Bleeding, a lump, itching, and discomfort are the classic hemorrhoid symptoms. They are also the classic early symptoms of anal cancer. The overlap is why anal cancer is so often diagnosed late, and why "it is probably just hemorrhoids" is not a conclusion anyone should reach on their own.
Symptoms that will not go away deserve an exam, not a guess. See a board-certified colorectal surgeon.
Book a virtual consultHemorrhoids are extremely common; roughly half of adults have symptoms at some point. Anal cancer is rare, with about 10,000 cases a year in the United States. Because the odds favor hemorrhoids, patients and sometimes physicians treat every anal symptom as a hemorrhoid, and anal cancer gets weeks or months of hemorrhoid cream before anyone looks closely.
The two conditions share the same short list of symptoms: bright red bleeding, a lump or swelling at the anus, itching, pain, and a feeling of fullness. Nothing about the symptoms alone tells them apart reliably. What separates them is the pattern over time and the findings on examination.
None of these findings means cancer. They mean the diagnosis of hemorrhoids should be confirmed by someone who can see the anal canal, not assumed.
Most anal cancers are caused by persistent infection with high-risk strains of human papillomavirus (HPV). Risk is higher in people with a history of HPV-related conditions such as anal or genital warts or abnormal cervical screening, people living with HIV or other causes of immune suppression, organ transplant recipients, smokers, and people over 50. Men who have sex with men and women with a history of cervical or vulvar dysplasia also carry higher risk. For people in these groups, anal symptoms should be examined promptly rather than watched.
HPV vaccination lowers the risk of anal cancer substantially and is recommended through age 26, with shared decision-making up to age 45.
The evaluation is quick and usually done in the office. It starts with a careful look at the skin around the anus, then a digital rectal exam, which can detect most anal canal tumors by touch. An anoscope, a short lighted tube, gives a direct view of the anal canal where internal hemorrhoids and most anal cancers live. Anything that looks unusual is biopsied, and the biopsy is what makes the diagnosis. High-resolution anoscopy is used for patients at elevated risk to find precancerous changes before they become cancer.
Because rectal bleeding can also come from higher in the colon, patients over 45 or with a family history of colorectal cancer may also need a colonoscopy.
Caught early, anal cancer is highly treatable. Most cases are treated with combined chemotherapy and radiation rather than major surgery, and five-year survival for localized disease is above 80 percent. Very early, small tumors at the anal margin can sometimes be removed with a local excision. The single biggest factor in outcome is how early the diagnosis is made, which is exactly why persistent "hemorrhoid" symptoms need an exam.
Most anal symptoms are hemorrhoids, and hemorrhoids are easy to treat. But the same symptoms can be the first sign of anal cancer, and the only way to know is an examination. If bleeding, a lump, or discomfort has lasted more than two or three weeks, or if you are in a higher-risk group, see a colorectal surgeon. Dr. Albert Chung evaluates these symptoms in the office and treats both hemorrhoids and anal cancer in Rancho Santa Margarita.
You cannot tell reliably from symptoms alone. Hemorrhoid symptoms usually come and go and improve with fiber and sitz baths; a firm or growing lump, a sore that will not heal, constant bleeding, or symptoms lasting more than a few weeks need an examination by a colorectal surgeon.
No. Hemorrhoids are swollen blood vessels and do not become cancer. The concern is that anal cancer can be mistaken for hemorrhoids and go undiagnosed while it grows.
Early anal cancer may cause bleeding, a lump or hard area at the anus, itching, pain, a sore that does not heal, or a feeling of fullness. Some people have no symptoms at all, which is why higher-risk patients benefit from screening.
People living with HIV, organ transplant recipients, people with a history of HPV-related disease, and other immunocompromised patients benefit from anal cancer screening with cytology or high-resolution anoscopy. Ask a colorectal surgeon whether screening is right for you.
Dr. Albert Chung is a double board-certified colorectal surgeon who evaluates anal symptoms in the office and treats everything from hemorrhoids to anal cancer.
Book a virtual consultCall (714) 988-8690