Hi Dr. Bruce,

Could you tell me, what would be some warning signs of anal cancer? I occasionally have a little blood in my stools. What would you advise?

Thank you, Concerned

Anal cancer can indeed present at change in bowel habit; blood in stool, pain with bowel movements, lump or bump in the area, and so on. Most anal cancers in HIV'ers are related to the human papillomavirus (HPV); HPV causes anal warts. Many anal cancers arise in the setting of anal warts. It is important for patients with external warts to have an internal anal examination to look for both internal anal warts and early changes of cancer. Most experts recommend that gay men, and particularly those with a history of receptive anal intercourse, have at the very least an anal PAP smear. If there are any abnormalities on the PAP smear or if there are any symptoms, then an internal examination should be performed. Some clinics perform high resolution anoscopy, which permits a detailed examination of the lining of the anus. Virtually all patients with blood in the stool should at the very least be seen by a health care provider. Often it's nothing more than hemorrhoids, small tears, fissures, and other benign findings. Knowledge is power. You need to find out what's going on.