Anal cancers in aging populations primarily consist of squamous cell carcinoma, which is by far the most common type. This cancer arises from the squamous cells lining the anal canal and anal margin. In older adults, the risk of developing anal cancer increases due to cumulative exposure to risk factors, including persistent infection with human papillomavirus (HPV), especially HPV type 16, which is strongly linked to anal cancer development.
HPV infection is the single biggest risk factor for anal cancer. The virus is transmitted mainly through sexual contact, including anal, vaginal, and oral sex, as well as genital touching and sharing sex toys. While many people clear HPV infections naturally, persistent infection with high-risk HPV types can lead to cellular changes and eventually cancer. In aging populations, the immune system’s ability to clear HPV may decline, increasing the chance that the infection persists and progresses to cancer.
Squamous cell carcinoma accounts for approximately 90% of anal cancers. Other less common types include adenocarcinoma, which originates from glandular cells near the anus, and melanoma or lymphoma, which are rare in this region. Adenocarcinomas may arise from the anal glands or from extension of rectal adenocarcinomas into the anal canal, but these are much less frequent than squamous cell carcinoma.
The incidence of anal cancer tends to be higher in certain groups within the aging population, such as men who have sex with men, individuals with a history of receptive anal intercourse, and those who are immunocompromised (including people living with HIV/AIDS). Smoking is another important risk factor that compounds the risk of anal cancer in older adults.
Symptoms of anal cancer often include bleeding, pain, itching, or a lump near the anus. Because these symptoms can be mistaken for benign conditions like hemorrhoids, diagnosis may be delayed, especially in older adults who might attribute symptoms to aging or other chronic conditions.
Treatment options for anal cancer in aging populations depend on the stage and type of cancer but commonly involve a combination of chemotherapy and radiotherapy (chemoradiotherapy), which can be curative for many patients. Surgery is less commonly the first choice except for very early-stage tumors or when chemoradiotherapy is not effective. The approach to treatment also considers the patient’s overall health and ability to tolerate therapy, which is particularly important in older adults.
In summary, the most common anal cancer in aging populations is squamous cell carcinoma, strongly associated with persistent HPV infection. Risk factors such as sexual behavior, immunosuppression, and smoking contribute to its development. Early detection and appropriate treatment are crucial, but challenges exist due to symptom overlap with benign conditions and the complexities of treating older patients.
