region. A neoplasm is a mass of cells that grow and multiply when they should not or do not die when they should die.

What Is Anal Adenocarcinoma?

Anal adenocarcinoma is a rare malignancy that is found in the anus. Malignancy is a cancerous condition where the cells begin to proliferate unconditionally. Anal cancer occurs when the cells in the anal canal grow and multiply abnormally. Based on the type of cells lining the anal canal, it is divided into three; colorectal zone, anal transition zone, and squamous zone. The World Health Organization divides anal adenocarcinoma into three; those arising from the mucosa of the transitional zone, those arising from the anal glands or ducts, and those developing in a setting of chronic anorectal fistula. People suffering from anal adenocarcinoma usually have a high rate of pelvic failure (the pelvic floor diaphragm, urogenital diaphragm, and the pelvic organs fail to function), distant metastasis (spread to distant organs or lymph nodes), and lower survival rates than those having epidermoid carcinoma. Epidermoid carcinoma is a cancer that arises from the squamous cells, while adenocarcinoma is a cancer arising from glandular cells.

The treatment for anal adenocarcinoma includes surgery, chemotherapy, and radiation therapy.

What Are the Causes of Anal Adenocarcinoma?

The exact cause of anal adenocarcinoma is not fully known. Cancer occurs when a genetic mutation turns a normal cell into an abnormal cell or when cell division is uncontrolled. A genetic mutation is a change in the DNA (deoxyribonucleic acid) to produce something different. These cells that proliferate do not die, causing an abnormal mass. These are called tumors and can metastasize to different places.

What Are the Signs and Symptoms of Anal Adenocarcinoma?

The signs and symptoms of anal adenocarcinoma can include;

  • Bleeding from the anus or rectum, especially during bowel movements.

  • Pain in the anal area.

  • Growth in the area.

  • Itching in the area.

  • A change in the bowel movements (like the frequency, consistency, etc.).

  • Leaking stool.

  • Having a very frequent urge to use the toilet.

  • Abscess in the anal area.

  • Spotting.

  • Rectal prolapse - A condition where the rectum falls over the anus. This can cause stool incontinence or leaking of the stool.

  • Unexplained weight loss.

Who Are at Higher Risk of Anal Adenocarcinoma?

There are certain risk factors associated with the condition. They include;

  • Human Papilloma Infection (HPV): It is the most common sexually transmitted disease. Everyone who is infected with the virus may not show symptoms, though some show warts and other skin lesions.

  • Immunosuppressants: Medications that stop the immune system from destroying healthy cells.

  • Anal Sex: Men and women are at high risk for anal adenocarcinoma through anal sex. Multiple sex partners increase the risk of HPV, HIV (human immunodeficiency virus), and anal cancer.

  • Age: Anal cancers are usually seen in people over 55 years of age.

  • Smoking: Smoking increases the risk of anal cancer.

  • Weak Immune System: Conditions that can weaken the immune system like those who take steroids for an organ transplant.

  • Anal Fistula: An anal fistula is an infected opening from the anus to the skin.

How Is Anal Adenocarcinoma Diagnosed?

Early diagnosis of the condition can help to prevent complications. The diagnosis is made with the help of the signs and symptoms exhibited by the patient. This can be confirmed with a biopsy and histological studies. Inguinal lymphadenopathies should be examined as anal adenocarcinoma is aggressive in nature and may have local and distant metastasis. Inguinal lymphadenopathy is the swelling of lymph nodes of the groin or the lower extremities. Other diagnostic methods to find out distant and local metastasis can include

  • Endoanal ultrasound (used to check the anatomy of the anal canal).

  • Magnetic resonance imaging (MRI) of the pelvic area.

  • Computed tomography (CT).

How Is Anal Adenocarcinoma Treated?

There are very limited cases in the medical literature as a whole about anal adenocarcinoma. Hence, it is difficult to point out a standard therapeutic approach for the treatment of the condition.

Radical surgery (abdominoperineal amputation) was the most recommended mode of treatment until the 1990s. An abdominoperineal amputation is a surgery to remove the anus, the rectum, and a part of the colon. This is done with the help of an incision made in the abdomen. A multicenter study in a retrospective manner done in different European countries recommended combined chemoradiotherapy (CRT) as the best treatment for the condition. Radiation therapy was done as a part of the preservation or preventive therapy. The overall survival rate was higher in patients who received combined CRT than those who received radiation therapy alone or surgery alone. Patients who showed inguinal lymphadenopathies exhibited poor prognoses due to distant metastasis.

At present, more experts advise maximizing the local control of the condition, avoiding transanal resection (removing the rectal tumors and surrounding tissues, leaving the anus and sphincter intact), and reducing the risk of distant metastasis with the help of intense chemotherapy.

What Is the Differential Diagnosis for Anal Adenocarcinoma?

  • Adenocarcinoma of the lower rectum.

  • Hemorrhoids are called piles, swollen veins in the anus and rectum.

  • An anal fissure is a small tear in the lining tissue of the anus.

  • Anal warts are the presence of warts in and around the anus.

  • Fistula-in-ano is an infected tunnel between the anus and the skin.

Conclusion

An anal adenocarcinoma is a rare form of cancer. At times, it is difficult to distinguish between adenocarcinoma of the lower rectum with extensions to the anal canal. It is highly aggressive in nature. Hence, early diagnosis and treatment are very important for a better prognosis. Although there is no standard treatment for the condition, combined CRT is commonly accepted, followed by radical surgery and adjuvant therapy to prevent metastasis. Adjuvant therapy is a treatment given additionally (after the primary treatment of cancer) to prevent recurrence or metastasis.

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Frequently Asked Questions

Anal adenocarcinoma is not thought to be a common illness. When compared to other forms of anal cancer, like squamous cell carcinoma, it is comparatively rare. It is included in the group of uncommon cancers. Anal adenocarcinoma is not as frequent as certain other types of cancer, though the prevalence may vary.

The stage at which anal adenocarcinoma is detected, the cancer's extent, and the patient's general health all affect the prognosis for the condition. The prognosis can be improved with early discovery and the right treatment. Early diagnosis and therapy increases the likelihood of a successful course of treatment for anal adenocarcinoma before it has progressed too far. Radiation therapy, chemotherapy, and surgery are among the possible treatment choices.

Radiation therapy, chemotherapy, and surgery are commonly used in combination for the treatment of anal adenocarcinoma. The precise course of action is determined by the cancer's stage, the tumor's location, and the patient's general health. The tumor and surrounding tissues may be removed during surgery, and a colostomy may be necessary in certain situations. The healthcare team will consider several aspects, including the patient's history and current condition, to identify the best course for their unique treatment plan.

Strategies like HPV vaccination to lower the risk of persistent infection, safe sex practices to reduce HPV transmission, quitting smoking, getting screened frequently for individuals with a history of anal dysplasia, and adopting a healthy lifestyle with appropriate diet and exercise are all part of the prevention of anal adenocarcinoma. Although total prevention may not be possible, these steps can help lower the chance that anal adenocarcinoma will develop. People should speak with healthcare experts for individualized advice based on their unique risk factors.

Several factors increase one's chance of anal adenocarcinoma development. One important risk factor is ongoing infection with high-risk strains of the human papillomavirus (HPV), especially HPV 16 and 18. A history of anal dysplasia or other anal disorders, immunosuppression, and, to a lesser degree, smoking are other contributing factors. Knowing these risk factors can make identifying the people who might benefit from early screening and preventative treatments easier.

There may be certain genetic variables that contribute to an individual's vulnerability to anal adenocarcinoma, even if a major genetic component has not been conclusively proved. In certain instances, genetic polymorphisms or familial predispositions may be relevant; nevertheless, further investigation is required to precisely identify the genetic variables driving the development of anal adenocarcinoma.

Anal adenocarcinoma growth is heavily impacted by ongoing infection with high-risk strains of the human papillomavirus (HPV), specifically HPV 16 and 18. HPV causes alterations in the anal canal's lining cells that could eventually lead to cancer. The virus can interfere with the regular processes that regulate cell growth, which can lead to the formation of aberrant cells and raise the risk of anal adenocarcinoma. Safe sexual behavior and HPV vaccination are essential for lowering the risk of HPV infection and, consequently, the chance of developing anal adenocarcinoma.

Several techniques are used to determine the stage of anal adenocarcinoma, including imaging examinations like CT, MRI, and PET scans to gauge the degree of disease spread. The purpose of biopsies is to examine tissue samples and validate the diagnosis. Together with clinical investigations, the data from these tests aid in staging the malignancy from localized to advanced. For those with anal adenocarcinoma, staging is essential for predicting prognosis and choosing the best course of treatment.

There are several possible side effects from anal adenocarcinoma treatment options, such as radiation therapy, chemotherapy, and surgery. Fatigue, nausea, diarrhea, and skin changes are typical adverse effects. Surgical operations can have further effects on bowel function, particularly if a colostomy is performed. While chemotherapy can result in side effects like hair loss, exhaustion, and nausea, radiation therapy can irritate the skin and produce digestive difficulties. Healthcare providers collaborate closely with patients to manage and minimize side effects, which vary depending on the therapy type and individual variables.

Recurrence of anal adenocarcinoma is possible after treatment. Cancer recurrence is possible even when an initial course of treatment is effective. Consistent monitoring and follow-up consultations are essential for identifying recurrence symptoms early on, enabling timely intervention and modification of treatment plans if needed. The likelihood of a recurrence is contingent upon various factors, including the cancer stage, response to treatment, and personal traits. For this reason, ongoing medical monitoring is crucial following the completion of initial therapy.

For anal adenocarcinoma, there are no substitute medical treatments; nonetheless, some people may think about complementary therapies in addition to traditional care. These could be massage, acupuncture, or methods for managing symptoms and enhancing well-being. Before implementing alternative therapies, it is imperative to speak with medical specialists to ensure they won't compromise the efficacy of recommended treatments.

The length of treatment for anal adenocarcinoma varies according to the cancer stage, types of treatment used, and patient response to treatment. Chemotherapy, radiation therapy, and surgery may be used in conjunction during several weeks to months of treatment. A thorough treatment plan is customized to meet each patient's unique needs, taking into account aspects like overall health and illness severity to obtain the best results.

Having a colostomy is not always necessary after surgery for anal cancer. A colostomy may be required depending on the tumor's size, location, and degree of invasion. Normal bowel function may be preserved in certain situations by removing the malignant tissue without needing a colostomy. However, a colostomy, which diverts the intestine through a hole in the abdominal wall, may be advised to improve surgical outcomes and ensure normal healing in cases when the tumor is large or involves the anal sphincter.

Anal adenocarcinoma patients have access to a wealth of support resources. These include counseling services to address emotional well-being, instructional materials offered by healthcare organizations to improve understanding of the ailment and its treatment, and support groups where patients can interact with others going through similar struggles.

After receiving therapy for anal adenocarcinoma, a patient's capacity to return to their regular activities differs depending on their overall health, the sort of treatment they got, and their recovery. After therapy, some people can return to regular activities quickly, while others may need more time to heal and adjust. Patients must communicate regularly with their healthcare team to comprehend post-treatment suggestions and instructions.

It is critical to get medical help as soon as possible if symptoms suggest anal cancer. Accurate diagnosis requires contacting a healthcare professional for an evaluation, which may involve diagnostic tests and a physical examination. It is important to pay attention to symptoms like lumps in the anal region, bleeding, changes in bowel habits, and persistent anal pain. Individuals experiencing troubling symptoms should prioritize getting medical care to ensure quick evaluation and proper action. This is because early discovery of anal adenocarcinoma can dramatically impact treatment outcomes.

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Dr. Abdul Aziz Khan from iCliniq
Dr. Abdul Aziz Khan

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