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Anal cancer
Causes and risk factors
Overall, the risk of anal cancer is rising, with data suggesting
that persons engaging in certain sexual practices, such as receptive
anal intercourse, or persons with a high lifetime number of sexual
partners are at increased risk of anal cancer. These practices may
have led to an increase in the number of individuals at risk for
infection with human papillomavirus (HPV);
Infectious agents
HPV: HPV infection is strongly associated with anal cancer
development and may be a necessary step in its carcinogenesis.
Researchers have found that 80 percent of the tumors were positive
for HPV DNA. Of these, over 60 percent tested positive for a strain
called HPV-16, and 7 percent contained a strain called HPV-18. Both
strains of HPV are implicated in cervical-cancer development as
well. An HPV produced protein E6, inactivates tumor suppressor gene
p53. The presence of genital warts increases the risk by a factor of
30.
HIV: The association between HIV and anal cancer reflects
the sexual practices (anal receptive intercourse) associated with
these diseases rather than a causative relationship. Anal cancer is
rare in intravenous drug abusers. The relative risk for homosexuals
with AIDS is 80 and for heterosexuals with AIDS is 40.
Other infections: Chlamydial infection in women,
herpes-simplex type 2 and gonorrhea in men have all been associated
with an increased risk of developing anal cancer.
Sexual practices
Anal-receptive intercourse in men but not women is associated
with anal cancer (risk ratio 33). There is also an increased
incidence in single men than married men (6-fold increase). Sexual
activity particularly with multiple partners, is associated with an
increased risk for anal cancer.
Immune suppression
Kidney transplant patients are associated with a 100-fold
increase in anogenital cancers.
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Cigarette smoking
Cigarette smokers have an 8-fold increase in anal cancer.
Diseases associated with anal cancer
- AIDS (relative risk 60).
- Anal diseases (fistulas, fissures, chronic local
inflammation, hemorrhoids)
- Chron's disease
- Lymphogranuloma venereum
- Condylomata acuminata
- Carcinoma of the cervix
- Carcinoma of the vulva
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