Cancers of the digestive system

1. CANCERS OF THE
DIGESTIVE SYSTEM

2. CANCER OF
OESOPHAGUS

3. FUNCTION
• The esophagus is a long, thin, and muscular tube that connects the pharynx
(throat) to the stomach. It forms an important piece of the gastrointestinal tract
and functions as the conduit for food and liquids that have been swallowed into
the pharynx to reach the stomach.

4. DEFINITION
• Esophageal cancer occurs when cancer cells develop in the esophagus a tube-like
structure that runs from your throat to your stomach. Food goes from
the mouth to the stomach through the esophagus. The cancer starts at the inner
layer of the esophagus and can spread throughout the other layers of the
esophagus and to other parts of the body (metastasis).

5. • The main types of oesophageal cancer are: Squamous cell carcinoma which starts
in the cells that line the oesophagus. (This is more common in Asia.)
Adenocarcinoma which starts in the glandular tissue of the cells lining the
oesophagus.

6. ETIOLOGY AND RISK FACTORS
• The exact cause of cancer of the esophagus is unknown. The etiology is often
associated with environmental factors and conditions that involve chronic
irritation of the esophagus.
• Men are 3 to 4 more times more likely to get esophageal cancer than women.
• Smoking or other use of tobacco
• Heavy alcohol use
• Gastroesophageal reflux disease (GERD), in which contents and acid from the
stomach back up into the esophagus

7. • Barrett's esophagus, a condition that affects the lower part of the esophagus and
can lead to esophageal cancer; Barrett's esophagus may be caused by GERD. Over
time, stomach acid in the esophagus can cause changes in the cells that increase
risk for adenocarcinoma.

8. SIGNS AND SYMPTOMS
• Difficulty or pain when swallowing
• Weight loss
• Pain in the chest, behind the breastbone
• Coughing
• Hoarseness
• Indigestion and heartburn

9. DIAGNOSIS
• Barium swallow X-ray, in which you drink a liquid that coats your esophagus.
This makes the esophagus stand out on the X-ray so that can identify certain
problems.
• Endoscopy: te doctor passes an endoscope, a thin, lighted tube, down your
throat into esophagus to examine it. Endoscopic ultrasound uses sound waves to
provide more information about the extent of tumor involvement in nearby
tissues.
• Biopsy: during an endoscopy, doctor can take cells or tissue from esophagus.
The cells are examined under a microscope for the presence of cancer.

10. • Other tests, including computed tomography (CT) scans, positron emission
tomography (PET) scan, thoracoscopy, and laparoscopy, may be performed to
determine if the cancer has spread, or metastasized, outside of the esophagus.
This process is called "staging."

11. TREATMENT
• Radiation therapy. Kills cancer cells with radiation.
• Chemotherapy . Powerful drugs that attack cancer cells throughout the body;
typically used in combination with radiation therapy and/or surgery.
• Immunotherapy. Helps the immune system to attack cancer cells.

12. PREVENTION
• Avoiding the controllable risk factors discussed in the previous section can be
reduce risk of esophageal cancer. Risk factors such as age, sex, race, and genetic
makeup cannot be altered, whereas avoidance of smoking, limiting alcohol intake,
maintaining good nutrition, and decreasing exposure to carcinogens are
advantageous. Adenocarcinoma incidence can be decreased by maintaining a
healthy weight, treating GERD, and avoiding intake of alcohol and tobacco.

13. CANCER OF THE
STOMACH

14. FUNCTION
• The stomach is a muscular organ located on the left side of the upper abdomen.
The stomach receives food from the esophagus. As food reaches the end of the
esophagus, it enters the stomach through a muscular valve called the lower
esophageal sphincter. The stomach secretes acid and enzymes that digest food.

15. DEFINITION
• Stomach cancer, also called gastric cancer, starts in the stomach.
Adenocarcinoma
• Most (about 90% to 95%) cancers of the stomach are adenocarcinomas. A
stomach cancer or gastric cancer almost always is an adenocarcinoma. These
cancers develop from the cells that form the innermost lining of the stomach (the
mucosa).
Lymphoma
• These are cancers of the immune system tissue that are sometimes found in the
wall of the stomach. The treatment and outlook depend on the type of
lymphoma..

16. Gastrointestinal stromal tumor (GIST)
• These rare tumors start in very early forms of cells in the wall of the stomach
called interstitial cells of Cajal. Some of these tumors are non-cancerous (benign);
others are cancerous. Although GISTs can be found anywhere in the digestive tract,
most are found in the stomach. For more information, see Gastrointestinal Stromal
Tumor (GIST).
Carcinoid tumor
• These tumors start in hormone-making cells of the stomach. Most of these tumors do
not spread to other organs. These tumors are discussed in more detail
in Gastrointestinal Carcinoid Tumors.

17. ETIOLOGY AND RISK FACTOR
• Several nutritional, environmental, social, genetic, and medical factors have been
associated with development of cancer of the stomach.
• Nutritional factors that have been associated with increased incidence of stomach
(gastric) cancer include obesity, (GERD), poor drinking water, high consumption of
foods high in nitrates, smoked or salt-cured food preparation, low dietary fiber,
and low dietary intake of vitamins A and C.
• Smoking and alcohol intake increase risk of gastric cancer.

18. SIGNS AND SYMPTOMS
• Stomach pain
• Blood in your stool
• Vomiting
• Weight loss for no reason
• Trouble swallowing
• Yellowish eyes or skin
• Swelling in your stomach
• Constipation or diarrhea
• Weakness or feeling tired

19. DIAGNOSING
• Blood tests to look for signs of cancer in body.
• Upper endoscopy. a thin, flexible tube with a small camera down your throat to
look into stomach.
• Upper GI series test. You’ll drink a chalky liquid with a substance called barium.
The fluid coats your stomach and makes it show up more clearly on X-rays.
• CT scan . This is a powerful X-ray that makes detailed pictures of the inside of
body.
• Biopsy . doctor takes a small piece of tissue from stomach to look at under a
microscope for signs of cancer cells.

20. TREATMENT
• Radiation Therapy
• Chemotherapy

21. PREVENTION
• Focused primarily on nutritional measures, smoking cessation, use of NSAIDS.
• Dietary measures include the proper preparation and storage of food and the
limitations of foods that are salted, smoked, and pickled. In addition, diets in high
fiber, rich in fruits and vegetables, and lower in red meat are advised and
maintain a health weight.

22. CANCER OF THE LIVER

23. FUNCTIONS
• Bile production and excretion.
• Excretion of bilirubin, cholesterol, hormones, and drugs.
• Metabolism of fats, proteins, and carbohydrates.
• Enzyme activation.
• Storage of glycogen, vitamins, and minerals.
• Synthesis of plasma proteins, such as albumin, and clotting factors.

24. DEFINITION
• Liver cancer is a type of cancer that starts in the liver. Some cancers develop
outside the liver and spread to the area.
• Liver cancer has a low survival rate
• Symptoms generally do not appear until the cancer is advanced.
• Primary liver cancer (hepatocellular carcinoma) tends to occur in livers
damaged by birth defects, alcohol abuse, or chronic infection with diseases such
as hepatitis B and C, hemochromatosis (a hereditary disease associated with too
much iron in the liver), and cirrhosis.

25. ETIOLOGY AND RISK FACTOR
• HCC commonly develops in the presence of chronic cell injury, which produces
inflammation, leading to hepatocyte regeneration and fibrosis. Repeated cycle of
cell death and regeneration may ultimately lead to cirrhosis.
• Chronic infections with hepatitis B virus (HBV) and hepatitis c virus (HCV) are the
most important cause of liver damage worldwide.
• Chronic alcohol use is an important cause of cirrhosis.
• Less common risk factors include certain genetic metabolic diseases, such as
hereditary hemochromatosis, and antitrypsin deficiency.

26. • Type 2 diabetes: People with diabetes, especially if they also have hepatitis, or
regularly consume a lot of alcohol, are more likely to develop liver cancer.
• Family history: If a person's mother, father, brother, or sister has had liver cancer,
the person has a higher risk than others of developing the cancer themselves.
• Low immunity: People with weakened immune systems, such as those
with HIV/AIDS have a risk of liver cancer that is five times greater than other
healthy individuals.
• Gender – Male

27. SIGNS AND SYMPTOMS
• jaundice
• abdominal pain
• unexplained weight loss
• an enlarged liver
• Fatigue
• nausea
• vomiting
• back pain
• itching
• fever

28. DIAGNOSING
• Blood tests: These will include tests to see how the blood clots, check levels of other substances
in the blood and measure the proportions of red and white blood cells and platelets.
• Tests for viral hepatitis: will check for the presence of hepatitis B and C.
• Imaging scans: Either an MRI or CT scan can show the size and spread of the cancer.
• Biopsy: A small sample of tumor tissue is removed and analyzed. The analysis can reveal
whether the tumor is cancerous or non-cancerous.
• Laparoscopy: This is an outpatient surgical procedure under general or local anesthetic. A long,
flexible tube with a camera attached is inserted through the abdomen. This allows the doctor to
observe the liver and surrounding area.

29. SURGERY/TREATMENT
• Radiation therapy: Radiation is directed at the tumor or tumors, killing a significant
number of them. Patients may experience nausea, vomiting, and fatigue.
• Chemotherapy: Medications are injected into the liver to kill cancer cells. In
chemoembolization, the blood supply to the tumor is blocked surgically or
mechanically, and anti-cancer drugs are administered directly into the tumor.
• Partial hepatectomy: When the tumor is small and occupies a small part of the liver,
that part of the liver can be surgically removed.
• Liver transplant: Candidates for a liver transplant cannot have a tumor larger than 5
cm or several tumors larger than 3 cm. The risk of the cancer returning is too great to
justify a procedure as risky as a transplant if the tumor is larger than this.

30. PREVENTION
• Moderate alcohol intake
• Hepatitis B vaccination
• Maintain a healthy body weight: As obesity is a risk factor and fatty liver
disease can lead to liver cancer and diabetes, looking after your physical health
and weight can be key to reducing the risk of liver cancer.
• Treating underlying conditions: Some conditions contribute to the
development of liver cancer, such as diabetes and hemochromatosis. Treating
these before they develop into liver cancer can reduce the risk of complications.

31. CANCER OF THE
GALLBLADDER AND BILE
DUCT

32. FUNCTION
• The gallbladder is a pear-shaped, hollow structure located under the liver and on
the right side of the abdomen. Its primary function is to store and concentrate
bile, a yellow-brown digestive enzyme produced by the liver. The gallbladder is
part of the biliary tract.
• The common bile duct is a small, tube-like structure formed where the common
hepatic duct and the cystic duct join. Its physiological role is to carry bile from
the gallbladder and empty it into the upper part of the small intestine (the
duodenum). The common bile duct is part of the biliary system.

33. DEFINITION
• This fluid, produced by the liver, helps digest fat. The
gallbladder releases bile into the small intestine through the bile duct. This thin
tube connects the live and gallbladder to the small intestine. Most gallbladder
and bile duct cancers are adenocarcinomas—cancers of cells that line the glands
and ducts.

34. ETIOLOGY AND RISK FACTORS
• Cholelithiasis (presence of gallstones in the gallbladder) increases the risk of
gallbladder cancer.
• Obesity increases the risk of gallbladder cancer.
• Being female also increases the risk.
• The risk of cholangiocarcinoma increases considerably if the bile ducts are
chronically inflamed due to an autoimmune disease or infection.

35. SIGNS AND SYMPTOMS
• jaundice
• abdominal pain or swelling
• nausea and/or vomiting
• lack of appetite
• losing weight for no reason
• itching
• fever that doesn't go away.

36. DIAGNOSIS
• Ultrasound — Ultrasound uses sound waves to make pictures of internal organs.
It can detect about half of gallbladder cancers. It can also help find a bile duct
obstruction or tumor, if it's large enough.
• Computed tomography (CT) — This test uses a rotating x-ray beam to make
detailed, cross-sectional images of the body. A CT scan can identify a tumor
inside the gallbladder or one that has spread outside of it. It also can help to
determine whether the tumor has spread to the bile duct, liver, or nearby lymph
nodes.
• Magnetic resonance imaging (MRI) — These scans also create cross-sectional
images of internal organs.

37. • Endoscopic retrograde cholangiopancreatography (ERCP) — In this procedure, a
flexible tube is passed down the throat, through the esophagus and stomach, and
into the common bile duct. A small amount of contrast dye is used to help outline
outline the bile duct in x-ray images. These pictures can show if the bile duct is
narrowed or blocked.
• Surgery — Sometimes surgery must be done to determine if there is cancer in the
gallbladder or bile duct.
• Biopsy — To be certain of the diagnosis, a tissue sample will be taken from the
tumor or mass and examined in a laboratory.

38. TREATMENT/ SURGERY
• Radiation Therapy
• Chemotherapy
• Cholecystectomy — a procedure that involves surgical removal of the gallbladder, regional
lymph nodes, and some of the tissues surrounding the organ — is the most effective treatment
for localized gallbladder tumors. Part of the liver also may be removed if the tumor has spread
(metastasized).
• Removal of the bile duct- A surgical procedure to remove part of the bile duct if the tumor is
small and in the bile duct only. Lymph nodes are removed.
• Partial hepatectomy: A surgical procedure in which the part of the liver where cancer is found
is removed.

39. CANCER OF THE
PANCREAS

40. DEFINITION
• Pancreatic cancer is a disease in which malignant(cancerous) cells form in the
tissues of the pancreas. The pancreas is a gland located behind the stomach and
in front of the spine. The pancreas produces digestive juices and hormones that
regulate blood sugar.

41. ETIOLOGY AND RISK FACTOR
• It's not clear what causes pancreatic cancer in most cases. Doctors have identified
factors, such as smoking, that increase your risk of developing the disease.
• Factors implicated in the development of pancreatic cancer are environmental factors,
disease related, and genetic.
• The strongest environment factor is cigarette smoking, and it accounts for 30% of
pancreatic cancers. With heavier use for longer periods increasing the risk.
• Diets high in fat and meat and lower in fruits and vegetables may also play a role,
with obesity increasing the risk whereas physical activity may decrease it.
• Disease related risk factors include diabetes mellitus and pancreatitis.

42. SIGNS AND SYMPTOM
• Pain in the upper abdomen that radiates to your back
• Loss of appetite or unintended weight loss
• Depression
• Blood clots
• Fatigue
• Yellowing of your skin and the whites of your eyes (jaundice)

43. DIAGNOSIS
• Computed tomography (CT scan): A scanner takes multiple X-ray pictures, and a
computer reconstructs them into detailed images of the inside of the abdomen.
• Magnetic resonance imaging (MRI): Using magnetic waves, a scanner creates
detailed images of the abdomen, in particular the area around the pancreas, liver,
and gallbladder.
• Ultrasound: Harmless sound waves reflected off organs in the belly create images,
potentially helping doctors make a pancreatic cancer diagnosis.
• Positron emission tomography (PET scan): Radioactive glucose injected into the
veins is absorbed by cancer cells. PET scans may help determine the degree of
pancreatic cancer spread.

44. TREATMENT/SURGERY
• Whipple procedure (pancreaticoduodenectomy): A surgeon removes the head
of the pancreas and sometimes the body of the pancreas, parts of
the stomach and small intestine, some lymph nodes, the gallbladder, and the
common bile duct. The remaining organs are reconnected in a new way to allow
digestion.
• Distal pancreatectomy: The tail and/or portion of the body of the pancreas are
removed, but not the head.
• Total pancreatectomy: The entire pancreas and the spleen is surgically
removed.
• Chemotherapy & Radiation Therapy

45. PREVENTION
• Stop smoking. If you smoke, try to stop. Talk to your doctor about strategies to
help you stop, including support groups, medications and nicotine replacement
therapy. If you don't smoke, don't start.
• Maintain a healthy weight. If you are at a healthy weight, work to maintain it. If
you need to lose weight, aim for a slow, steady weight loss — 1 to 2 pounds (0.5
to 1 kilogram) a week. Combine daily exercise with a diet rich in vegetables, fruit
and whole grains with smaller portions to help you lose weight.
• Choose a healthy diet. A diet full of colorful fruits and vegetables and whole
grains may help reduce your risk of cancer

46. CANCER OF THE
SMALL INTESTINE

47. FUNCTION
• The small intestine is the part of the intestines where 90% of
the digestion and absorption of food occurs, the other 10% taking place in the
stomach and large intestine. The main function of the small intestine
is absorption of nutrients and minerals from food. Digestion involves two
distinct parts.

48. DEFINITION
• Small intestine cancer is a rare disease where cells in the tissue of the small
intestine change. They grow out of control and can form a mass, or tumor.
• There are five types of small intestine cancer. The types of cancer found in
the small intestine are adenocarcinoma, sarcoma, carcinoid tumors,
gastrointestinal stromal tumor, and lymphoma. Most of these tumors occur in
the part of the small intestine near the stomach. They may grow and block the
intestine.

49. • Adenocarcinomas. These make up an estimated 30% to 40% of cases.
An adenocarcinoma starts in the lining of the small intestine. At first, it may look like a
small, noncancerous growth called a polyp, but over time it can turn into cancer.
• Sarcoma . Cancerous cells develop in the soft tissue of the small intestine.
• Carcinoid tumors . These slow-growing cancers often take root in the lower section of
the small intestine. They might also affect your appendix or rectum. These tumors give
off large amounts of certain body chemicals, like serotonin.
• Gastrointestinal stromal tumors (GISTs). This is a rare form of small intestine cancer.
More than half of them start in the stomach. Not all GISTs are cancerous.
• Intestinal lymphomas. A lymphoma is a cancer that starts in the lymph nodes. People
who develop them often have a type of immunodeficiency disorder. That means your
body’s natural defense system is weakened and may not fight infection and disease
the way it should.

50. ETIOLOGY AND RISK FACTOR
• How old you are (average age at diagnosis is 60)
• Your sex (slightly higher risk in men)
• Genetics (some disorders you’re born with raise the odds)
• Smoking and alcohol use
• High-fat diet
• Living or working near large quantities of some chemicals, like phenoxyacetic acid
• Other conditions that affect your gut, like Crohn’s, colon cancer or celiac disease
• Lymphedema (damage to the vessels that connect to the lymph nodes)

51. SIGNS AND SYMPTOMS
• Pain or cramps in the middle of your stomach
• Losing weight for no known reason
• A lump in your abdomen
• Blood in your stool

52. DIAGNOSIS
• Blood chemistry tests. These measure the amount of certain substances your
body is making.
• Liver function tests . Your doctor checks your blood to measure substances
released by your liver (and how much). A higher than normal amount of a
substance can be a sign of liver disease that may be caused by small intestine
cancer.
• Fecal occult blood test. This detects blood in your stool.
• Lymph node biopsy . Your doctor removes a piece of your lymph node to check
for cancer cells.
• Laparotomy. This is major surgery. A doctor cuts into the wall of your abdomen
to look for signs of disease.

53. TREATMENT/SURGERY
• Radiation therapy This uses high-energy X-rays to kill cancer cells.
• Chemotherapy (chemo). These are drugs you take by mouth or through an IV
tube. They, too, kill cancer cells or stop them from growing.
• Surgery may also relieve symptoms when the cancer has caused a bowel
obstruction. A bypass procedure or limited tumor removal.

54. PREVENTION
• At this time, there is no known way to prevent most small intestine
adenocarcinomas. There are some factors that might increase the risk for these
cancers, such as smoking, drinking alcohol, and eating a diet that’s high in red
meats, so making healthier choices concerning these risk factors might lower
your risk. Small intestine cancers are rare to begin with, but making these types of
healthy choices might also lower your risk of some other types of cancer.

55. CANCER OF THE
COLORECTAL

56. DEFINITION
• Colorectal cancer (CRC), also known as bowel cancer and colon cancer, is the
development of cancer from the colon or rectum (parts of the large intestine). A
cancer is the abnormal growth of cells that have the ability to invade or spread to
other parts of the body.

57. ETIOLOGY AND RISK FACTOR
• older age
• a diet that is high in animal protein, saturated fats, and calories
• a diet that is low in fiber
• high alcohol consumption
• having had breast, ovary, or uterine cancer
• a family history of colorectal cancer
• having ulcerative colitis, Crohn's disease, or irritable bowel disease (IBD)
• overweight and obesity
• smoking
• a lack of physical activity
• the presence of polyps in the colon or rectum, as these may eventually become
cancerous.

58. SIGNS AND SYMPTOMS
• changes in bowel habits
• diarrhea or constipation
• a feeling that the bowel does not empty properly after a bowel movement
• blood in feces that makes stools look black
• bright red blood coming from the rectum
• pain and bloating in the abdomen
• a feeling of fullness in the abdomen, even after not eating for a while.
• fatigue or tiredness
• unexplained weight loss
• a lump in the abdomen or the back passage felt by your doctor
• unexplained iron deficiency in men, or in women after menopause

59. DIAGNOSIS
• Fecal occult blood test (blood stool test) This checks a sample of the patient's stool (feces) for
the presence of blood.
• Stool DNA test This test analyzes several DNA markers that colon cancers or precancerous
polyps cells shed into the stool.
• Flexible sigmoidoscopy The doctor uses a sigmoidoscope, a flexible, slender and lighted tube,
to examine the patient's rectum and sigmoid.
• Barium enema X-ray Barium is a contrast dye that is placed into the patient's bowel in an
enema form, and it shows up on an X-ray. In a double-contrast barium enema, air is added as
well.
• Colonoscopy A colonoscope is longer than a sigmoidoscope. It is a long, flexible, slender tube,
attached to a video camera and monito

60. TREATMENT/SURGERY
• Chemotherapy involves using a medicine or chemical to destroy the cancerous
cells. It is commonly used for colon cancer treatment. Before surgery, it may help
shrink the tumor.
• Radiation therapy uses high energy radiation beams to destroy the cancer cells
and to prevent them from multiplying. This is more commonly used for rectal
cancer treatment. It may be used before surgery in an attempt to shrink the
tumor.
• Surgery for colorectal cancer this is the most common treatment. The affected
malignant tumors and any nearby lymph nodes will be removed, to reduce the
risk of the cancer spreading.

61. PREVENTION
• Regular screenings: Those who have had colorectal cancer before, who are over 50
years of age, who have a family history of this type of cancer, or have Crohn's disease
should have regular screenings.
• Nutrition: Follow a diet with plenty of fiber, fruit, vegetables, and good
quality carbohydrates and a minimum of red and processed meats. Switch from
saturated fats to good quality fats, such as avocado, olive oil, fish oils, and nuts.
• Exercise: Moderate, regular exercise has been shown to have a significant impact on
lowering a person's risk of developing colorectal cancer.
• Bodyweight: Being overweight or obese raises the risk of many cancers, including
colorectal cancer.

62. CANCER OF THE ANUS

63. DEFINITION
• Anal cancer is an uncommon type of cancer that occurs in the anal canal. The anal
canal is a short tube at the end of your rectum through which stool leaves your
body.

64. ETIOLOGY AND RISK FACTOR
• Anal cancer forms when a genetic mutation turns normal, healthy cells into
abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at a
set time. Abnormal cells grow and multiply out of control, and they don't die. The
accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby
tissues and can separate from an initial tumor to spread elsewhere in the body
(metastasize).
• Anal cancer is closely related to a sexually transmitted infection called human
papillomavirus (HPV). Evidence of HPV is detected in the majority of anal cancers.
HPV is thought to be the most common cause of anal cancers.

65. • Older age. Most cases of anal cancer occur in people age 50 and older.
• Many sexual partners. People who have many sexual partners over their lifetimes have
a greater risk of anal cancer.
• Anal sex. People who engage in anal sex have an increased risk of anal cancer.
• Smoking. Smoking cigarettes may increase your risk of anal cancer.
• History of cancer. Those who have had cervical, vulvar or vaginal cancer have an
increased risk of anal cancer.
• Human papillomavirus (HPV). HPV infection increases your risk of several cancers,
including anal cancer and cervical cancer. HPV infection is a sexually transmitted
infection that can also cause genital warts.
• Drugs or conditions that suppress your immune system. People who take drugs to
suppress their immune systems (immunosuppressive drugs), including people who
have received organ transplants, may have an increased risk of anal cancer. HIV — the
virus that causes AIDS — suppresses the immune system and increases the risk of anal
cancer.

66. SIGNS AND SYMPTOMS
• Bleeding from the anus or rectum
• Pain in the area of the anus
• A mass or growth in the anal canal
• Anal itching
• fecal incontinence, or problems controlling bowel movements

67. DIAGNOSIS
• A rectal examination This may be uncomfortable, but it is not usually painful. The
doctor may use a proctoscope, anoscope, or sigmoidoscope to examine the area in
more detail. The examination will determine whether a biopsy is needed.
• A biopsy A small sample of tissue is taken from the anal area and sent to the lab for
testing. Tissue will be examined under a microscope.
• If the biopsy reveals cancerous tissue, further tests will be done to find out how large
the cancer is and whether it has spread.
• A CT, MRI, or ultrasound scan can help confirm the results. This may be a rectal
ultrasound, where the instrument is inserted into the anus.

68. TREATMENT/SURGERY
• Surgery The type of surgery depends on the size and position of the tumor.
• Resection The surgeon removes a small tumor and some surrounding tissue. This
can only be done if the anal sphincter is not affected. After this procedure, the
person will still be able to pass a bowel movement.
• Abdominoperineal resection The anus, rectum and a section of the bowel are
surgically removed, and a colostomy will be established. In a colostomy, the end
of the bowel is brought out to the surface of the abdomen
• Chemotherapy and radiotherapy

69. PREVENTION
• Practice safer sex. Abstaining from sex or practicing safe sex may help prevent
HPV and HIV, two sexually transmitted viruses that may increase your risk of anal
cancer. If you choose to have anal sex, use condoms.
• Get vaccinated against HPV. Two vaccines — Gardasil and Cervarix — are given
to protect against HPV infection. Both boys and girls can be vaccinated against
HPV.
• Stop smoking. Smoking increases your risk of anal cancer. Don't start smoking.
Stop if you currently smoke.