Farrah Fawcett, the face of a new generation in the 1970s, re-emerged reluctantly in 2006 as the face of anal cancer.
Reluctantly, because of the stigma anal cancer carries — most cases are caused by the human papillomavirus, the sexually transmitted disease that is responsible for most cervical cancers and some oral cancers.
But Fawcett ultimately went public with her cancer fight, chronicling her treatments in Germany in a documentary that aired earlier this year.
Anal cancer is still relatively rare in the U.S. but has been on the rise in recent years, mostly because of the increased spread of HPV. The American Cancer Society estimates there will be 5,290 new cases of anal cancer in 2009. About 3,190 will occur in women and 2,100 in men.
Risk factors for the disease include having unprotected sex with multiple sex partners, having anal sex, smoking and having a compromised immune system or HIV.
Aggressive treatment — including surgery, chemotherapy and radiation — when caught early, is usually successful, but can be disfiguring, said Dr. Stan Gerson, director of the Ireland Cancer Center of University Hospitals Case Medical Center and the director of the Center for Stem Cell and Regenerative Medicine of Cleveland, Ohio.
“It is absolutely curable, but the side effects can be significant,” he said. “There can be significant bleeding in the area because you end up with a lot fragile blood vessels and tissue.”
Several months after completing standard treatments for cancer in the U.S. in 2006, Fawcett declared herself cancer-free.
But the cancer returned in 2007, and Fawcett began seeking alternative treatments in Germany.
Women are more likely to have cancers inside the anus (the anal canal), while anal tumors in men tend to develop on the outside of the anus. For this reason, it’s often harder to diagnose cancer in women, Gerson said, especially since women are less likely than men to have invasive procedures such as colonoscopies.
Most people who get anal cancer will be cured, according to the American Cancer Society. But it can be fatal if not caught early. The cancer society estimates that 710 people (450 women and 260 men) will die from anal cancer in 2009.
Death is almost certain if the cancer spreads to a vital organ or to the lymph nodes, bones or blood. Fawcett’s cancer spread to her liver.
“When it spreads to the liver, it is Stage 4 cancer,” said Dr. Deepjot Singh, a hematologist and oncologist with University Hospitals Case Medical Center in Ohio. “The standard treatment is usually aggressive chemotherapy and radiation. Because anal cancer is still so rare, it’s very hard to put a five-year survival rate on Stage 4 anal cancer. It really all depends on how the person responds to treatment.”
Singh, who did not treat Fawcett, said when cancer spreads through the body as it had in Fawcett’s case, there is no cure. At that point, doctors work to extend the life and the comfort of the patient as long as possible.
“When a cancer spreads to different parts of the body, the person usually experiences a decrease in appetite, weight loss, fluid collection in the belly, nausea, vomiting, weakness, fatigue, sometimes even jaundice,” he said. “Also, your blood becomes thinner and you can be prone to disease. With Stage 4 cancer, the goal of treatment is to improve survival and quality of life, rather than eradicating the disease.”