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Anal cancer

CISS relies strongly in its evaluations below on impartial analyses by the International Cochrane Collaboration and the British Medical Journal’s Clinical Evidence Group – two groups of researchers who specialise in Evidence Based Medicine.
Conventional medicine supports the paradigm that the tumour is the first stage of cancer, therefore, treating and removing the tumour should cure the cancer.
Unfortunately statistics will show this is rarely the case. Conventional medicine also advocates treatment should only be used if supported by appropriate clinical trials showing efficacy. In fact, evidence based medicine suggests that the only reliable evidence needs to come from properly run randomised controlled trials. Again, with conventional cancer treatment, this is generally not the case.The following is based on the conventional cancer paradigm.The anus is part of the body’s digestive system and is the last part of the large intestine after the rectum. Stool (solid waste) leaves the body through the anus.

Anal cancer (usually classified as a squamous cell carcinoma of the anal canal) is an uncommon cancer, although its incidence is increasing. It occurs more frequently in people over the age of 60.

Incidence of anal cancer has doubled in the last 20 years (Cancer Council Australia).

Although never a welcome diagnosis, there are several advantageous features to this disease.

  • First, anal cancer rarely metastasizes;
  • Second, it turns out to be highly sensitive to chemoradiation, i.e., chemotherapy-plus radiation.

This second fact led to a switch from the one obligatory radical surgery (abdominoperineal resection) to treatments that, while a bit difficult in themselves, at least preserve the function of the anorectal area for most patients.

The vast majority of anal cancers are of the epidermoid (squamous cell) type. The remainder are typically of the basaloid transitional cell type.

Other types of cancer can also arise in the anal canal. Adenocarcinomas – that is, cancers deriving from glandular cells within the lining of the anal canal – also occur, as do melanomas of the anal canal, but rarely.

The causes of anal cancer are not fully understood, but there is little doubt that a

significant connection exists between the human papillomavirus – HPV (particularly

subtypes 16 and 18) – and the occurrence of anal cancer.

It is important to mention a precancerous lesion known as anal intraepithelial neoplasia (AIN). This is the lesion that is closely linked to HPV infection, and is analogous to the HPV-associated cervical intraepithelial neoplasia (CIN) lesions that are precursors to cervical cancer in women. There is a high progression rate from the precancerous AIN lesion to outright invasive anal cancer.

Anal cancer is strongly associated with immune suppression.

Kidney transplant patients who receive immune suppressive drugs are 100 times more likely to develop anal cancer than people in the general population.

People with AIDS are 84 times more likely to develop anal cancer than those without AIDS.

All of these facts point to treatment strategies that enhance immunity and enhance general wellness.

Risks:

  • Tobacco use,
  • anal fissures,
  • weakened immune systems,
  • infection with the human papillomavirus (HPV), chlamydia, genital warts, HIV,
  • a history of cervical, vulval or vaginal cancer,
  • a history of abnormal cells in the cervix, vulva or vagina

(National Cancer Institute)

Signs and Symptoms: The symptoms of anal cancer overlap with some benign conditions.

Sometimes pain, discharge of mucus, difficulty controlling bowel movements or a palpable mass may bring the patient to the doctor’s office.

Usually, though, the first sign of anal cancer is bleeding, which occurs in about 45 percent of patients.

This can be mistaken for haemorrhoids or some other benign condition. This fact, coupled with reticence and embarrassment, may delay diagnosis and treatment.

Because of the semi-external nature of the anus, however, these cancers sometimes do cause symptoms earlier than internal cancers.

Treatment: The main treatment is surgery, radiotherapy and chemotherapy, these can be used alone or in a combination (Australian Cancer Council).

  1. Surgery – the most common treatment, which usually involves the tumour being removed. Please note: there is little evidence that surgery for cancer has any benefit on increased percentage 5 year survival except in cases where the tumour is in a life threatening position (The efficacy of surgical treatment of cancer, DJ Benjamin).
  2. Radiation – uses high energy x-rays to kill cancer cells. Please note: radiation has been shown to reduce recurrence with many types of cancer but this rarely results in increased survival. (The efficacy of radiotherapy, DJ Benjamin).
  3. Chemotherapy – the use of toxic drugs to kill the cancer cell or stop them from growing. Research by Morgan et al concludes that chemotherapy provides a 2.3% increase in 5 year survival for cancer overall.

The aim of treatment is to remove the tumour, slow its growth, or relieve symptoms by shrinking the tumour and swelling.

The above therapies all come with risks and side effects which should be discussed in detail with your treating physician.

Before deciding on one of these treatments you would benefit from asking your physician three questions:

Question 1: What are my treatment options? – These should include doing nothing.

Question 2: What are the possible outcomes of those options? – including benefits and side effects.

Question 3: How likely is each of the outcomes to occur?

If your doctor or other health practitioner cannot answer these questions, or shows that he or she is not comfortable with you asking these questions, it raises the question as to whether they are practising evidence based medicine and you should consider getting another opinion.

These three questions can be expanded.

For a complete comprehensive overview of conventional treatments used for anal cancers with up to date information on % effectiveness of each treatment on mortality and morbidity, please follow this link to The Ralph Moss Reports.

Alternative Cancer Therapies

As mentioned above, conventional medicine supports the paradigm that the tumour is the first stage of cancer; therefore treating and removing the tumour should cure the cancer.

Another paradigm believes that cancer is a systemic disease and the tumour is in fact a late stage symptom, element or manifestation of that disease.

Therefore treating the disease should be systemic and wholistic (meaning treating the whole body) and should include the following principles:

  1. Treatment should cause no harm
  2. Treatment should be Wholistic (ie consider the whole person – body, mind, emotions and spirit)
  3. The person with cancer needs to take control of their own health.

This latter paradigm is supported by CISS (See Introduction to CISS).

Alternative cancer therapies are generally consistent with the above principles. In fact those believed to be the most effective in controlling cancer – psychotherapy and immunotherapy – also have strong supporting evidence from randomised controlled trials.

There are approximately 200 alternative cancer therapies that have been shown or anecdotally reported to help a person with cancer have reduced morbidity and mortality. The following are those with the most scientific evidence for benefit. What is important in any cancer treatment is to both understand and believe in your chosen therapy.

  • Psychotherapy

Because anal cancer is relatively rare, no patients with anal cancer participated in the randomised controlled trials evaluating psychotherapy. However those with all types of cancer who did participate experienced a significant increase in percentage five year survival. There is therefore no reason that those with anal cancer would not have experienced the same benefits.

References: (1. Eysenck, HJ & Grossarth-Maticek, R. Creative Novation Behaviour Therapy as a Prophylactic Treatment for Cancer and Coronary Heart Disease: Part II – Effects of Treatment. Behav Research and Therapy 1991; 29 (1): 17-31.)

  • Immunotherapy

Several RCTs have shown benefits of Iscador therapy on people with different types of cancer.

Salzer G: [30 years of experience with mistletoe therapy in public health facilities]. In: Leroi R, ed.: [Mistletoe Therapy: A Response to the Challenge of Cancer]. Stuttgart, Germany: Freies Geistesleben, 1987, pp. 173-215;Grossarth-Maticek R, Kiene H, Baumgartner SM, et al.: Use of Iscador, an extract of European mistletoe (Viscum album), in cancer treatment: prospective nonrandomized and randomized matched-pair studies nested within a cohort study. Altern Ther Health Med 7 (3): 57-66, 68-72, 74-6 passim, 2001 May-Jun;

Issels’ Wholebody Therapy

Although not based on RCTs the most successful therapy for late stage cancers was Issels’ Whole Body Therapy that focussed on restoring the body’s immune systems.

It was estimated that a representative sample (252) of Issels’ patients with late stage cancers showed a 16.6% five year survival following his treatment and 15% 15 years survival. Although there were no cases of anal cancer among those evaluated there is no reason to expect that they would have responded differently to those in evaluated.

References: Issels, J. Immunotherapy in Progressive Metastatic Cancer – A Fifteen-Year Follow-up. Clinical Trials Journal, August 1970: 357-365 – editorial by Phillips S. Dr Joseph Issels and the Ringberg Klinik. Clinical Trials Journal. August 1970: 355-56.

As with psychotherapy therefore no reason that those with anal cancer would not have experienced the same benefits from these two types of immunotherapy as those with the more common types of cancer.

The above studies, that include RCTs, show that systemic therapies are much more successful than therapies based on the orthodox paradigm.

In anal cancers, Ralph Moss (Cancer Therapy, The Independent Consumers Guide to Non-Toxic Treatment and Prevention) reports the following alternative therapies have been shown to benefit.

  • Imiquimod – is a prescription drug which has been approved for the treatment of actinic keratoses, genital warts, etc., has been tested in a clinical trial as a treatment for AIN (Anal Intraepithelial Neoplasia or Anal Dysplasia, a pre-malignant condition that is characterized by the presence of abnormal cells and changes in the epithelial lining of the anal canal and signifies a propensity to develop anal cancer at a later date).

With a median follow-up of 33 months, 53 patients completed the study: 28 were on imiquimod and 25 on placebo. In the imiquimod group, 4/28 patients had disappearance of their AIN and 8/28 had their AIN downgraded to low-grade squamous intraepithelial lesion (LSIL), for an overall response rate of 43 percent.

In the placebo group, only one patient resolved and only one patient discontinued owing to side effects. “During this extended follow-up period, 61% have exhibited sustained absence of high-grade squamous intraepithelial lesion (HSIL),” the British authors wrote.

References. Fox PA, Nathan M, Francis N, et al. A double-blind, randomized controlled trial of the use of imiquimod cream for the treatment of anal canal high-grade anal intraepithelial neoplasia in HIV-positive MSM on HAART, with long-term follow-up data including the use of open-label imiquimod. AIDS. 2010;24(15):2331–2335)

  • Astragalus – is one of the most effective, least toxic and least expensive ways of positively impacting the immune system. It has been tested along with chemotherapy, where it increases tumour response, performance status and decreases toxicity.

Some scientists have called for a reintegration of fever into conventional therapy. They recognise that prolonged, natural fever enhances the effects of natural body defence proteins.

Astragalus may counteract the immune suppressing effects of cyclophosphamide, a medication used to reduce the chances of rejection in transplant recipients, as well as corticosteroids.

References. University of Maryland Web site: http://www.umm.edu/altmed/articles/astragalus-000223.htm)

  • Melatonin – although primarily known for regulating circadian rhythms (i.e., the influence of time-of day on mammalian physiology), melatonin also exerts anticancer activity through at least five mechanisms.

These include:

  • Anti-proliferative effect on cancer cells
  • Stimulation of anticancer immunity
  • Changes in the expression of cancer-prone genes called oncogenes
  • As a powerful antioxidant
  • Anti-angiogenic effects

References. Lissoni P. Is there a role for melatonin in supportive care? Support Care Cancer. 2002;10:110-116

  • Cat’s Claw – in prior scientific testing, Cat’s Claw (Uncaria tomentosa) was shown to be a non-specific stimulator of the immune system.

Limited research suggested that it was beneficial in the treatment of not just cancer, but other diseases in which a malfunctioning immune system formed part of the clinical picture.

There have been some anecdotal reports that Cat’s Claw could cure intractable intestinal problems, including spastic colon, liver dysfunction, etc. It was also said to reduce the side effects of radiation and cancer chemotherapy. However, most of this was anecdotal, until now.

Italian scientists previously established that Cat’s Claw causes a 90 percent inhibition of cancer cells in the test tube, at the highest concentrations. Researchers also focused on non-alkaloid components of Cat’s Claw. In 2005, scientists in Lund, Sweden, characterized the active ingredients in a Cat’s Claw extract, C-Med-100.

These quinic acid esters can inhibit growth without actually killing the cancer cell. It provides new possibilities of enhancing DNA repair, as well immune stimulation, anti-inflammation and cancer prevention.

References.

Riva L, Coradini D, Di Fronzo G, et al. The antiproliferative effects of Uncaria tomentosa extracts and fractions on the growth of breast cancer cell line. Anticancer Res. 2001;21(4A):2457–2461;

Sheng Y, Akesson C, Holmgren K, et al. An active ingredient of Cat’s Claw water extracts Identification and efficacy of quinic acid. J Ethnopharmacol. 2005;96:577-584

If you or someone close to you has just been diagnosed with anal cancer, it is important you research and understand your chosen treatment, whether that be conventional, alternative or a mixture of both. For the best results your treatment should include physical, mental, emotional, psychological and spiritual treatment.

For more information on some more common evidenced based alternative treatments please go to the alternative treatment tab. If you don’t know where to begin in your journey to wellness then we suggest you read where to start.

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