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

What is a bowel perforation or hole in your colon and what are the symptoms? Who is at risk? And how is a perforation treated? Overview Your colon is composed of layers of smooth muscle and mucous membranes. The innermost layer, called the mucosa, is soft and pliant—similar to the tissues in your mouth. Bowel perforations occur when a hole is made in this lining, often as a result of colon surgery or serious bowel disease. A hole in the colon then allows the contents of the colon to leak into the usually sterile contents of your abdominal cavity. Symptoms The symptoms of a bowel perforation can vary and may come on slowly or rapidly depending on the underlying cause. Symptoms may include: Abdominal pain (often severe and diffuse) Severe abdominal cramping Bloating Nausea and vomiting A change in your bowel movements or habits. Rectal bleeding Fever (usually not immediately) Chills Fatigue Risk Factors Scientists have found that a number of factors may increase your risk of developing a bowel perforation. These include both factors involved in surgery or a procedure (iatrogenic causes) and bowel diseases characterized by inflammation. Risk factors may include: Recent or prior abdominal. Recent or prior pelvic surgery. Age greater than 75. History of multiple medical problems. Trauma to the abdomen or pelvis (such as in an automobile accident.) A history of diverticular disease. A history of inflammatory bowel disease. Colon cancer Use of the monoclonal antibody immunotherapy drug ipilimumab. Pelvic adhesions (scar tissue, usually related to previous surgeries.) Female gender (women typically have a more flexible colon, which can lead to accidental perforation during medical procedures, including a colonoscopy.) Diagnostic and surgical procedures involving the digestive tract, abdomen, or pelvis. Risk factors for a perforation during a colonoscopy include being female, older age, a history of diverticular disease, and bowel obstructions. Causes Bowel perforations may occur spontaneously (unexpectedly) as a result of a medical condition or instead be a complication of various diagnostic and surgical procedures which accidentally create a hole in the colon. Trauma, especially blunt trauma to the abdomen, is also an important cause of bowel perforations. Procedure associated causes include: Enema – An improperly or forcefully inserted rectal tube for an enema can rip or push through the colon lining. Bowel preparation for colonoscopy - Rarely, the bowel preparation for a colonoscopy can result in a perforation. This is more common in people with a history of constipation. Sigmoidoscopy – Although the endoscope for a flexible sigmoidoscopy is flexible, perforation remains a risk, but a rare one. Colonoscopy – The tip of the endoscope has the potential to push through the inner lining of the colon, although this is a rare complication of the procedure and is not seen in the virtual colonoscopy. Perforation of the bowel associated with a colonoscopy is more common in those who have the severe acute disease of the bowel as well as those who are on steroid medications. The colonoscopy perforation rate appears to be around 1 in 1400 people who have screening colonoscopies and 1 of 1000 people who have a therapeutic colonoscopy (for example, to remove a polyp.) Abdominal or pelvic surgery, particularly colon surgery as for colon cancer. Causes of spontaneous bowel perforation (those unrelated to surgery or procedures) include: Inflammatory bowel disease/colitis such as Crohn's disease and ulcerative colitis. The lifetime risk of a bowel perforation with Crohn's disease is between one and three percent, making this a very common cause. Severe bowel obstruction, especially when the colon is "weakened" by diverticular disease, another process, or cancer. Trauma. Ischemic bowel disease (when the blood supply to the colon is compromised.) Colon cancer. Foreign body ingestion - Most commonly due to the ingestion of fish bones, and bone fragments, as well as non-food items. Severe bowel impaction. Diagnosis If your doctor suspects a bowel perforation, she can order tests to confirm her suspicion. A simple abdominal x-ray may show gas outside the colon but is not often diagnostic. A CT scan of your abdomen with or without contrast or a barium enema or swallow may be needed. A complete blood count may show an elevation of your white blood cell count if the perforation has been present for a while, or evidence of anemia due to bleeding. Small perforations may sometimes take several imaging studies and time to accurately diagnose. Treatment Perforation of the bowel is considered a medical emergency and requires immediate treatment. Left untreated, the contents of the bowel can leak out and cause inflammation, infection and even abscesses in your abdomen. The technical name for this is peritonitis, which is a painful precursor to sepsis—or a body-wide infection. The majority of perforations are surgically repaired. Depending on the location and size of the tear, the doctor might be able to fix it through an endoscope, similar to the one used during a colonoscopy—but this is not an option for everyone. Open bowel surgery may or may not result in a stoma and colostomy: an artificial opening outside of your stomach where stool drains into a small bag until the bowel is healed. Complications Complications of untreated perforation may include: Bleeding Infection (peritonitis and sepsis) Death Complications depend on a person's general health, as well as the amount of time it has taken to diagnose and treat the perforation. Recovery During your initial recovery period, you will not be able to drink or eat anything by mouth. This is called resting the bowels and allows the inner lining time to heal properly. You will also have a nasogastric tube in place to drain the contents of your stomach for a period of time. You may receive intravenous antibiotics and nutrition for a few days if you're in the hospital. Although you may be anxious to return to your normal routine, it's important that you give your colon time to heal properly, and follow your doctor's orders. The Bottom Line Bowel perforation may occur spontaneously, such as with inflammatory bowel disease, or during surgery or diagnostic tests. Symptoms may come on rapidly, or instead slowly, and should be considered in anyone who has risk factors for a perforation combined with risk factors for the condition. When caught early, there are different treatment options available, but even with surgery (which is most often required) the bowel can often be preserved and repaired without a colostomy. Recovery can take time, both for healing, and to correct and risk factors which led to the perforation.

Appendicitis is the swelling of the appendix which is present in the right side of the abdominal region. It is generally a 5-10 cm tube connected to the large intestine. If it is not treated at the right time it can burst out, spilling infection in the abdominal cavity that can be more fatal. Appendicitis can occur anytime between the age of 10 to 30. Both men and women can suffer from this condition. The infectious material or the puss which is formed inside the appendix can be more dangerous to life as it spreads in the entire abdominal cavity. Patient suffering from appendicitis ignore this because it seems like a common stomach pain. There are many causes that can cause appendicitis out of which one common cause is the blockage or obstruction in appendix. Obstruction can cause due to the bacteria multiply inside the organ causing the increase in the infection inside the appendix forming a puss. Symptoms: Patient suffering from appendicitis commonly have a pain in the right side of the abdomen. A raise temperature, means, they may feel that they are having fever. Nausea and vomiting, other symptoms includes abdominal swelling, inability to pass wind, painful urination. Dr Jiten Chowdhry notes that these treatments can cause appendix to burst if the patient is suffering from appendicitis. If you have tenderness in the right side of the consult a doctor. Diagnosis: Abdominal examination is done to detect the inflammation. A urine test is done. Rectal examination, CT scan and blood test is done to diagnose the appendicitis condition properly. Treatment and Recovery: Laparoscopic surgery is performed where a small incision is done in the lower right side. The recovery time is very short and the patient can get discharged within 3 to 4 days of the surgery.

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.

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