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 signs Diagram of the sphincter Common symptoms of anal cancer may include rectal bleeding noticeable if there is blood on feces or toilet paper pain in the anal area lumps around the anus, which may be mistaken for piles, or hemorrhoids mucus or jelly-like discharge from the anus anal itching changes in bowel movements, including diarrhea, constipation, or thinning of stools fecal incontinence, or problems controlling bowel movements bloating women may experience lower back pain as the tumor presses on the vagina women may experience vaginal dryness. Causes In 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 factors Multiple 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. Treatment Treatment 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. 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. 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 radiotherapy Most 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 constipation soreness and blistering around the target area, which is the anus a higher susceptibility to infections during treatment fatigue loss of appetite nausea or vomiting mouth ulcers or sore mouth loss of hair narrowing and dryness of the vagina a low white blood cell count, increasing the risk of infection anemia, due to a low red blood cell count a low platelet count, raising the risk of bruising or bleeding dry skin rashes muscle and nerve problems excessive coughing and sometimes breathing difficulties fertility problems

An Inguinal Hernia is a gap in the strong tissue in the abdomen which holds the stomach muscles. It occurs in the abdominal muscles and weakens them which cause a bulge in the stomach. Hernia causes discomfort and pain in the stomach. Both men and women can get inguinal hernia. Symptoms of Inguinal Hernia: It can cause a severe pain in abdomen especially in pelvis region. The later symptoms also result in swelling and severe pain in the testicles or groin area. Apart from that the patients who are suffering from inguinal hernia have a problem in walking straight and straining the abdominal muscles by lifting up some things. Diagnosis: The diagnosis of this type of hernia is physical examination as the doctor can see and feel the bulge. For further diagnosis other tests like ultrasound and CT scan is also done. Treatment and Recovery: The surgery of inguinal hernia is done with laparoscopic approach with the help of instrument called laparoscope. Small incisions are made in the abdomen to insert the laparoscope and treat the hernia. This technique is also known as keyhole surgery. Patient takes about 1 to 2 weeks to get properly recover after the surgery. They have to wait atleast for 4 weeks to start exercising after the operation.

Hernias will not go away by themselves. Surgery is the only way to repair a hernia. A hernia repair returns the organ or structure to its proper place and fixes the weakened area of muscle or tissue. Having surgery is a big decision. It can be tempting to put it off, and that may be okay in some cases. Before you decide, make sure you understand the risks and benefits of your decision. Here are some things to consider and discuss with the doctor who is helping you make the decision. How Is the Hernia Affecting You? The first thing to consider is whether or not you are experiencing symptoms. Not everyone has symptoms with a hernia, especially small ones. When symptoms occur, the most common one is pain. Others can include a feeling of heaviness or fullness in the belly or groin. Whether you have symptoms or not, a hernia can also interfere with your leisure activities and your work. So you also need to recognize if you are taking time off from work or interests due to your hernia. Delaying surgery may mean you spend more time away from work and fun instead of returning to activities after recovery. If you have symptoms, especially pain, your doctor is likely to recommend surgery. But what if you don’t have symptoms or they are minimal? In this case, your doctor may recommend watchful waiting. Before you agree to watchful waiting, be sure your doctor knows the whole story. Be honest about any limitations your hernia puts on your time and activities. What Are the Risks of Waiting? 1. Hernias can become incarcerated. One potentially serious risk of not fixing a hernia is that it can become trapped outside the abdominal wall—or incarcerated. This can cut off the blood supply to the hernia and obstruct the bowel, resulting in a strangulated hernia. This requires urgent surgical repair. Not all hernias progress to this point, but it is a risk nonetheless. Avoiding an emergency situation that you can’t control is one reason to consider not delaying surgery. 2. Hernias grow. A more likely scenario is that your hernia will continue to grow and weaken with time. This is likely to increase your symptoms, including pain, and cause more changes to your lifestyle. Surgeons know that smaller hernias are easier to repair than larger hernias. Going ahead with surgery instead of delaying it can prevent your symptoms from getting worse. It can also help you avoid losing work or missing activities. 3. Hernias require surgery eventually. Even if you aren’t having symptoms, you may still want to consider having surgery sooner rather than later. Surgery for a hernia is somewhat inevitable in most cases. Research shows that most people with hernias have surgery within 10 years. Keep in mind that delaying surgery until your hernia is larger and the muscles are weaker may make surgery and recovery more difficult. 4. Your overall health may change. Your age may determine whether waiting is a risk for you. Putting off surgery for years down the road may mean you are not in as good overall health or physical shape. This will also affect your surgery and recovery. So having surgery at a younger age can be beneficial. However, if you are elderly (older than about 75 years of age), not very active, and your hernia isn’t causing problems, it may be better to not fix it. The risks of surgery may outweigh the benefit of repair. Making the Decision Surgery is never convenient and life is always busy. Being in control of when you have surgery is a huge benefit of not delaying your hernia repair. You can schedule your surgery at your convenience. And if you are a candidate for laparoscopic hernia surgery, you’ll be back to life and work sooner than in years past. Surgery should be easier on you and recovery will likely be smoother at a younger age and with a smaller hernia. Ultimately, your doctor is best able to help you decide whether watchful waiting or surgery is the best option for you.