Tests for anal cancer

If you think you might have anal cancer, you usually begin by seeing your GP. Your doctor will examine you, and ask about your general health. They will also ask about any symptoms you are having, when you get them and what makes them better or worse.

Your doctor will feel your abdomen and may do a rectal examination. This is when the doctor puts a gloved finger into your back passage to see if he can feel anything wrong.

After examining you, your doctor may refer you to hospital for tests and X-rays, or to see a specialist. This is usually a surgeon, who specialises in treating the bowel (a colorectal surgeon).

The specialist at the hospital is likely to

• Ask you about your medical history and any symptoms that you have
• Examine you again, including checking your back passage (rectum) and anus
• Feel the lymph glands in your groin to see if they are larger than normal

The specialist will feel your groin because enlarged lymph nodes can be a sign of cancer that has spread. But they can also simply be a sign of infection.

After examining you, your specialist will arrange for any tests that you need. These tests may include

• Blood tests
• A more detailed examination of your back passage
• Fine needle aspiration of your lymph nodes

You will have a full blood count, which includes a check for low red cells (anaemia). You are also likely to have blood tests to check that your liver and kidneys are working normally.

If your doctor has felt an abnormal growth during the first rectal examination, you will need to have further tests. You may have these during your clinic appointment or your specialist will arrange them for a later date. Before you have any of these tests your bowel has to be empty, so you may need an enema. The tests you could have are

• Looking inside the bowel (proctoscopy or sigmoidoscopy)
• Examination under anaesthetic (EUA)

Looking inside the bowel

A proctoscopy is a test that uses a tube to look into your rectum. The sigmoidoscopy test uses a longer tube to look further into the lower part of your large bowel. You may have a colonoscopy to look at your whole bowel.

You will probably be asked to change into a gown before the procedure and lie on your side on a bed. The doctor will put a fine tube into your back passage and inflate your bowel with some air. The air in the bowel helps the doctor to see inside more clearly. The tube also has a small light inside it, which allows the doctor to see into your bowel. The doctor may take a small sample of tissue (a biopsy) if necessary. A specialist looks at this tissue sample under the microscope in the laboratory to see if it contains any cancer cells.

Usually, you can have these tests as an outpatient, which means you can go home afterwards. The tests may be uncomfortable but are not normally painful. So you don’t need an anaesthetic. If you have had a biopsy, you may notice a small amount of bleeding for a day or so, but this is normal.

Examination under anaesthetic

You have this test while you are asleep under a general anaesthetic. The anaesthetic allows your muscles to relax so your specialist is able to examine the suspicious area more easily. It also allows the specialist to take biopsies from areas that are more painful. You may also have this test to help stage anal cancer.

If the lymph glands in your groin are larger than normal your specialist may recommend they take a sample of cells. This is to see if there are any cancer cells in the lymph glands.

The specialist uses a fine needle and syringe to take a sample of cells from the lymph gland. This is called fine needle aspiration (FNA). The specialist may use an ultrasound scan to help guide the needle into place. A pathologist then examines the cells in the laboratory.