1. < Colorectal Cancer

Worried this might be anal cancer

Posted by blac @blac, Jan 13, 2024

Have been having this pain around the left side of my anus its very painful mostly at night and feels hard,
This pain as lasted for 3years now each day,
And more recently am noticing some kind of small growth in the left opening

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celia16 | @celia16 | Mar 21 1:41am
In reply to @rioa21 "I am happy to report that my scans were all good. I am considered to be..." + (show)
@rioa21

I am happy to report that my scans were all good. I am considered to be in remission! I won’t need a CT scan again until next year. It’s been a long three years.

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That’s great news! So happy for you.

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lana67 | @lana67 | Mar 22 8:49pm
In reply to @roywalton "See the following..... I believe proton therapy is preferred only when the cancer is very localized..." + (show)
@roywalton

See the following..... I believe proton therapy is preferred only when the cancer is very localized and difficult to target...

Proton therapy may be advised for anal cancer in specific situations where its unique properties can provide an advantage over traditional radiation therapy (like X-ray-based treatments such as IMRT). Proton therapy delivers radiation with high precision, targeting tumors while minimizing damage to surrounding healthy tissues due to its ability to deposit most of its energy at a specific depth (the Bragg peak) and then stop, reducing "exit dose" radiation.
For anal cancer, proton therapy might be considered in the following scenarios:
Preserving Nearby Organs: Anal cancer is typically treated with chemoradiation (chemotherapy combined with radiation). The anus, rectum, bladder, reproductive organs, and pelvic bones are close to the treatment area. Proton therapy can reduce radiation exposure to these structures, potentially lowering the risk of side effects like bowel or bladder dysfunction, sexual dysfunction, or pelvic bone damage.

Recurrent Disease: In cases where anal cancer recurs after prior radiation, proton therapy might be used to target the tumor while sparing previously irradiated tissues, reducing the risk of cumulative toxicity.

Complex Tumor Location: If the tumor is in a challenging location (e.g., near the sacral nerves or involving lymph nodes in the pelvis), proton therapy’s precision might help avoid nerve damage or other complications.

Reducing Long-Term Side Effects: For younger patients or those with a good prognosis (e.g., early-stage squamous cell carcinoma of the anus), proton therapy might be considered to minimize long-term risks like secondary cancers or chronic gastrointestinal issues.

Patient-Specific Factors: It may be recommended for patients with specific comorbidities (e.g., inflammatory bowel disease) where minimizing radiation to healthy tissue is critical, or in cases where standard radiation doses might exceed safe limits for nearby organs.

When It’s Typically Not Advised
Standard Cases: For most patients with anal cancer (especially early-stage disease), conventional radiation therapy (like intensity-modulated radiation therapy, IMRT) combined with chemotherapy (e.g., 5-FU and mitomycin-C) is highly effective, with cure rates exceeding 80% for localized disease. Proton therapy’s added cost and limited availability often make it unnecessary unless there’s a clear benefit.

Lack of Evidence: While proton therapy shows promise, large-scale clinical trials directly comparing it to IMRT for anal cancer are limited. It’s not yet a standard recommendation in guidelines like those from the National Comprehensive Cancer Network (NCCN) unless specific circumstances apply.

Expert Consensus
Doctors typically weigh factors like tumor stage (e.g., T1-T4), lymph node involvement, patient health, and prior treatments.

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Thank you for your opinion.

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lana67 | @lana67 | Mar 22 9:04pm
In reply to @katme "Samclembeau, Thank you for your post! Galleri blood test detected anal cancer markers and HPV16 in..." + (show)
@katme

Samclembeau, Thank you for your post! Galleri blood test detected anal cancer markers and HPV16 in early February 2025 (now confirmed via HMO biopsy). My Medicare HMO feels like my cancer is slow growing and is not urgent, so I’m awaiting surgery and testing for staging at end of march 2025. I’m in SF Bay Area and I’m amazed that there are 4 proton radiation centers in SoCal but not a single one in our tech heavy area. I’m planning 2nd opinion for post surgery treatment. I’m guessing that I will need to self pay to go outside of my Medicare HMO for proton treatment in SoCal. I would love to hear more about your experience, if you have time. I have lots of planning to do while waiting for surgery and staging because I am primary caretaker for my life partner who has lots of health problems, including severe dementia. I need to plan for his care too.

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I am a 67 year old woman
That is still in the staging and final testing phase. I did check in into the proton center in San Diego and they told me my insurance which is a Blue Cross and Medicare would cover it. I’m still trying to look at all my options as I have severe osteoporosis and urinary urgency so I’m so nervous about regular IMRT radiation and it’s long term effects.

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1 reply
roywalton | @roywalton | Mar 22 9:28pm

Intensity-Modulated Radiation Therapy (IMRT) is an advanced form of radiation treatment commonly used to target cancerous tumors with precision, minimizing damage to surrounding healthy tissues. It uses computer-controlled linear accelerators to deliver radiation in sculpted doses that conform to the shape of the tumor. While effective for many cancers (e.g., prostate, head and neck, breast, and brain tumors), IMRT’s long-term effects depend on factors like the treatment area, dosage, patient health, and duration of exposure. Below, I’ll outline the potential long-term effects based on available medical understanding.
General Long-Term Effects
Secondary Cancers: Radiation, even when precisely targeted, can damage DNA in healthy cells, potentially leading to secondary malignancies years or decades later. The risk is relatively low with IMRT due to its precision, but it’s not zero—estimated at 1-5% higher than no radiation, depending on the study and site treated.
Fibrosis: Over time, radiation can cause scarring or thickening of connective tissues (fibrosis) in the treated area. This might lead to stiffness, reduced mobility, or organ dysfunction (e.g., lung fibrosis after chest radiation).
Chronic Fatigue: Some patients report persistent tiredness long after treatment, though this is less specific to IMRT and more a general radiation therapy outcome.
Vascular Damage: Radiation can affect blood vessels, potentially leading to reduced blood flow or increased risk of cardiovascular issues, especially in areas like the chest or neck.
Site-Specific Long-Term Effects
Head and Neck: Dry mouth (xerostomia) from salivary gland damage, difficulty swallowing (dysphagia), dental issues, or thyroid dysfunction. Some patients experience hearing loss or jaw stiffness (trismus).
Prostate: Urinary incontinence, erectile dysfunction, or bowel issues like chronic diarrhea or rectal bleeding due to damage to nearby tissues.
Breast: Skin changes (thickening or discoloration), lymphedema (arm swelling), or rare heart complications if the left breast is treated.
Brain: Cognitive decline (e.g., memory or concentration problems), radiation necrosis (dead tissue in the brain), or hormonal imbalances if the pituitary gland is affected.
Factors Influencing Outcomes
Dosage and Fractionation: Higher doses or fewer fractions (hypofractionation) might increase late effects.
Age: Younger patients may face higher risks of secondary cancers due to longer life expectancy post-treatment.
Adjuvant Therapies: Combining IMRT with chemotherapy can amplify long-term effects on tissues or organs.
Mitigation and Monitoring
Modern IMRT techniques (e.g., image-guided IMRT or proton therapy variants) continue to evolve, reducing collateral damage compared to older radiation methods. Long-term effects are monitored through follow-ups, imaging, and symptom management (e.g., salivary stimulants for dry mouth or physical therapy for fibrosis). Patients are often advised to avoid smoking and maintain a healthy lifestyle to minimize risks.

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mariesylvie | @mariesylvie | 3 days ago

Hi, I have bleeding when emptying my bowls on the toilet paper (bright red) and some spots on Poo, also mucus on Poo, massive amounts of itching all the way around the anus, not always the same spots, I feel like there is a baseball stuck in my bowels, fowl smelling gas, no signs of any outer hemorrhoids or warts and I can never empty my bowels completely, more frequent use of washing. I have ibs-C so normally I only go to the bathroom every 4 or 5 days and now it is much more often. I have also had rectocele and cystocele repair. My doctor first said I had fissures and now healed but all symptoms remain, he then followed up with a digital exam and said he truly didn’t know what was going on. Sigmoidoscopy next week and I am afraid.
I have possible lupus signs (currently investigating, blood ANA test next week), fibromyalgia (another autoimmune disease).

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hopenjoy2024 | @hopenjoy2024 | 2 days ago

My prayers are with you. When was your last coloscopy?

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katme | @katme | 17 hours ago
In reply to @lana67 "I am a 67 year old woman That is still in the staging and final testing..." + (show)
@lana67

I am a 67 year old woman
That is still in the staging and final testing phase. I did check in into the proton center in San Diego and they told me my insurance which is a Blue Cross and Medicare would cover it. I’m still trying to look at all my options as I have severe osteoporosis and urinary urgency so I’m so nervous about regular IMRT radiation and it’s long term effects.

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I am 74yo and also waiting for staging. However, recent MRI results show metastasis to lymph nodes. I’m guessing stage will be 3b or 4. I am also concerned about effects of radiation with osteoporosis. Also 40% of our bone marrow is in pelvic area. Quality of life after radiation is important to me. I have an HMO and may have to self fund care outside my HMO at the SD Proton Center.

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