Being mindful about any changes in your body includes attention to your anus, rectum, colon, and bowel functions—uncomfortable but important topics to discuss with your health care provider. Early detection of anal dysplasia—a precancerous change to the cells of the anus—may prevent the transformation of normal cells to cancerous cells.
Acknowledge Annoying Symptoms
Bartley Pickron, MD, professor of surgery at Ï㽶ÊÓƵ of Utah Health and a specialist in colon and rectal surgery, notes that most of his patients with anal cancer have not had a prior diagnosis of dysplasia or may have neglected their symptoms for some time. He has observed the following conditions in patients he has treated:
- Discomfort or pressure in the anus
- A lump-like sensation in the anus
- Anal bleeding
- Itchiness of the anus
- Pus or mucus discharge from the anus
Even though these are common symptoms of anal dysplasia, they may not be apparent until the condition has advanced into anal cancer. The presence of pain may indicate that the lesion has advanced to cancer.
"The most common signs and symptoms we see are related to the presence of an anal mass that appears like warts and can be associated with itching or bleeding but may not be painful," Pickron says.
Schedule Diagnostic Tests
There are several ways to diagnose anal dysplasia with a biopsy. "For a patient who presents with a concerning mass, a biopsy may be taken either during a clinic visit or as part of a procedure in the operating room," Pickron says.
For patients at high risk, an anal Pap test is an option. For this procedure, a swab is used to collect cells from the anus. These cells are examined under a microscope to determine if they are abnormal.
Evaluate Risk Factors
Because symptoms of anal dysplasia may be difficult to notice, patients should review the following risk factors:
- Being HIV positive
- Engaging in unprotected anal sex
- Being exposed to or contracting HPV (human papillomavirus)
- Having an infection of the genitals or anus, including anal warts or a sexually transmitted disease
- Getting results indicating HPV from a Pap test
- Taking immunosuppressant drugs
- Smoking tobacco products
- Using intravenous drugs
- Having multiple sexual partners
If you are worried about any of these risk factors, talk to your health care provider about regular screenings that can result in an early diagnosis before anal dysplasia progresses to cancer.
The most common misinformation about anal dysplasia is that you must have anal sex to get it. "This statement is simply not true," Pickron says. "While HPV can be transmitted through anal sexual contact, any sexual contact can result in HPV transmission which is a leading cause of anal dysplasia."
Realize Treatment Benefits
Anal dysplasia is treated with either destruction or excision of the lesions performed in a clinic under local anesthesia or an operating room under full anesthesia, depending on the extent of the dysplasia. For patients with larger lesions, it can be challenging to eradicate the full extent of dysplasia in one procedure, so several procedures may be needed.
Recovery can be painful for the first few days, depending on the size of the dysplasia and how much is removed. However, recuperation is usually quick as these lesions are typically superficial. The degree of pain can also vary depending on the location of the lesions. Those on the outside of the anus tend to be more painful to treat than those on the inside due to a greater number of pain nerves outside of the anus. Bloody, mucus drainage is common for about a week.
There is also a high risk of recurrence of dysplasia following treatment. "Continued surveillance is important, which may mean follow-up visits every three to 12 months," Pickron says.
Most patients whom Pickron sees with anal dysplasia are treated easily, come in for surveillance about once a year, and do just fine. "It is exceedingly rare for anal dysplasia to progress to cancer if it is treated and patients participate in a surveillance program," he says.
Practice Preventive Measures
The HPV vaccine is very effective when used prophylactically to prevent infection and subsequent dysplasia. Other preventive measures include using a condom during sexual activity, continuing with treatment if you are HIV-positive, quitting smoking, and getting regular anal Pap smears and exams.
Once you know your risk for anal dysplasia, you can try to prevent its occurrence. Or, if you already have symptoms, you can slow its progression from low-risk changes to anal cancer through diagnosis, treatment, and follow-up care.