Anal Pap Smear

Anal Pap Smear

What is an Anal Pap smear?

You may have heard the term Pap smear used before but not in connection with the anus or men for that matter. An Anal Pap Smear is a screening test that takes a cell sample from the anal canal to determine whether you have anal cancer or are at risk of getting it. 

Located at the top end of the rectum and past the anal sphincter to outside the body, the anal canal is made up of cells that can be infected by the human papillomavirus (HPV), which can cause anal cancer the same way it the virus causes cervical cancer in women.

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What is Anal Cancer?

Anal cancer is an abnormal growth of cells around or inside the anal opening. Anal cancer affects both men and women and is most common in people aged 55-64. It is a relatively rare cancer that accounts for about 1-2% of cancers of the intestines and affects about 1 in 500 people, but due to the rise of HPV and HIV, the number of anal cancer cases has also been steadily increasing. 

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The most common risk factor for anal cancer is HPV, a sexually transmitted virus that can cause warts in and around the anus and genitals. Do note that anal cancer can occur without the presence of warts as well. 

Only a small number of anal cancer cases spread, but when they do, they commonly spread to the liver and lungs and can be difficult to treat. Hence, early diagnosis and treatment is imperative. 

What are the symptoms of anal cancer?

Early-stage anal cancer usually has no noticeable symptoms. However, later stages are usually accompanied by the following:

• Pain, itching, and general discomfort around the anus.
• Mucus or blood in your stool (evidence is often seen on the toilet paper)
• Fecal Incontinence
• Anal ulcers
• A lump near the edge of the anus
• A sensation of fullness or pain in the rectum

Who is at risk of anal cancer?

Besides being infected with HPV, other risk factors of anal cancer include: 

• Being above 55 years old 
• Anal sex 
• Multiple sex partners
• Sexually transmitted diseases 
• Smoking 
• History of HPV-related cancers, such as cervical cancer 
• Weakened immune system from HIV or chemotherapy
• Chronic inflamed areas around the anal area, such as anal fistulas or open wounds in the anal area 
• History of pelvic radiation therapy for prostate, bladder, rectal or cervical cancer

How is an Anal Pap Smear done?

An anal pap smear is a simple procedure. Your doctor will insert a swab into your rectum to collect a cell sample. You may feel a bit uncomfortable, but it is not a painful process and should be done quickly.

What should I do to prepare for an Anal Pap Smear?

You don’t need to do anything before an anal pap smear. However, we recommend that you do not use any creams or cells before the test, since this may compromise the cell sample.

If a confirmed diagnosis is made, your doctor will order for an anal ultrasound or imaging tests like an MRI to determine the extent of cancer. 

Who should get an Anal Pap Smear?

If you fall into any of the categories below, you may want to consider having an anal pap smear.

• HIV positive individuals
• HPV positive individuals
• Individuals who engage in anal intercourse
• Cigarette smokin
• Individuals who are infected with Hepatitis B

* There have been studies to support that the administering of antiretroviral therapy in HIV positive individuals help with reducing the risk of anal cancer.

What is HPV?

HPV stands for Human Papillomavirus. While there are more than 100 types of HPV, we are more concerned with HPV causing genital warts and High-risk HPV.

Cervical cancer, penile cancer, and anal cancer are all cancers caused by High-risk HPV. As such, it is a real concern.

Genital warts are a sexually transmitted disease that is highly contagious and affects both men and women.

How is anal cancer treated?

There are three types of treatment of anal cancer; 

1. Surgery to remove the cancer 
2. Radiation therapy to kill cancer cells 
3. Chemotherapy to kill cancer cells 

In most cases, a combination of radiation and chemotherapy is the standard to treat anal cancer. Surgery is usually only put in place for very small or early stage tumours (no further treatment required after) or if the cancer is advanced. 

Fortunately, most cases of anal cancer are detected early as they are in a location your physician can easily see or touch. If you fall in any of the risk categories, consider including an anal pap smear as part of your annual health screening.