Megan Haensgen thought she had a hemorrhoid. A few years ago, the Menomonee Falls mother of two had symptoms including anal bleeding, itching and burning. She saw her primary care doctor, Ana Caban Cardona, MD, who immediately connected Megan to Kirk Ludwig, MD, colorectal surgeon and Medical College of Wisconsin faculty member.
After he examined her, Dr. Ludwig told Megan he was almost certain she had anal cancer. A biopsy confirmed the diagnosis — stage II squamous cell carcinoma affecting the lining of the anus. It is the most common type of anal cancer.
“People need to know the disease can be cured if it is found early,” Megan said. “They need to know what to watch for and where to get help. It changed everything for me — how can I not talk about this?”
Most anal cancers are caused by the human papillomavirus (HPV), best known for its link to cervical cancer. HPV can also lead to cancer of the vulva, vagina, penis and anus, as well as mouth and oral cancers. The HPV vaccine is designed to prevent HPV infection and can prevent these cancers.
“My dad used to tell me we need to come up with a shot to cure cancer,” said James Thomas, MD, PhD, medical oncologist and MCW faculty member. “The HPV shot can stop cancer before it starts.”
Expert Treatment Plan for Anal Cancer
Specialists from the Froedtert & MCW Colorectal Cancer Program and other experts within the Froedtert & MCW Cancer Network worked together as a multidisciplinary team to create Megan’s treatment plan.
Her case was presented at a weekly disease-specific cancer conference where experts from every discipline review details of patient cases and discuss which treatments will offer the best possible outcome.
Megan’s personalized plan included targeted radiation therapy, followed by chemotherapy. Surgery is not recommended for most anal cancers, as the procedure can be extensive and leave patients with a permanent ostomy.
Beth Erickson, MD, radiation oncologist and MCW faculty member, was on Megan’s care team.
“Treatment is intensive,” Dr. Erickson said. “That’s why you want to have it where doctors are experienced with the most current anal cancer treatment and can manage its side effects.”
Megan had a few side effects during treatment, including raw, painful skin from radiation therapy. Dr. Erickson’s nurses devised a routine of skin healing and comfort measures. Radiation also brought on early menopause. Megan’s gynecologist prescribed hormonal therapy to combat those symptoms. She also received medications to reduce chemotherapy-induced nausea and fatigue.
The payoff was worth it. Megan is considered cured. She will be carefully monitored by Froedtert & MCW colorectal cancer specialists with imaging scans and anoscopes, an in-office technique using a thin tube with a camera to view the lining of the anus and rectum.
Positive Outcomes for Anal and Colorectal Cancers
Froedtert & MCW colorectal cancer experts work hard to ensure more people with cancer have positive outcomes.
“We treat a high volume of patients with anal and other colorectal cancers, so we know what works and what doesn’t,” Dr. Ludwig said. “Our goal is to discover what could work better. For some individuals, a clinical trial may be the best treatment.”
The colorectal cancer team is active in clinical research to test treatments that may be more effective while reducing side effects and improving quality of life. The Froedtert & MCW Cancer Network offers the largest cancer clinical trials treatment program in Wisconsin.
Anal Cancer Awareness and Action, Not Embarrassment
“Everyone should talk to their doctors about risk factors for anal cancer and consider screening,” Dr. Erickson said.
Screening is typically a manual exam where the doctor feels for unusual growths or other problems. If you are at high risk or have been exposed to HPV, talk to your doctor about monitoring. People at high risk may be candidates for the Froedtert & MCW Anal Dysplasia Clinic, which provides regular monitoring to find and treat the disease early. Megan’s conversation is just beginning. She volunteers and works in a peer-to-peer program to help people through what can be an overwhelming diagnosis.
“Some patients feel devastated,” Dr. Erickson said, “I will connect them with one of my patients who has experienced the disease and treatment. They make the path for the next person so much easier.”
Megan and her care team hope her story encourages others to seek treatment if they notice any troubling symptoms like a lump or bleeding from the anus.
“Don’t be embarrassed,” Dr. Ludwig said “There’s no shame in the diagnosis.”
