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The Dangers of Anal Cancer

The Silent Killer in Men with HIV


Updated June 19, 2014

Rectal cancer symptoms can start out very subtly. Sometimes it begins as itching around the anus, much like the itching one gets with hemorrhoids. Later, it can become painful and/or bleed. Eventually the lesion may open, and result in malodorous drainage. This is the point when most people feel it is time to see a doctor. Unfortunately, by then, the anal cancer is quite advanced.

What Is Anal Cancer?

Simply put, cancer is an abnormal growth of cells. Anal cancer is abnormal cellular growth that occurs in the anus. A few facts about anal cancer:
  • In the general population, anal cancer is fairly rare; about one in 100,000 people.
  • In men who have sex with men (MSM), the incidence climbs to about 70-144 in 100,000.
  • MSM who are HIV positive are twice as likely to get anal cancer than MSM who are HIV negative.
  • Anal cancer can develop in the anal mucosa or in the epidermis-lined anal margin that merges with the skin.
  • The earlier it is diagnosed, the easier it is to treat.

10 Things Gay Men Should Discuss With Their Doctors

Risk Factors for Anal Cancer

There is a close association between infection with human papillomavirus (HPV) (genital warts) and anal cancer. (This is the same virus associated with cervical cancer.) Other risk factors include smoking, number of sexual partners, receptive anal sex, history of hemorrhoids, anal fissures or fistulas and HIV.

The Signs and Symptoms of Anal Cancer

One of the things that makes anal cancer so dangerous is that many people who have it show few or no symptoms prior to diagnosis. If there are symptoms they can include:
  • warts on the anus or genitals
  • "sores" or "bumps" around the anus or in the anal canal
  • itching in and around the anus
  • discharge or bleeding from the anus
  • pain or pressure around the anus
  • painful areas around the anus in the absence of visible bumps or lesions
  • open sores around the anus that don't heal
  • a history of HPV infection

Diagnosing Anal Cancer

Many experts and guidelines now recommend screening for anal cancer in people at high risk, which includes HIV-infected men. Recommended diagnostic techniques include a yearly visual and digital exam, and a yearly anal Pap smear, which consists of taking a sample of cells from around the anus and looking at them under a microscope to identify cellular changes consistent with anal cancer. Abnormal Pap smears should be followed by further evaluation with high-resolution anoscopy or biopsy.


The optimal treatment for anal cancer depends on the cell type and how advanced the cancer is at diagnosis. After an evaluation to determine how advanced the cancer is -- and whether the cancer has spread -- a treatment plan will be determined. In the case of a squamous cell carcinoma, usually chemotherapy and radiation are the first line of treatment. In cancer that is of the adenocarcinoma type, the treatment is more similar to rectal cancer and often includes surgery.


As mentioned earlier, a high percentage of anal cancer cases are in people with HPV. Therefore it would follow that to decrease the risk of anal cancer you must decrease your exposure to HPV. This is done by using condoms with each and every sexual encounter. In addition, anyone with a history of benign lesions should have these lesions followed closely. Finally, many experts recommend regular anal Paps for HIV-infected men who have sex with men. The anal Pap can detect early cell changes that are associated with anal cancer, allowing for early intervention and reducing the risk of progressing to anal cancer.

Key Points of Prevention!

  • Condom use to decrease exposure to HPV
  • Regular biopsy of lesions every 6 to 12 months
  • Annual anal Pap smears for people at high risk

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