‘Here’s How I Knew I Had Anal Cancer’: One Patient’s Story With a Connection to HPV

Updated: Apr. 03, 2024

"Anal cancer is a completely different disease" from colon cancer, says one expert doctor—and in this case, it stemmed from a common infection. A woman with a stage 3 anal cancer diagnosis shares her story.

Conversations and awareness about cancer nowadays have reached an all-time high, yet some forms, including anal cancer, still don’t receive the attention they deserve. Often, anal cancer may be confused with the more familiar colorectal cancer, given its position at the very end of the digestive tract.

While discussing issues related to anything “down there” might feel awkward, it’s essential to understand what anal cancer is, including its risk factors and symptoms. After all, the anus plays a pivotal role in our body’s waste elimination process (better known as pooping), making it an area we cannot afford to ignore, with this condition projected to affect 10,540 Americans in 2024.

Van Morris, MD, an MD Anderson Cancer Center physician, said in a March 2024 article:  “Anal cancer is a completely different disease with a different biology [in regards to colorectal cancer]. It’s also treated differently.”

When anal cancer is localized and hasn’t spread, the standard treatment is the Nigro protocol, a chemoradiation regimen that has been around since the 1970s that merges the chemotherapy drugs 5-fluorouracil and mitomycin with radiation therapy.

According to Dr. Morris, anal cancers are typically squamous cell carcinomas arising from the skin’s inner layers and primarily attributed to HPV (human papillomavirus) infection. Over 150 HPV types exist (in fact, the age limit for the HPV vaccine has been increased to cover far more adults in recent years). In particular, HPV-16 is one strain significantly increasing anal cancer risk.

Though HPV is often transmitted through skin-to-skin contact, including sexual activities (vaginal, anal, or oral), not everyone with HPV will develop anal cancer—nor has everyone who develops anal cancer engaged in these specific activities. Further, you may already be familiar with HPV in connection to cervical cancer; in fact, women who have experienced cervical cancer face a higher risk of developing anal cancer.

Other risk factors for anal cancer to be aware of include:

  • Presence of anal warts

  • A history of cancer not only in the cervix, but in the vagina or vulva

  • HIV (human immunodeficiency infection) or conditions that weaken the immune system

  • Smoking

  • Sexual behaviors, such as having had numerous partners, which can heighten the risk of HIV and HPV infections; and engaging in receptive anal sex, which raises the risk for both men and women. It’s important to note, however, that anal cancer does not solely result from sexual behavior, and cases can occur without these risk factors

Recognizing the symptoms of anal cancer is critical

The symptoms of anal cancer can often resemble those of less serious conditions, such as hemorrhoids, making it challenging to diagnose early. Key symptoms of anal cancer include:

  • Rectal bleeding

  • Anal itching

  • A lump or mass at the anal opening

  • Pain or a feeling of fullness in the anal area

  • Abnormal discharge from the anus

If you experience any of these anal cancer symptoms, it’s essential to consult a healthcare provider for a thorough evaluation.

Beyond understanding the facts about anal cancer, it’s helpful to gain perspective from those who have personally navigated through it.

Ahead, you’ll learn about Becky A., a 48-year-old woman from Columbus, OH, who survived Stage 3 anal cancer with the Nigro protocol. Despite initially feeling uneasy about the location of her cancer, Becky embraced a positive outlook that she felt played a significant role in her healing process.

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Here’s how I knew I had anal cancer: One survivor’s story

By Becky A., as told to Dr. Patricia Varacallo, DO

I eat well, stay active, and always keep up with my yearly medical check-ups. So, when I began to notice some itching and bleeding “down there,” I initially didn’t give it much thought. Having dealt with hemorrhoids in the past, I assumed it was the same issue reoccurring.

During a routine appointment in January 2021, I brought it up with my primary care physician, who didn’t seem overly concerned. “It’s probably just hemorrhoids,” she suggested, advising me to try some over-the-counter remedies and warm baths, and to return if there was no improvement.

Following her advice, I tried to manage the symptoms…but three months later, there was no relief. On the contrary, the symptoms had intensified. The bleeding became more frequent, and I discovered a tender lump. That was the moment I realized something was seriously wrong.

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An anal cancer diagnosis

Reaching a point of frustration, I decided to proactively schedule a visit with a gastroenterologist: A decision I am immensely grateful for today. Upon examining me, he immediately expressed concern that what I presented with didn’t resemble a typical hemorrhoid. He conducted an anoscopy—a procedure where a scope is used to inspect the anus and lower rectum—and I could see his concern. He suggested a biopsy, a step I was more than ready to take.

One week after the biopsy, I received a call that quite literally changed my life: I had Stage 3A anal cancer related to HPV-16. I was floored. The CT scan I had gotten revealed that the cancer had spread to my groin’s lymph nodes.

Cancer? In that area? The very idea of anal cancer was completely new to me.

Looking back, I remembered a diagnosis of cervical dysplasia in my twenties, which is a change in cells on the cervix that my gynecologist had mentioned was linked to HPV. At the time, the full significance couldn’t have sunk in. Reflecting now, and knowing the link between HPV-16 and anal cancer, I can’t help but ponder whether the HPV vaccine could have averted this entire ordeal.

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Treatment after I knew I had anal cancer

I opted for treatment at a local center just outside Columbus, where I felt exceptionally at ease with my healthcare team. They assured me I was receiving the gold standard of care.

By the end of May 2021, I had a port installed to begin my treatment regimen, which included six weeks of radiation therapy paired with chemotherapy. The focus of the radiation was my pelvic area, requiring my presence at the clinic five days a week.

The aftermath was tough: I faced extreme tiredness, nausea, and incredibly painful skin irritation—imagine the worst possible sunburn in the most unimaginable of places. Adapting to these circumstances, I found myself wearing a diaper, but surprisingly, this experience brought a new attitude out of me. There’s a unique kind of humor that some sickness gives you the chance to develop, especially considering the rather awkward positions you find yourself in during radiation treatments.

My chemotherapy involved two medications, 5-fluorouracil (5FU) and mitomycin. Mitomycin was administered via injection on the first day, followed by a 5FU infusion lasting several days that continued even at home. During the fifth week of radiotherapy, I underwent another round of 5FU infusion.

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My advice for anyone going through a similar trial

After completing the six-week course of chemoradiation, I finally allowed myself some much-needed downtime, and the burns actually healed within a month. The anticipation for the results from my follow-up scans was overwhelming. Hearing my doctor announce the absence of any disease prompted tears of immense relief.

I’ve since undergone CT and MRI scans every six months, along with anoscopy and digital rectal exams every three months. Thankfully, all results have been clear thus far.

I also want to spread awareness of the connection between HPV and anal cancer, and the importance of getting the HPV vaccine—the vaccine works by triggering the body’s immune response to prevent future HPV infections. It’s recommended for preteens but can be administered to individuals up to 26 years old, with certain recommendations extending to age 45 under specific conditions.

To those reading this, I urge you not to overlook any suspicious symptoms. Additionally, discuss your eligibility for the HPV vaccine with your doctor. It could very well be a lifesaver.

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