Diagnosis
If you have any symptoms of anal cancer, make an appointment with your doctor. Your doctor will conduct a physical exam and ask you questions about your general health, lifestyle, and medical history. If your doctor suspects anal cancer, he or she may recommend any of the following procedures.
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Digital Rectal Exam (DRE)
Your doctor may perform a digital rectal exam (DRE), a procedure in which he or she inserts a gloved, lubricated finger into your anus to feel for any lumps or abnormalities. If you doctor still suspects anal cancer, he or she may recommend additional tests.
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Anoscopy
Your doctor will use an anoscope (a short tube with a light on the end) to examine your anal canal and lower rectum for any lumps or abnormalities. If your doctor finds anything suspicious, a tissue sample can be obtained.
Proctoscopy
Your doctor will use a rigid sigmoidoscope or proctoscope (a short tube with a light at the end) to examine your anal canal, lower sigmoid, and rectum for any lumps or abnormalities. If your doctor finds anything suspicious, a tissue sample will be removed for biopsy.
Flexible Sigmoidoscopy
Your doctor will use a flexible sigmoidoscope (a slightly longer tube with a camera and light on the end) to examine your rectum and lower colon for any lumps or abnormalities. If your doctor finds anything suspicious, he or she will remove a tissue sample for a biopsy.
Colonoscopy
Your doctor will use a colonoscope (a longer tube with a camera and light on the end) to examine your colon and rectum for any lumps or abnormalities. If your doctor finds anything suspicious, he or she will remove a tissue sample for a biopsy. Your doctor may advise a virtual colonoscopy or CT colonoscopy.
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Double-contrast barium enema
Your doctor gives you an enema of barium (a chalky, white liquid) and pumps air into your rectum. The barium coats the lining of the rectum and colon and clearly outlines them on X-rays. This makes it easier for your doctor to identify any polyps or tumors. This study can be limiting since it is very dependent on the mobility of the patient in getting the contrast to coat the bowel during the examination.
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Endo-anal or Endorectal ultrasound
Your doctor will insert an ultrasound probe into your rectum or anus. This device bounces sound waves in order to create echoes that form a picture. This allows doctors to see how deeply the tumor has grown and give an approximation if it has invaded the lymph nodes.
Fine Needle Aspiration (FNA) Lymph Node Biopsy
If there is a suspicious lymph node in the groin, your doctor may perform or refer you for a lymph node biopsy to find out whether the cancer has spread to your groin. The doctor will use a thin needle to extract a tissue sample from a lymph node. Your pathologist will then examine it under a microscope and make a diagnosis.
Chest X-Ray
A chest X-ray uses electromagnetic waves to create pictures of the inside of your body. Your doctor will order a chest X-ray to check any suspicious areas in your lungs. If your chest X-ray looks suspicious in any way, your doctor will order additional tests.
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Computed tomography (CT) scan
A computed tomography (CT) scan uses X-rays to produce an image of the body. A special dye may be injected into your veins and you may be asked to drink a special fluid in order to make the internal organs stand out. A CT scan delineates the extent of the tumor and any other potential abnormalities related to the tumor such as lymph nodes and whether or not the cancer has spread to other parts of your body.
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Magnetic resonance imaging (MRI) scan
Magnetic resonance imaging (MRI) scans use radio waves and a strong magnet to create clear and detailed images of body parts. Radio waves are absorbed by the body and then released in a certain pattern, which is translated by a computer in order to show "slices" of the body. It will give similar information as the CT scan but with better resolution.
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Positron Emission Tomography (PET) Scan
For a PET scan, the doctor injects a radioactive substance into the patient's bloodstream. This substance collects in malignant (cancerous) cells in the patient's body. The doctor then uses a PET scanner to detect these areas of radioactivity and to find the exact location of cancer in the patient's body.
