Anal intraepithelial neoplasia Information for patients Gynaecology
What is anal intraepithelial neoplasia? Anal intraepithelial neoplasia (AIN) is not cancer. AIN describes the presence of abnormal cells in the skin in or around your anus. It can occur in more than one area on the anal skin. In women, it may also be associated with similar changes in the neck of your womb (cervix), vagina and vulva (outer folds of skin around your vagina). These changes may have been present before finding AIN or it could develop later on. AIN may occur: Anywhere on the skin in or around the anus May occur in more than one site The abnormal cells in AIN are pre-cancerous; which means that rarely a cancer of the anus can develop from these changes. Is this a common condition? AIN is more common in younger women aged 35 to 55, but may also occur in older women. What causes AIN? The exact cause of AIN is unknown. We do know that: Infection of the anus with the human papillomavirus (HPV) is commonly associated with AIN. HPV is a common virus spread by skin-to-skin contact during sexual relations. If HPV enters the skin, your body s immune system will attack the virus. If the virus is not cleared, then it may result in anal warts or the abnormal cells seen in AIN. Smoking increases your risk of developing AIN and can worsen AIN. page 2 of 8
AIN is not caused by lack of cleanliness. AIN is more common in women with reduced immunity (e.g. due to having a kidney transplant, HIV, steroid use). What are the symptoms of AIN? You may experience the following: No symptoms at all Itching around the affected area (in/around the anus) Pain (discomfort or a burning feeling) Bleeding or discharge from the AIN (less common) Lesions (flat or raised areas of skin which may have a rough surface) Change in the skin or an anal skin tag that you already have (becoming rougher or thicker) Changes in the normal colour of the skin Can there be any complications of AIN? Yes. In a very small percentage of women, the abnormal cells of AIN can go deeper than just the skin surface. This means that anal cancer has developed. This process may take many years to develop and is usually very slow. We do not know the exact percentage of AIN that progress to anal cancer as very few studies have been undertaken. page 3 of 8
How is AIN diagnosed? Diagnosis is made by: Appearance - your doctor will carefully examine the skin in/around your anus. If AIN is suspected, a small sample (biopsy) of the affected skin will be removed under local anaesthetic at the clinic. The skin sample is sent to the laboratory and examined under a microscope to confirm the diagnosis and determine the grade of the AIN. The neck of your womb (cervix) vagina and vulva will also be examined for skin changes. If a cervical smear is due (or overdue) then this will be performed at the same time during your examination. Although these examinations will be done, AIN can also occur on its own. How will I get to know my results? The results of the skin sample should be ready within two weeks. How is AIN treated? There is no ideal single treatment for AIN. The treatment of AIN depends upon the: Symptoms it is causing Areas that are affected AIN can be treated in several ways. Your doctor will discuss these with you and advise which treatment is recommended for you: page 4 of 8
Treatment options If not treated, AIN could improve, remain the same or become worse. Close observation in some cases may be sufficient because AIN may not always worsen; although this means that regular follow up is necessary. Cream locally applied to the skin around the anus may be used. The cream tries to clear the HPV virus by improving your body s own immune response in the area where the cream is applied. Applying simple emollients (moisturiser) to the affected skin. Surgery - the abnormal area of skin is removed. A general anaesthetic may be required. If necessary, your doctor will also examine inside your anal canal, using a proctoscope, to ensure there are no similar changes there. A proctoscope is a short metal tube with a light at the end of it which allows the doctor to clearly see the inner lining of your rectum. If a large/wide area of abnormal skin around the anus is removed; this can lead to problems, which might include loss of control or tightness of the anus. If surgery is considered, this might have to be done in several stages. Your doctor will discuss this with you. Is there anything I can do to help myself? The following may help with some of the symptoms: Avoid scented soap/shower gels that may irritate the skin around your anus and vulva Wear cotton underwear. page 5 of 8
Can AIN be cured? AIN is a pre-cancerous condition that can come back after treatment, so you will need to attend the clinic on a regular basis. You will also need to have regular cervical smears to examine the cells on your cervix for any changes. How often will I need to attend the clinic? It is recommended that you are seen every 6 to 12 months in the clinic. You will be given or sent an appointment to attend the Gynaecology Out Patients Clinic. Who can I contact if I have any questions? If you need any further information then please do not hesitate to contact the Vulval Clinic Secretary: 0114 226 8300 page 6 of 8
Where can I get further information? We recommend that you only use dedicated websites or help lines to gain further information. General internet searches can lead to you reading information that is not accurate or is out of date. Macmillan www.macmillan.org.uk HPV and Anal Cancer Foundation www.analcancerfoundation.org Pruritus Ani (Itchy bottom) www.patient.co.uk/health/pruritus-ani-itchy-bottom page 7 of 8
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