After surviving anal cancer treatments, living beyond cancer raises a lot of questions and uncertainties. After treatment is a new chapter in your life. You have successfully overcome the most challenging part of your life, and now that all has been defeated, somehow there is still this ominous feeling that is bugging you. All throughout the journey, you have experienced a roller-coaster ride of emotions – sorrow and depression, hopelessness, relief, happiness, overwhelming gratitude, and now, the foreboding feeling that cancer can always return. According to Danna Costa-Sahs, PsyD, “Depression is a serious mental illness that negatively affects how you feel, the way you think and how you act.”

Now What? 

You already get used to a routine – going to your doctor, chemotherapy sessions, or appointment with your nutritionist. Following a schedule somehow gave you direction on what your day should go. In as much as the whole process is depressing, you know what and how your day will end. But now that all treatment procedures are done, you are placed in a position where you don’t know what’s going to happen next. You might feel alone when visits to health care team end. You will miss the sense of security and support provided by your team.  

Start Living Once Again – One Day At A Time 

At this point, you and everyone else are grateful that you have survived cancer. There is so much to be thankful for, so much to enjoy about life. You can now start doing things that were put on hold because of cancer treatments. Go start accomplishing your bucket list and enjoy your lost times with friends and families. Get connected once again with your social media accounts and express your gratitude to those who had shown and offered their support when you were battling cancer. According to Suzanne Phillips, PsyD, “gratitude is the gift that gives back because it puts us in touch with the best of who we are.”

Going back to your “normal” life may not be easy. It may take time and a lot of adjustments for you and the people around you. Learn to wait until you get by and slowly learn how to overcome worried and anxious feelings.  

How To Be More Hopeful While Dealing With Fear And Uncertainty 

There will always be an instance to remind you, events that will rouse worry again – like visits to hospitals when a member of the family or close acquaintance suddenly become ill or dies of cancer. In times like these, it is normal to feel anxious about your condition. Here are some tips on how to handle this situation: 

• Acknowledge your fears. You’ve been in this situation before. The day when you learned that you had cancer was the most dreadful feeling ever. In as much that you don’t want to go back to this emotion anymore, learn to identify your fears again so that you will know what concrete steps to take to allay these fears. 

• Learn and understand what to expect in cases of recurrence and be knowledgeable of symptoms to look for.  

• Open your concerns to others. Do not worry alone. Expressing your feelings is a way to deal with your emotions. Talk to someone who can understand; it may help you recognize the reasons for your fear. Joining support groups can also make you feel less alone. Talking with others who are in situations like yours can help ease loneliness. According to Alicia H. Clark, PsyD, “Talking is one way that we process and absorb emotional experience – organize it, if you will, for later.”

• Divert negative thoughts that will increase your level of anxiety. Do things that can relieve you of stress. Spend time to enjoy with your family and friends. Focus on hobbies that you like or maybe start a new one to make you more productive.  

• Choose to be well and focus on your health. Continue to live a healthy lifestyle and do away with unhealthy habits.  

• Go back to your healthcare team and bravely talk about followup care. 

Cancer is a life sentence. It does not end even if one has survived the condition. The best way to be prepared for cancer is when you accept your mortality. This way, you are more focused and dedicated to doing more meaningful experiences with your loved ones. Be grateful that you have reached this point and by spiritual grace, another chance is provided to start a new life. 

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After learning that you have cancer, it is understandable that you are eager to start your treatment. Several elements are considered in selecting treatment options and recommendations for anal cancer. Doctors will examine the stage of cancer, patient’s overall health, and personal preferences. Conventional treatments for anal cancer are surgery, radiation therapy, and chemotherapy. 

In making treatment decisions, it is essential to take the option that best fits your needs. If time permits and the situation is not too urgent, take time to understand the best possible choice. You may need to clarify information from your cancer care team, or you may find it helpful to talk about your thoughts and seek a piece of advice from your most trusted people – your family and friends. It is relevant to know about the permanent effect of the treatment, its risks, and benefits. Most often others would consider asking for a second opinion. 

Surgery 

Surgery is the removal of abnormal and some surrounding healthy tissues. After the procedure, the patient will undergo several evaluation tests to determine that the cancer cells have not recurred. If this happens, another surgery is needed. Abdominoperineal resection (APR) is a type of surgery where the anus is removed, so a new opening is made for the stool to leave the body. This procedure results in a patient needing a colostomy. A doctor may recommend this type of surgery if cancer hasn’t responded to chemotherapy and radiation and for late-stage anal cancer. 

Potential risks and side effects mostly depend on the extent of the surgery. Pain is a common side effect and can usually be controlled by medication to reduce discomfort. It is also essential to check on the drainage from the surgery site. Signs of infection include redness and pain in the operative and surrounding areas, foul odor coming from the surgical site, increased count of white blood cells, and complaints of fever. 

The surgical procedure also entails the patient to lifetime colostomy that will eventually affect his/her usual lifestyle. 

Radiation Therapy 

Another recommended treatment is the use of radiation therapy which utilizes high powered beams to suppress and kill cancer cells. It can be used as the primary treatment or along with chemotherapy. During the procedure, the patient lies on a table while a large machine emits radiation beams to the specific area. For anal cancer, radiation therapy is given in 5 to 6 weeks’ duration, depending on the doctor’s recommendations. 

The risk of radiation therapy may include damage to healthy tissue adjacent to where the beams are aimed. Fatigue, skin reactions, diarrhea, low white blood cell count and radiation proctitis are also common side effects. 

Chemotherapy 

Chemotherapy drugs are given via intravenous administration. The drug enters the bloodstream to destroy cancer cells thus halting its ability to grow and divide. Due to the potency of these drugs, regrettably, the chemicals are also toxic to healthy cells thus damaging them too. It is also a combined therapy for radiation therapy called chemoradiation. 

Just like any treatment, there are side effects that accompany chemotherapy including fatigue, lowering blood count, nausea, vomiting, and hair loss. Chemoradiation increases the effectiveness of two treatments but considerably have more side effects. 

In all these treatments, make sure that you ask your doctor all the necessary information pertaining to the therapeutic outcomes, side effects, and complications. …

Continuing to live a normal life with a cancer diagnosis can be very difficult. Studies have shown that persons who receive an initial diagnosis of cancer experience bouts of depression immediately. “I wasn’t ashamed about having breast cancer. Having depression made me feel that I’d let down my loved ones. Well-meaning friends encouraged me to cheer up, as though my sickness was an option,” said Nancy Alterman, LCSW from her own experience of having depression and cancer at the same time.

At first, a cancer patient will need some time to accept the fact that they have cancer. Once it is certain that you have cancer, it will leave you and your family with feelings of uncertainty and anxiousness. Here’s what online counseling has provided on ways you can do after learning about your diagnosis. 

Equip Your Knowledge 

It is imperative to learn the diagnosis and treatment options. Your medical provider will be providing all the information that you need to know about your condition. On your own, you can also supplement this by going to many sources like reading medical literature online or in your local library. There is a wide range of treatments for anal cancer that you can talk about with your doctor. Share what you learn with your doctor and discuss together the treatment options that you are both comfortable with. 

Get Additional Support 

It’s reassuring to keep in mind that you are not alone in this battle. Trying to deal with it by yourself can increase your anxiety levels. Family members and friends are your excellent source of strength and support. Surrounding yourself with a support network will help you experience a better quality of life after anal cancer. 

Addressing Anxiety On Side Effects 

It is known that chemotherapy and radiation therapy offer multiple side effects and complications. Significant changes to the body brought about by side effects can cause fears related to treatment. Your doctor and members of the care team will answer your questions and will work to prevent and relieve these side effects for you to feel more satisfied with your overall care. 

“Most psychologists treat anxiety with cognitive-behavior therapy strategies. The general idea is to target your anxiety-producing thoughts with their rational counterparts,” says Shawn Meghan Burn, Ph.D.

Dealing With Emotions During Treatment 

Receiving emotional support is an essential part of healing. Some cancer patients experience different kinds of emotions like depression, anger, anxiety, and distress. They need all the emotional support and assistance to face their present ordeal. The presence of family and friends can help alleviate specific fears and allay anxieties. A referral to a counselor is also beneficial if the patient demonstrates clinical depression. A good state of mental health is necessary while undergoing cancer treatment. Remember that the body is already compromised by the massive proliferation of cancer cells. Thus, having a cynical point of view is not helpful and can only add further damage to healthy cells. 

Supporting a Loved One with Cancer 

The course of cancer treatment can consume a lot of the patient’s time and energy. Their daily activities are curtailed and attending to personal needs may pose enormous problems. Let the patient know that he is not alone in his journey – you can do something to support his health and healing.

“I’ve noticed there are three particularly challenging times for people with cancer: between diagnosis and the start of treatment, right after treatment ends, and around checkups in the future. The end of treatment can be weirdly anticlimactic and disorienting. Annual checkups can bring up all kinds of weird feelings, even years out,” says Miri Mogilevsky, LISW.

The following are simple ways on how you can help: 

• Be a companion. The best comfort that you can provide is your company. Be there all throughout his treatment. Get ready for long hours of hospital visits. 

• Lend a hand to assist with daily house chores, running errands and offering childcare. 

• Assist patient with eating and grooming especially when he/she is too tired and sick to do self- care. 

Staging is the process of describing the extent or progression of the disease. In solid tumors like anal cancer, staging is important in determining the treatment plan, monitoring the patient’s response to the treatment and to assess its prognosis. 

The most commonly known staging system utilized today is the TNM (Tumor/Node/Metastasis) System, established by the American Joint Committee on Cancer (AJCC). It assesses tumors based on the size or extent of primary tumor (T), the absence or presence of lymph nodes involvement (N) and the absence or presence of metastasis or spread of cancer cells to distant parts of the body. 

Interpreting The Meanings 

As described by The American Cancer Society, each factor is numbered from 0-4 or the letter X representing the severity of the condition. For example, in primary tumor, Tx is used, and this means a primary tumor cannot be assessed; T0 means no evidence of primary tumor; Tis reading would mean that the cancer is only in the mucosa or top layer of cells lining the anus; T1 the tumor is 2cm in dimension; T2 means the tumor is more than 2cm but not more than 5cm; T3 is a tumor that is larger than 5cm; and T4 where the tumor is any size and is growing into nearby organs.  

For the lymph nodes involvement, the following are used: 

• NX – Regional lymph nodes cannot be assessed 

• N0 – No regional lymph nodes metastasis 

• N1 – Involvement in perirectal lymph nodes 

• N2 – Involvement in unilateral internal iliac and inguinal lymph nodes 

• N3 – Metastasis in perirectal and inguinal lymph nodes and bilateral internal iliac and inguinal lymph nodes.  

Lastly, for the metastasis, there are only two categories involved:  

• M0 – For no distant metastasis  

• M1 – With distant metastasis.  

After TNM scores have been assigned, it is then grouped into stages. It ranges from stage I to IV, Stage I being the early stage and IV being the advanced stage.  

Stages Of Anal Cancer 

According to AJCC system effective January 2018, the following are the staging of anal cancer (Source: American Joint Committee on Cancer). 

Stage 0 – Tis, N0, M0. The cancer is only in the mucosa, no lymph nodes and metastasis involve. 

Stage I – T1, N0, M0. The tumor size is merely 2cm, has not spread to nearby lymph nodes or to distant sites. 

Stage IIA – T2, N0, M0. The tumor can range from 2cm, but not more than 5cm has not spread to nearby lymph nodes or to distant sites. 

Stage IIB – T3, N0, M0. The tumor is larger than 5cm but has not spread to nearby lymph nodes or to distant sites. 

Stage IIIA – T1, N1, M0. The tumor is 2 cm, has spread to lymph nodes near the rectum but no distant sites involve. Another interpretation is T2, N1, M0 which means the tumor is more than 2cm but not more than 5cm in greatest dimension, has spread to lymph nodes near the rectum but no metastasis. 

Stage IIIB – T4, N0, M0. At this stage, the tumor is of any size and is growing into nearby organs such as vagina, urethra, prostate gland or bladder, but no lymph nodes or metastasis involve. 

Stage IIIC – T3, N1, M0. The tumor is larger than 5cm, has spread to lymph nodes but no metastasis) or T4, N1, M0 wherein the tumor is any size and growing into nearby organs, has spread to lymph nodes but no metastasis. 

Stage IV. This is when any T, any N, M1 tumor can be any size may or may not grow into nearby organs or spread to nearby lymph nodes and it has spread to distant organs such as liver or lungs. 

Helping Through The Stages 

Getting a diagnosis of cancer can be a life-altering situation. There is no degree of putting the icing on the cake when cancer is the main topic. Relationship problems can occur as deterioration of physical and psychological dimension progress. Family members and significant others should be there with the person when this happens. A person diagnosed with cancer needs all the love and support they can need during this ordeal. Whatever stage they are in, continuous physical, emotional, psychological, and spiritual support is highly encouraged.  

References:  

https://cancerstaging.org/Pages/default.aspx 

https://www.cancer.org/cancer/anal-cancer/detection-diagnosis-staging.html 

www.cancercenter.com/anal-cancer staging/  

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Anal cancer and its treatments like chemotherapy, radiation, and surgery may affect the patient in a variety of ways. It can change not only the physical but also functional, social and psychological aspects of a patient’s quality of life as well as their families. They need total support from the time of the diagnosis, course of treatment, and long-term monitoring or follow up after. The following are some effects of cancer that need to be addressed accordingly. 

Cancer May Affect Patients’ Nutritional Status. They may experience poor appetite since they are emotionally-stressed about their illness, from the effects of treatment regimen like nausea and vomiting and diarrhea, and the extent of their disease that may affect the metabolism of essential nutrients needed by our body. Dieticians or nurses providing direct care can provide nutritional education and counseling to the patient and family. The family should be involved as part of the team as they can afford psychosocial support towards patients’ dietary practices. Medications like appetite stimulants and vitamins as prescribed can help. 

“While the emotional, practical, social, and spiritual impact of cancer is often in the form of distress, many people are positively affected by cancer. As patients and/or family members experience this positive influence on their lives, it is often something they talk with our therapists about to make sense of for themselves.” says Cheyenne Corbett, PhD, LMFT

Impaired Skin Integrity Problems. Skin integrity of anal cancer patients especially with a wound or after surgery like abdominoperineal resections with permanent colostomy needs to appropriate care. Stoma care nurses can provide education about colostomy care and help patients adapt to having a colostomy. Patients receiving radiation can experience skin changes during or after treatment. Training regarding skin care by keeping the affected clean and well hydrated and protection for the further injury like avoidance of constrictive clothing and exposure to sunlight should be provided. 

Infection. Neutropenia is one of the most common side effects on cancer patients receiving chemotherapy. It is a condition in which there is a marked decreased of circulating neutrophils, our first line of defense against infection. Hand washing is one of the critical intervention to prevent infection. Maintaining personal hygiene, proper oral care, safe food handling and limiting visitors are some precautionary measures also. Oral antibiotics are given as prophylaxis in neutropenic patients, and once infection has been established, antimicrobial treatment should be started immediately.  

Sexual Practices. The sexual problem also arises in anal cancer patients. Some lose interest in sex at the time of diagnosis, during treatment and post-treatment. This might be due to the physical or emotional effect of cancer. The patient can seek help from doctors or do counseling on how to cope and improve the sexual relationship. 

Psychological Effects. Patient diagnosed with anal cancer also needs psychosocial care as well as their families. A cancer diagnosis can create stressful feelings for the patient and their family.  It demands individual and entire family positive outlook and active involvement on how to cope with the illness.  Extended support from community, friends or groups like cancer society people that can provide emotional support, is a big help. 

“There are so many things that cancer patients need to communicate to their loved ones. These range from sharing the diagnosis, what the treatment will look like, specifics about how the treatment is affecting them, where they need help, where/when they need privacy, financial decisions, end-of-life planning and decision making, etc.” says June C. Foss, LMFT.

Cancer is one of the leading cause of death worldwide. But remember that fighting cancer is not an individual battle. It needs support that involves a multidisciplinary team with the same end in providing a good quality of life for all cancer patients. “Many cancers can be prevented and regress if carbohydrate intake is restricted.” says Jack C Westman M.D.…