The news that one of America’s TV icons is suffering from cancer brought sadness. Learning the type of cancer she had made some squirm.
Former “Charlie’s Angels” actress Farrah Fawcett, 62, was hospitalized this week. She received a diagnosis of anal cancer in 2006. This type of cancer is less common than rectal and colon cancer, and the location of the tumor and risk factors make people squeamish about discussing it openly, doctors said. Colon cancer at one time also was not openly talked about, because of the body part and functions affected, but with the public awareness campaigns and celebrities advocating for screenings, it has been largely destigmatized. Anal cancer is less familiar. Fawcett has not publicly confirmed the specifics of her illness, but is working on a documentary, titled “A Wing and a Prayer,” about her health battle. Anal cancer affects more women and the illness is usually found in people who are in their early 60’s. The American Cancer Society estimates that 5,000 new cases of anal cancer are diagnosed each year and about 680 people die from it annually. Meanwhile, colon and rectal cancer has 148,000 new cases and about 50,000 deaths each year.
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The numbers of anal cancer cases are rising, although experts haven’t been able to pinpoint why. Cultural squeamishness about certain body areas could prevent early diagnosis and treatment of anal cancer, said Dr. Petr F. Hausner, an associate professor of medicine at the University of Maryland Medical Center in Baltimore, Maryland. “Patients in the United States hate to be examined in these areas,” said Hausner, who trained in Czechoslovakia. “They like to keep their private parts more private than in Europe. In the U.S., the patients hate those exams and physicians hate to do them. The examination is incomplete.” The cultural discomfort might be a minor factor, though. “The bigger role is the virus,” he said referring to the human papilloma virus, a key risk factor for anal cancer that also can cause cervical cancer. Getting vaccinated against HPV is a step in prevention, Hausner said. More than half of anal cancer patients experience bleeding as a symptom. Others have no symptoms or report common conditions, such as hemorrhoids, fissures, or warts. Symptoms also include itching or pain in that area, changes in the diameter of stool, abnormal discharge, swollen lymph nodes in the anal or groin areas, according to the American Cancer Society. “The most common thing is people think it’s a hemorrhoid,” said Dr. Cathy Eng, associate professor in the department of gastrointestinal medical oncology at the University of Texas M.D. Anderson Cancer Center. Patients should consult with their physicians, she said. Anal pap smears are routine only for HIV-positive patients, who are at higher risk for this cancer. There are no anal cancer screening recommendations for non-HIV individuals, because it remains a rare disease, Hausner said. People whose immune system are suppressed, from HIV or drugs taken after organ transplants are at risk for anal cancer. Other risk factors include a sexual history with many partners, a medical history of human papilloma virus (HPV), sexually transmitted diseases or gynecological cancers. People tend to view anal cancer negatively, because they associate the cancer with a few of its risk factors — such as sexually transmitted diseases or anal sex.
MayoClinic.com: Anal cancer
“It’s one of the risk factors, not the only risk factor,” Eng said. “It’s fair to say people are stigmatized, she said, primarily because of the disease’s association with that type of sex. When anal cancer is caught early, chemotherapy and radiation are highly effective. But if the cancer doesn’t respond to treatment and spreads to other areas of the body, the five-year survival rate plummets to 20 percent, Eng said. “Anal cancer is unique,” she said. “The majority of time you can cure the patient, but if you have recurrent or residual disease, you could end up losing your sphincter.” The sphincter are muscles that holds in urine and feces. If the sphincter is removed, the patient must have a special bag, called an ostomy pouch, that collects the waste. Anal cancer is “much rarer than colon cancer,” Hausner said. “For 50 colon cancer patients, we see one anal cancer… It’s a rare disease. It is becoming a little bit more frequent. I would say that people are not aware.”