(McClatchy-Tribune Information Services) -- If caught in time, anal cancer isn't typically deadly and doesn't require surgery.

But a lack of awareness and a general reluctance to pay attention to symptoms in the anal area are fueling mortality rates, medical experts say.

"Unfortunately, when we catch it, it is usually too late," said Dr. Vassiliki L. Tsikitis, a colorectal surgeon at the Arizona Cancer Center in Tucson. "We are doing better in catching other cancers, but with anal cancer, it's not being caught."

Though uncommon, anal cancer is also on the rise in the United States -- increasing at a rate of 2.1 percent per year since 1975, the National Cancer Institute says. The mortality rate for anal cancer is rising at a faster rate than it is for melanoma or prostate cancer. But until recently, it's had far less publicity.

Actress Farrah Fawcett, who died Thursday, brought more public awareness to anal cancer since going public with her diagnosis in 2006. A two-hour documentary about her cancer battle, which included surgery, aired on NBC on May 15. The documentary was reshown on the broadcast network's cable stations MSNBC, Bravo and Oxygen.

"It's a tough cancer. Many people have problems down there, but they won't come in and have it checked," Tsikitis said. "If people have terrible burning itching on their hand, they go to the doctor. But in the anus. ...

"The surprising part that comes to my mind so often is seeing patients and wondering how they waited so long to come to me. It gets fungated. It bleeds. It smells."

Anal cancer is a relatively rare disease, with about 5,000 people in the United States diagnosed every year. The National Cancer Institute says 710 people per year in the United States die of anal cancer.

By comparison, there are 40,000 to 50,000 new cases of rectal cancer per year, and 100,000 new cases of colon cancer each year, said Dr. Alfred M. Cohen, also an Arizona Cancer Center colorectal surgeon.

Only 2.3 percent of all colorectal malignancies are in the anus, Tsikitis said, noting there's a significant difference in treatment between cancer in the anus versus the rectum and colon.

"We're talking about a half-an-inch difference that will define treatment," Tsikitis said.

The anus is a small area, between 1.2 and 1.6 inches long. But without it, patients will have to use a colostomy bag for their waste.

Tucsonan Connie Mills, a 79-year-old retiree, went to the doctor last year after spending years sitting on what felt like a lump in her anal area.

"It just felt like I was sitting on something," she said.

By the time she sought help, it was the size of a billiard ball. Mills has since gone through radiation -- she did not want chemotherapy. But the cancer came back, and eventually she had surgery. Her anus was removed, and she now must use a colostomy bag.

Mills, who is now cancer-free, insists she never felt any pain. That's why any unusual lesion or bump -- even something as small as a pimple -- needs to be checked out, as does persistent perianal itching, Tsikitis said.

In its later stages, doctors say, symptoms of anal cancer nearly always include persistent pain and bleeding.

People in higher risk groups, including anyone with human papillomavirus infection, should consider including anal cancer screening in their yearly checkup, Tsikitis said. That screening should include a digital rectal exam and a cell swab from the anal area. The average age of diagnosis is 61.

The drug Gardasil, which is marketed for preventing cervical cancer, is also believed to prevent anal cancer, Cohen said.

Yet it's impossible to say precisely who will get anal cancer, stressed Dr. Tom Dragovich, director of the Arizona Cancer Center's clinical gastrointestinal cancer program.

"It happens in a most unfortunate play of genes and environmental factors," he said.

The most important thing is early detection, medical experts say.

"You don't want to wait months and hope it's not cancer," said Cohen, who spent 15 years as head of the colorectal cancer program in New York City at the Memorial Sloan-Kettering Cancer Center.

"Farrah Fawcett is one of the rare people where the cancer metastasized, so it went elsewhere. I don't know where elsewhere, but the liver and lungs are the most common site of spread, and none of those patients are curable with chemotherapy."

Risk Factors

--Human papillomavirus infection

--Immunosuppressed patients, including those infected with the human immunodeficiency virus, or people who have undergone organ transplantation

--Smoking

--Sexual practices -- a history of anal intercourse and/or multiple sexual partners

--History of cervical/perineal cancer or cervical/anal dysplasia

Colorectal and anal cancer support group

The Arizona Cancer Center sponsors a monthly support group for individuals who have colon, rectal or anal cancer and for significant others who want to share concerns and educational information. There is no charge.

The group meets the last Tuesday of each month. Meetings are held at 4 p.m. in the Sunstone Living Room at the Arizona Cancer Center (UMC North), 3838 N. Campbell Ave. For information, contact Kathleen Pickrel at 694-4786 or kpickrel@umcaz.edu or Marsha Drozdoff at 694-4605.

Did You Know

In 1997, the Arizona Attorney General's Office sanctioned a Texas company for misrepresenting items sold at a Tucson estate sale as belonging to Farrah Fawcett.

The company reached an agreement with the state to refrain from making false promises and misrepresentations and concealing material facts in its advertising. It also agreed to pay the Attorney General's Office $2,500 for investigation costs and give refunds.

Copyright (C) 2009, The Arizona Daily Star, Tucson