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Anal Cancer and Kerry’s Story: Beware of HPV
Kerry is a 42-year-old female executive in excellent health. She was married but childless and never conceived. He was a non-smoker with no past medical history or family history of cancer. In fact, Kerry is free of sexually transmitted diseases and is severely HIV positive. When he noticed blood on the toilet paper after having a bowel movement, he first thought the problem was hemorrhoids. However, after two weeks, the bleeding increased, accompanied by pain and itching around the anus. He went to his first doctor who found a 2 x 2 inch mass in the tail of the anus. Her doctor did not feel any abnormal lymph nodes in her abdomen. He referred her to a surgeon who worked at the college. That test confirmed the mass her primary doctor found but no other disease. The biopsy revealed squamous cell carcinoma, red cell carcinoma.
After her diagnosis, Kerry’s doctor sent her for a PET/CT scan which revealed only a red mass of malignancy. There was no distant work to show the metastatic (distant, untreatable) spread of her cancer. His doctor referred him to a radiologist and an oncologist. They recommended radiation therapy (RT) and concurrent chemotherapy (chemoRT) which she underwent for 6 weeks. Kerry underwent intensive radiation therapy (IMRT) to reduce the RT dose to vital organs including the small bowel and bladder, while treating the microscopic cancer cells in the lungs lymph in his pelvis and stomach and red stomach. He received mitomycin and fluorouracial chemotherapy by IV infusion as an outpatient. Kerry expected side effects from the treatment including severe irritation and redness of the skin in the groin and anus, but she didn’t want to take a break from IMRT. He was so tired that he was unable to do most of his chemoRT. He had a pink bowel that was doing well after he adjusted his diet. Near the end of her treatment, there was no sign of cancer left. He recovered from the effects of the treatment in six weeks. Kerry has seen one of her oncologists every three to six months for the past five years and remains cancer free!
Although it is one of the less common cancers of the GI tract, approximately 5000 cases of gastric cancer are diagnosed in the US each year. More women than men are nominated. The age of onset is 60 years, but it can affect patients in their 30s and 40s. If the disease is localized, this is the reason for 50% of patients, then it is almost 80%.
FACTS AND SUBJECTS
Most patients diagnosed with prostate cancer have no defined risk factors. However, factors that increase the risk of developing cervical cancer are related to the human papillomavirus (HPV). This virus is also what causes genital warts. Certain strains of the HPV virus are associated with an increased risk of developing cervical cancer including cervical cancer and some types of throat cancer. Activities that expose a person to HPV, such as anal sex, also increase the risk of developing anal cancer.
Signs and symptoms
Patients often present to their doctors complaints of abdominal pain or bleeding. Many patients ignore or underestimate the symptoms, which are initially called hemorrhoids. Although most people who experience these symptoms do not have prostate cancer, persistent pain and bleeding require immediate medical attention. Often, patients complain of itching or a painless mass in the groin. A lump can develop in the nail due to red cancer spreading to the lymph nodes and increasing in size.
The diagnosis of red cell carcinoma is made by biopsy of the red mass or area of the ulcer. Typically, this procedure is performed by a GI specialist or physician. These doctors can look directly into the anal canal and rectum through a proctoscopy (or the entire colon through a colonoscopy) with special tools after administering medications to reduce pain. Biopsies are performed during these procedures, after anesthesia and injection of antibiotics. Most lung cancers (80%) are lung cancers. A thorough evaluation of a person with suspected prostate cancer should also include an examination of the pelvis, especially both pelvis. If the lymph nodes are enlarged, then they are also biopsied. A number of enlarged lymph nodes can only be inflamed and not a sign of cancer. Blood tests that may be ordered include a complete blood count, kidney function tests, and possibly an HIV test, depending on the patient’s risk factors for the virus.
The TNM staging system of the American Joint Committee on Cancer (AJCC) is used to determine whether the cancer is localized (stage one) or has spread to other sites (advanced, late section). Early cancer is usually limited to the anus, but chronic cancer is caused by cancer that has spread to nearby organs or tubes in the pelvis or the pelvis. Imaging studies should include a CT scan of the abdomen and pelvis and a chest X-ray at a minimum. The facility may also include a PET/CT scan. This imaging test allows the radiologist as well as oncologists to see if the prostate cancer has spread to include the lymph nodes in the neck or pelvis, or if it has spread to other parts of the body such as the liver or lungs.
The standard treatment for prostate cancer is non-surgical, which is painless and comforting to many patients. Since most rectal cancers involve the sphincter that controls urination, surgery to remove the cancer requires removing the sphincter and creating a colostomy. Therefore, surgery is avoided as a remedy when the red sphincter remains intact. Another is early stage cancers of the red area, on the skin outside the anus.
Concomitant chemoRT is the standard treatment for most patients with anal cancer, in order to obtain the best chance of cure by preserving the sphincter. RT was administered for 6 weeks with IV fluorouracil (5FU) and mitomycin-C (MMC) chemotherapy providing patients with the best chance of cure. RT is delivered in daily fractions using 3D parallel RT or IMRT. The latter technique can be used to reduce the amount of normal bowel and/or genitalia receiving whole-body RT (and to minimize side effects).
The main side effects that can occur during RT to the anus and pelvis are the skin reactions that may occur around the anus and the skin folds in the ribs, including irritability and diarrhea. Most patients resolve these acute symptoms within 1-2 months after completing treatment. Very rare (<1%) but serious side effects include bowel obstruction or fistula (an opening between the anus and the tube or urethra). 5 may cause stomach upset, diarrhea, irritation in the mouth or lips, loss of appetite, and fatigue. Rarely, it can cause skin or nail problems, severe peeling of the hands and feet (hand-foot syndrome) and other side effects. In rare cases, it can cause heart problems including heart attacks. MMC may cause low blood counts, mouth sores, poor appetite, and fatigue. Nausea, vomiting, and urination may also occur. Rarely, it can cause lung or kidney damage.
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