People who are in the last stages of cancer should pay some attention to end-of-life decisions. The most important is advance directive, also known as living will, for medical treatment. This is nothing but a document written by the terminally ill person while he or she is still capable of making decisions. The advance directive basically states that the patient does not want artificial means of surviving should he or she become mentally incompetent. Artificial life saving measures include CPR, respirators or anything else the person can think of.

The reason why advance directive only applies to a person who in mentally incapable of making decisions is because prior to that a doctor can ask the person what his or her preferences are about the treatment. However, once the person becomes mentally incompetent, he cannot be asked to state to state his or her preference.

However, advance directive is not only about dying with dignity. There are some patients who might want to live as long as possible using CPR or artificial breathing machines. If this is mentioned in your living will, the doctors and your family would have to respect it. In fact, the doctor would have to do everything to save your life or prolong it.

Those who find writing advance directive morbid, do not have to do it. Instead they can appoint a health care agent. This is someone who makes all the healthcare decisions on your behalf when you are incapable of making them. However, you would have to tell the agent what your wishes are while you are still able to think and comprehend coherently.



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The number of cases of anal cancer is increasing on a year to year basis. And research shows that it can affect both men and women equally. However, homosexual men are 17 times more likely to contract anal cancer than men who do are heterosexual.

According to the Cancer Association of South Africa, one of the main causes of this cancer is Human Papilloma Virus, better known as HPV. This virus is transmitted from an infected through sexual contact and is, therefore, a sexually transmitted infection. Other factors that increase the risk of this type of cancer are smoking, using immunosuppresants, having multiple sex partners, and having anal sex, which increases the chances of getting the HPV virus.

The reason why homosexual men are at higher risk of contracting this cancer is because they engage in unprotected sex. Gay men who indulge in unprotected sex are at higher risk due to infection. The HPV virus can be spread even by touching the genitals. And that is why condoms are advocated by healthcare professionals. However, it is important to note that using a condom cannot protect you completely from the HPV virus.

Healthcare professionals also say that being HIV positive or having other STIs besides HPV also increases the risk of getting anal cancer. According to the Medical Research Council based in the UK, the rate of this cancer is around 37 out of 100,000 gay men and if they are HIV positive, the rate doubles.

The cancer is usually treated through surgery in the initial stages and later stages are treated with a combination of chemotherapy and radiation therapy.

The good news is that researchers have found a new technique for detecting pre-cancerous and cancerous cells in early stages. This technique is known as minichromosome maintenance proteins. This technique will be a greatly benefit gay men who are at the highest risk of contracting anal carcinoma.


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The treatment for anal cancer actually depends on several factors -- the location of the cancer, the size of the tumor and the overall health of the patient. Usually the doctors work together with the patient to decide the best possible treatment plan.

There are primarily three types of treatment for anal cancer and they are surgery, radiation and chemotherapy.

Surgery:
The type of surgery depends upon the stage of the cancer. Early stage cancer or in situ cancer is treated by removing the cancerous cells along with a small area of the surrounding tissue mass. Thereafter, the patient has to have regular follows ups for screening and subsequent removal of cancerous tissue.

Patients in later stages of cancer first undergo a small surgery wherein a piece of the tissue is removed for biopsy. Thereafter chemotherapy and radiation are given in combination. Patients who have combination therapy invariably are not subjected to treatment through major surgery. However, patients who cannot have chemotherapy and radiation therapy may have to undergo major surgery. Usually this happens when the cancer is still present after the initial treatment or there is a relapse after the treatment is completed. In case the cancer is recurrent, the patient may have to undergo a colostomy where the anus, rectum and part of the colon are removed; and an opening is created in the abdomen so that feces can be collected in a bag. Even lymph nodes are removed in this procedure.

Radiation Therapy:
This therapy involves using high energy X-rays to kill the cancer. The most common type of radiation is known as external beam radiation therapy wherein the radiation is given through an external machine. However, at times radiation can be given through implants this type of therapy is known as internal radiation therapy or brachytherapy.

This therapy has side effects which include fatigue, stomach problems, skin reaction, anal irritation, and discomfort when passing feces. Sometimes, scar tissue can form and this can cause problems with bowel movements. However, most of the side effects disappear once the therapy is over.

Chemotherapy:
Here drugs are used to kill the cancer cells. The drug is intravenously fed into the blood stream and target only cancer cells. This treatment is highly effective when combined with radiation therapy. The benefit of the combination ensures that lower doses of radiation are used and the chances of destroying the cancerous tissue completely are very high.

Patients who are HIV positive are given low doses of chemotherapy and radiation therapy but it depends on how badly the immune system is compromised by the HIV.

Side effects of chemotherapy include fatigue, possibility of infection, nausea, vomiting, diarrhea and loss of appetite. However, these side effects are dependent on the overall health of the patient and usually disappear once the therapy is completed.



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