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Chest/Heartburn not responding to anti-acidity medications.Long standing hyperacidity (to detect Helicobacter Pylori infection ).Severe nausea/recurrent vomiting.Upper abdominal (epigastric ) pain.Difficulty in swallowing (Dysphagia,odynophagia).Feeling of indigestion/Gas bloat/Excessive flatulence.Unexplained weight loss.Chronic anaemia.Chronic diarrhoea.Unexplained chronic cough.Hematemesis or malena (black stools).Diagnosis of early esophageal/stomach cancer.Endoscopic extraction of accidentally swallowed

Anal cancer is rare, but the number of new cases is rising. According to the American Cancer Society, in 2017, there are likely to be about 8,200 new cases, of which 5,250 will affect women and 2,950 will affect men. Around 1,100 people are expected to die from anal cancer, including 650 women and 450 men.Various risk factors are linked to anal cancer, but infection with two types of the human papilloma virus (HPV) appear to underlie 79 percent of cases.Anal cancer is rare before the age of 35 years. The average age of diagnosis is in the early 60s. Men have a 1-in-500 chance of getting anal cancer, and the risk is slightly higher in women.Symptoms and signsDiagram of the sphincterCommon symptoms of anal cancer may includerectal bleeding noticeable if there is blood on feces or toilet paperpain in the anal arealumps around the anus, which may be mistaken for piles, or hemorrhoidsmucus or jelly-like discharge from the anusanal itchingchanges in bowel movements, including diarrhea, constipation, or thinning of stoolsfecal incontinence, or problems controlling bowel movementsbloatingwomen may experience lower back pain as the tumor presses on the vaginawomen may experience vaginal dryness.CausesIn anal cancer, a tumor is created by the abnormal and uncontrolled growth of cells in the anus.The anus is the area at the very end of the gastrointestinal tract. The anal canal connects the rectum to the outside of the body. It is surrounded by a muscle known as the sphincter. The sphincter controls bowel movements by contracting and relaxing. The anus is the part where the anal canal opens to the outside.The anal canal is lined with squamous cells. These flat cells look like fish scales under the microscope. Most anal cancers develop from these squamous cells. Such cancers are known as squamous cell carcinomas.The point at which the anal canal meets the rectum is called the transitional zone. The transitional zone has squamous cells and glandular cells. These produce mucus which helps the stool, or feces, pass through the anus smoothly.Most anal cancers are squamous cell carcinomas, but adenocarcinoma can also develop from the glandular cells in the anus.Risk factorsMultiple risk factors have been studied that are linked to anal cancer. They include any or a combination of the following:Human papilloma virus (HPV): Some types of HPV are closely linked to anal cancer. Around 79 percent of people with anal cancer have HPV 16 or 18, and 8 percent have other types of HPV.Multiple sexual partners: This activity increases the risk of contracting HPV, which, in turn, increases the risk of anal cancer, which is a known risk factor.Receptive anal intercourse: Men and women who receive anal intercourse have a higher risk of developing anal cancer. Men who are HIV-positive and who have sex with men are up to 90 times more likely to develop anal cancer, compared with the general population.Other cancers: Women who have had vaginal or cervical cancer, and men who have had penile cancer are at higher risk of developing anal cancer. This is also linked to HPV infection.Age: Anal cancer, like most cancers, are more likely to be detected at an older age.A weakened immune system: People with HIV or AIDS and those who are taking immunosuppressant medications after a transplant are at greater risk.Smoking: Smokers have a significantly higher risk of anal and other cancers than non-smokers.Benign anal lesions: Irritable bowel disease (IBD), hemorrhoids, fistulae, or cicatrices have been linked to anal cancer. Inflammation resulting from benign anal lesions may increase the risk.TreatmentTreatment for anal cancer will depend on various factors, including how big the tumor is, whether or not it has spread, where it is, and the general health of the patient. Surgery, chemotherapy, and radiation therapy are the main options.SurgeryThe type of surgery depends on the size and position of the tumor.ResectionThe 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 resectionThe 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. A bag is placed over the stoma, or the opening. The bag collects the stools outside the body. A person with a colostomy can lead a normal life, play sports, and be sexually active.Chemotherapy and radiotherapyMost patients will probably need chemotherapy, radiation therapy, or both.Radiation therapy may be combined with chemotherapy to destroy anal cancer cells. Treatments may be given together or one after the other. This approach increases the chance of retaining an intact anal sphincter. Survival and remission rates are good.Chemotherapy uses cytotoxic drugs that prevent the cancer cells from dividing. They are given orally or by injection.Radiotherapy uses high-energy rays that destroy the cancer cells. Radiation can be delivered internally or externally.Radiotherapy and chemotherapy have adverse effects, and combining them may make the side effects more acute.Side effects may include:diarrhea or constipationsoreness and blistering around the target area, which is the anusa higher susceptibility to infections during treatmentfatigueloss of appetitenausea or vomitingmouth ulcers or sore mouthloss of hairnarrowing and dryness of the vaginaa low white blood cell count, increasing the risk of infectionanemia, due to a low red blood cell counta low platelet count, raising the risk of bruising or bleedingdry skinrashesmuscle and nerve problemsexcessive coughing and sometimes breathing difficultiesfertility problems