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Old 12-07-2008, 08:52 PM   #1
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Just found out I have anal warts, am I at risk for anal cancer?

I was diagnosed a few months ago with genital warts and just today, I noticed two small bumps right outside my anus. I am pretty sure they are warts. I have not been with anybody since I was infected by my ex-boyfriend. We only had anal sex one time, and he was only inside of me a few seconds before he pulled out. I guess that was was enough to give me anal warts.

As further background, I had an abnormal pap right after my initial diagnosis of GW, and had a colposcopy done. They found one small area on my cervix which the clinician said was very mild; the lab results said it was CIN I, and the clinic told me just to wait and see if my immune system clears it and to have another pap smear in a couple months.

My fear now is that I might develop warts inside my anal cavity, which might lead to anal cancer someday. I am about to turn 30, and am good health, but I'm worried that now I'm at risk for developing this later. Also, I'm worried that I might get internal vaginal warts, even though the colposcopy did not detect anything. What are the chances of me developing internal vaginal warts and internal anal warts?

 
Old 12-08-2008, 06:44 PM   #2
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Re: Just found out I have anal warts, am I at risk for anal cancer?

I highly suggest you call your doctor since you are finding new warts, especially since they are in a different orafice. You might ask if you need to see a gastroenterologist.

I can't answer your question about fears of anal cancer. I personally think anyone who has had intercourse is at risk of being exposed to HPV. I don't know at all, but figure the strains that cause genital warts (low risk) are not the type that can lead to cancer (of any of the genitals: cervix, vagina, vulva, anus, penis, mouth/throat).

I *think* your doctor could do an anal swab. I *think* they use the same types of swabs that are used in the vagina, but they use it in/on the anus. I don't know for sure.

Please let us know what your doctor says.

 
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Old 01-22-2009, 12:48 PM   #3
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Re: Just found out I have anal warts, am I at risk for anal cancer?

Yes, the human papiloma virus does seem to be precursor to cancer but to what degree on body areas other than the cervix is not completely known or understood. HPV can be spread orally, vaginally, and annally just like herpes. Dr's believe that Gardisil helps to reduce the occurance of HPV related cervical cancer but either it's ineffective or the jury is still out on it's effect on HPV related anal, oral and laryngeal cancer.
Since you've just been diagnosed I'm sure that your Dr is planning on treating you. It's important that you are completely honest with your provider get regular screenings for cancer. If you've had oral sex with this partner, it would be wise to at least inquire about getting a laryngoscopy. Warts can form along the mucus membranes anywhere that contact occured and untreated warts are more likely to cause problems. Since these warts are caused by a virus, you will have to be very procactive with your medical care. Just because you don't have active infection doesn't mean that the virus isn't at work altering the cells in your organs. Early detection and treatment are your best defenses so keep all survellience and screening appointments.

 
Old 01-22-2009, 03:13 PM   #4
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Re: Just found out I have anal warts, am I at risk for anal cancer?

Having personally experienced having anal cancer caused by HPV in addition to condyloma (warts in the rectum at that time also - 1991) I can speak a bit on this. The warts I had at that time were fulgurated (burned off) and sutured. The invasive squamous cell cancer of the anus had to be completely resected followed by radiation and chemo. This cancer was caused however by high risk HPV not low risk HPV (GW). I noticed what could have been considered a wart near the anus as you described however it was not a low risk HPV "wart" but AIN3 (intraepithelial neoplasia 3 or in situ) precancerous level just before invasive in 2006. I have had three laser surgeries and now they have found me positive for squamous cell carcinoma in the rectum.

Just because it may appear to be a wart, I would strongly suggest that you go to a colorectal surgeon to have this biopsied. A gastroenterologist would typically not do this although some GYN's will also but a colorectal surgeon would be your best bet if your GYN is not comfortable handling that area. Since you can have both high and low risk HPV simultaneously you need to be aggressive in getting this biopsied.

Guardasil has not been tested with respect to any other cancer except cervical. Conceptually, the vaccine should prevent the cancers caused by HPV regardless of the place of origin (cervix, vagina, anus etc) but there is no documented study to show the vaccine reduces the risks of these cancers. Hopefully Merck will do more research along these lines.

Given my very dire history with HPV I would not allow nor would I allow my doctor to just sit and wait. You need to get this biopsied and not presume it is a wart as opposed to AIN. By the way, you do not have to have anal intercourse to develop HPV around the anus. Also, when I hear people talk about colposcopies it is typically of the cervix however this procedure can also be performed for the external genitalia including the anal area.

When I was pregnant, I got what I thought were bad hemorrhoids and the colorectal surgeon I saw while I was pregnant gave me a steroid cream to use which I used just about every day because of the itching and burning. After the hemorrhoidectomy (after I delivered my daughter) it turned out these weren't hemrorhoids at all but warts and the steroid cream he gave me only lead to rapid progression of the virus to a true invasive cancer!

I'm not trying to scare you but I was diagnosed when I ws 29 and I do not want to see anyone go through what I have these past 22 years so please, if you have any lesion get it biopsied and do not just assume or let your doc assume it is a wart.

 
Old 01-23-2009, 01:02 PM   #5
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Re: Just found out I have anal warts, am I at risk for anal cancer?

Dragonfly, I just came back from a visit with the colorectal surgeon today. I no longer have any external anal warts (they were burned off last month and I've been applying Aldara) but I just wanted to have that area checked out. The doctor examined me and did not find any lesions externally or internally. I am wondering how you first discovered that you might have internal warts? Did you have any bleeding or feel any internal lumps that led you to believe something was going wrong in there? The doctor told me to come back in a couple months for monitoring and to make sure there is nothing suspicious externally or internally.

 
Old 01-25-2009, 08:42 PM   #6
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Re: Just found out I have anal warts, am I at risk for anal cancer?

Actually I had been dealing with HPV for about five years. I had severe recurrent lesions on the vulva requiring numerous laser surgeries and finally the decision was made to do a vulvectomy. (I also had CIN3 and VAIN2/3) so it was affecting everything. I had my surgery scheduled for the vulvectomy but then found out I was pregnant so it was put on hold for 8 months.

During this time I developed hemorrhoids and went to see a colorectal surgeon about removing them after delivery. He gave me this steroid cream to use every day because the itching and pain was driving me crazy.

He did the hemorrhoidectomy and I get a call 2 weeks later telling me that the pathology came back invasive squamous cell cancer of the anus. Well these "hemorrhoids" weren't hemorrhoids at all but warts which had grown to about the size of the first digit of the pinkie finger. He had me applying STEROID CREAM to these every day for months. Between this and the immunosuppression during pregnancy, the HPV went crazy and the progression to malignancy which should have taken conceivably years happened in a matter of months.

I had to have an anal resection along with the vulvectomy and during that surgery the surgeon also checked internally and fulgurated (burned off) a few warts he found internally.

I was in good shape for 15 years until 2006 when I again developed AIN3. I had a small "skin tag" type lesion at the anus which was painful, sometimes would bleed and itched. It was always that itch till its raw type of itch that clued me into the fact I was getting another lesion. I has surgery for this in 2006 and then last August (don't ask me why, hypervigilance perhaps) I did a digital rectal exam while in the shower because I had been having some bleeding. I found a lesion and when the surgeon went to do the laser for the AIN he checked internally. Despite my being adamant about him doing a biopsy he didn't. Six weeks later when the area healed well enough to check it again it was still there so I went back to the doc and he said he never did the biopsy because it looked normal. So back I go for ANOTHER surgery to do these biopsies WHICH 2 out of 4 came back positive for SCC (squamous cell carcinoma). Was referred to a colorectal surgeon who did colonoscopy and also said area looked normal. Third surgery they did rectal "mapping" with 14 biopsies and again it looked normal BUT 2 were positive for SCC. So now I've been referred to radiation oncologist but since I previously had radiation in 1991 they cannot do any more external beam radiation. Chemo will not work because it is not invasive yet (thank God) but all anyone can seem to recommend is to have an APR (abdominoperitoneal resection) which basically means, cut out the rectum, permanently close the anus and get a colostomy. I'm not anywhere near being psychologically prepared for that at this point so I'm pretty much in limbo here.

Sorry this is so long but hard to respond without giving the details. Hope this helps.

 
Old 01-26-2009, 01:04 AM   #7
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Re: Just found out I have anal warts, am I at risk for anal cancer?

Hi Dragonfly, I am so sorry that you've had to deal with the horrors of this terrible virus for so long. I really hope things get better for you!

I am trying to be vigilant about checking down there to see if there are any lesions either on my vulva/vagina or anal area. You had mentioned that you had to get a vulvectomy. Did having that that eliminate the VIN completely?

I am asking because I have noticed this small red bump on my inner labia. It does not hurt or itch but it has been there for about a month now. I've been applying Aldara on it but it doesn't seem to be working. It does not look like the other genital warts I've treated so I'm kinda worried that it might be a VIN lesion. (I've already been diagnosed with CIN I).

Can you tell me what are the symptoms to look out for in VIN? I do have an appointment with the gynocologist next month but in the meantime, I'm trying to educate myself on VIN so I know what I might be dealing with.

Also, I'm still so freaked out by the idea that I might later develop AIN. I have noticed a kinda very small lumpy spot (doesn't hurt or itch) right outside the anus. It kinda follows the contour of how the anus looks, if that makes any sense. The colorectal surgeon did not seem to think it was anything alarming. I'm going to monitor it and might get a second opinion. If it starts to itch or bleed, would this be a sign that it might be an AIN lesion?

Thank you so much for your input....

 
Old 01-26-2009, 04:46 PM   #8
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Re: Just found out I have anal warts, am I at risk for anal cancer?

Hi Blue,

The Aldara is only approved for use on genital warts (low risk HPV usually type 6 or 11 that causes these) which is obviously very different from high risk HPV on which Aldara is not approved, nor (I was told by my doctor) will it work on high risk HPV lesions. Guess that's why it's only approved for low risk, duh.
Anyway, not everyone goes through the horrors I have. I am more the exception than the rule, but it is important for people to understand what can happen and to not take this virus lightly even if it does seem to go away for quite some time.
If your colorectal surgeon doesn't feel it's anything perhaps it isn't. However, I would recommend before your appointment next month you call and ask them to schedule time to do a colposcopy. This can be used externally, including in the anal area to look for HPV lesions. Most gynecologists done have an issue doing a colposcopy in that area since they are in the vicinity anyway. I'm sure he would refer you out if he were uncomfortable proceeding should it show HPV.
Like I have mentioned in other posts, my most sensitive indicator of a newly arising HPV lesion was the intense itching. When they do a colposcopy they use acetic acid (vinegar basically). I would apply white vinegar and could actualy see the lesions become white and very obvious as it took up the vinegar solution.
Yes, the vulvecotmy did finally clear up the VIN but I went through years of "_ell" in the interim. Sometimes up to six biopsies at a time, not fun. Mine were also VIN3 so they were all high grade lesions and obviously this simply could not continue to go as it had for four years.
I wouldn't get too freaked out just yet about the AIN. Try to take it a step at a time. I'm sorry but I don't recall is you indicated what strains of HPV you have. Was HPV DNA analysis even done?
During my radiation therapy I had a huge lesion show up on my left labia about the size of my pinkie finger. Doctors couldn't believe this still showed up even during radiation and they did a LEEP procedure to remove it. It was VIN3 and never recurred.
Try to get that colposcopy scheduled with your next visit and let me know how it goes.

 
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