benign ulcer? getting a diagnosis

veryworried
veryworried Member Posts: 3
in Anal Cancer #1

Hi everyone, First of all, I would like to wish everyone here all the best and thank you for being on this board and helping each other. I am new here, and feel a bit like an intruder, but I have read through a lot of the links and messages and I am hoping I'll be able to find the answers to my questions here. I've been in constant worry for about 8 months now, and I am still without a diagnosis. After some discomfort and an episode of bleeding etc I discovered a small ulcer/ fissure on the perianal skin. My doctor didn't think much of it but agreed to refer me to a colorectal surgeon. He also didn't think it looked anything suspicious but as I had a history of condylomas he suggested a sygmoidoscopy and a biopsy. The first one was done and was all clear, but he wanted to do the biopsy under general anesthetic, which I did not understand. To cut a long story short, as they made me wait for this for months! I went to see a different doctor, who also thought the lesion looked benign, thought a biopsy would be a bit too invasive at this stage, but did a cytology and HPV test instead, which came back negative. However, when I got back to my first doctor, he said, these tests were not appropriate and I still need the biopsy to rule out any serious conditions. All this time, I've had on and off pain, discomfort, the occasional bleeding, and I really don't know what to do. My question is really, is there anyone here, whose first symptom was a fissure-like ulcer, which did not behave like a fissure (ie not hurting when on the toilet, but hurting any other random time) and if so, how was a diagnosis confirmed? Cytology? Or if a biopsy was taken, did the doctor use general or local anesthesia? Many thanks for your replies.

Comments

  • sephie
    sephie Member Posts: 650 Member
    #2
    yes general anesthesia not local

    i had ulcer looking bumps on outside...proctologist treated it like hemmorrhoid for over a year...WRONG....even had a colonoscopy which he said all fine.....should have been biopsied....at first not in so much pain but had bleeding ---- as time went by i was in horrible pain with bleeding.... colorectal surgeon did biopsy under anesthesia..confirmed cancer..... sephie

  • veryworried
    veryworried Member Posts: 3
    #3
    sephie said:

    yes general anesthesia not local

    i had ulcer looking bumps on outside...proctologist treated it like hemmorrhoid for over a year...WRONG....even had a colonoscopy which he said all fine.....should have been biopsied....at first not in so much pain but had bleeding ---- as time went by i was in horrible pain with bleeding.... colorectal surgeon did biopsy under anesthesia..confirmed cancer..... sephie

    Thank you!

    Thank you for the quick reply, Sephie!  Did the surgeon say why s/he did not use local anesthesia?

  • mp327
    mp327 Member Posts: 4,440 Member
    #4
    very worried

    My internist was the first doctor to take a look and told me I had a bleeding hemorrhoid.  However, she told me I was overdue for a colonoscopy, so referral was made to a colorectal doctor for the scope and to take care of the "hemorrhoid."  The colorectal doctor examined me on my initial visit after reading about my history of bleeding and told me that very day I had anal cancer, which was confirmed by biopsy two days later, done at the same time of my colonoscopy.  Two year after I had completed treatment for anal cancer, I went for a regular follow-up with my colorectal doctor and she found 3 anal condylomas (internal) when she did the anoscope.  She told me those had to come out because they could become cancerous, so I had minor surgery to remove them under general anesthesia.  The biopsy came back negative on them. 

    In your case, I think I would want a biopsy.  Just because cytology and HPV tests came back negative, does not mean it is benign. 

    My tumor had probably been there for a long time.  However, it ulcerated and began bleeding with bowel movements, which got my attention.  I guess what I'm saying is if I were you, I would be asking for a biopsy.

    I wish you all the best and hope it all gets sorted out and the news is good.

    Martha

     

     

  • veryworried
    veryworried Member Posts: 3
    #5
    mp327 said:

    very worried

    My internist was the first doctor to take a look and told me I had a bleeding hemorrhoid.  However, she told me I was overdue for a colonoscopy, so referral was made to a colorectal doctor for the scope and to take care of the "hemorrhoid."  The colorectal doctor examined me on my initial visit after reading about my history of bleeding and told me that very day I had anal cancer, which was confirmed by biopsy two days later, done at the same time of my colonoscopy.  Two year after I had completed treatment for anal cancer, I went for a regular follow-up with my colorectal doctor and she found 3 anal condylomas (internal) when she did the anoscope.  She told me those had to come out because they could become cancerous, so I had minor surgery to remove them under general anesthesia.  The biopsy came back negative on them. 

    In your case, I think I would want a biopsy.  Just because cytology and HPV tests came back negative, does not mean it is benign. 

    My tumor had probably been there for a long time.  However, it ulcerated and began bleeding with bowel movements, which got my attention.  I guess what I'm saying is if I were you, I would be asking for a biopsy.

    I wish you all the best and hope it all gets sorted out and the news is good.

    Martha

     

     

    Thank you!

    Hi Martha, thank you for your reply! Originally I agreed with the suggestion that a biopsy should be done, just did not understand why it had to be done under general anesthesia. (Which I am really scared of.) Also, the doctor put it down as a routine exam, and made me wait over three months, which did not make any sense to me,if he was worried enough to order it; by which time, the other doctor told me I did not need it. So that's where I got really confused. How come one doctor thinks cytology and HPV are enough? A biopsy is not without risks either, I suppose. I could not find anything on the internet, that said that cytology was inferior to a biopsy. Could you, please explain it to me, if you have some time,please, because my doctor refused to. He was just sitting there, and said "just because". I do not understand, what more they can see just because I am sedated? I mean, there is nothing there anyone could see but the ulcer. Do they biopsy ulcers? Sorry about asking so many things. I guess, it is because doctors just never have enough time and we are left worrying with all our questions unanswered. Thank you so much for your time.

  • nicotianna
    nicotianna Member Posts: 209
    #6
    veryworried said:

    Thank you!

    Hi Martha, thank you for your reply! Originally I agreed with the suggestion that a biopsy should be done, just did not understand why it had to be done under general anesthesia. (Which I am really scared of.) Also, the doctor put it down as a routine exam, and made me wait over three months, which did not make any sense to me,if he was worried enough to order it; by which time, the other doctor told me I did not need it. So that's where I got really confused. How come one doctor thinks cytology and HPV are enough? A biopsy is not without risks either, I suppose. I could not find anything on the internet, that said that cytology was inferior to a biopsy. Could you, please explain it to me, if you have some time,please, because my doctor refused to. He was just sitting there, and said "just because". I do not understand, what more they can see just because I am sedated? I mean, there is nothing there anyone could see but the ulcer. Do they biopsy ulcers? Sorry about asking so many things. I guess, it is because doctors just never have enough time and we are left worrying with all our questions unanswered. Thank you so much for your time.

    veryworried

    Hi - Would your CR surgeon be willing to do the biopsy under IV sedation?  Spinal anesthesia is another option.  I am not fond of a spinal.  I had one for inguinal nodes removal & anal exam.  I was embarrased due to being awake & in a lithotomy position (legs in same position as having a baby).  I also suffered from a spinal headache, which is supposedly a rare complication.  I vote for a biopsy.

    Nic

  • sephie
    sephie Member Posts: 650 Member
    #7
    veryworried said:

    Thank you!

    Thank you for the quick reply, Sephie!  Did the surgeon say why s/he did not use local anesthesia?

    why i had general anesthesia

    i can only guess since i never even asked any questions back in 2009....my tumor was inside the anus and had grown to the outside which made it look like hemmy.....nerve endings are on the outside of anal area. not inside ...some tumors are only on the inside ....perhaps he wanted me knocked out so that there would be no movement at all. while he cut things out......he stitched me up on the inside and of course i tore them all up with bowel movements....i have a huge scar on the inside of anal canal so my colorectal surgeon tells me....sephie

  • eihtak
    eihtak Member Posts: 1,473 Member
    #8
    Veryworried....

    Hi,

    I am so sorry that you have this worry in your life, but I am glad you have come here with your questions.  It can be so frustrating to just want answers and not have them!

    My only biopsy was to confirm my already suspected anal cancer (as I presented with a very large and painful tumor) and was performed in my surgeons office under local anesthesia. That was over 5 years ago and I have learned over the years that it seems every doctor has their own preferred method for things like this.  I do also remember once reading about cytology vs biopsy and that the conclusion was that biopsy is overall considered more accurate and better at determining details if needed, such as tumor grade, etc.

    Please keep us posted and I will have you in my prayers for answers that can give you some peace of mind soon.

    katheryn

  • lizdeli
    lizdeli Member Posts: 569 Member
    #9
    eihtak said:

    Veryworried....

    Hi,

    I am so sorry that you have this worry in your life, but I am glad you have come here with your questions.  It can be so frustrating to just want answers and not have them!

    My only biopsy was to confirm my already suspected anal cancer (as I presented with a very large and painful tumor) and was performed in my surgeons office under local anesthesia. That was over 5 years ago and I have learned over the years that it seems every doctor has their own preferred method for things like this.  I do also remember once reading about cytology vs biopsy and that the conclusion was that biopsy is overall considered more accurate and better at determining details if needed, such as tumor grade, etc.

    Please keep us posted and I will have you in my prayers for answers that can give you some peace of mind soon.

    katheryn

    very worried

    I had a biopsy during my colonoscopy.  The tumor was found after a physical exam and the colonoscopy was ordered for the next day and that is when they did the first biopsy.  I was under anesthesia.  If I recall, I had another biopsy once I got to MD Anderson during some other test.  Again under anesthesia.  I tested negative for HPV.  It is very possible that you have an ulcer of some sort, but to put your mind at ease I suggest  you find a colorectal doctor that you feel is respecting and addressing your feelings and concerns.  

    Liz

  • mp327
    mp327 Member Posts: 4,440 Member
    #10
    veryworried said:

    Thank you!

    Hi Martha, thank you for your reply! Originally I agreed with the suggestion that a biopsy should be done, just did not understand why it had to be done under general anesthesia. (Which I am really scared of.) Also, the doctor put it down as a routine exam, and made me wait over three months, which did not make any sense to me,if he was worried enough to order it; by which time, the other doctor told me I did not need it. So that's where I got really confused. How come one doctor thinks cytology and HPV are enough? A biopsy is not without risks either, I suppose. I could not find anything on the internet, that said that cytology was inferior to a biopsy. Could you, please explain it to me, if you have some time,please, because my doctor refused to. He was just sitting there, and said "just because". I do not understand, what more they can see just because I am sedated? I mean, there is nothing there anyone could see but the ulcer. Do they biopsy ulcers? Sorry about asking so many things. I guess, it is because doctors just never have enough time and we are left worrying with all our questions unanswered. Thank you so much for your time.

    very worried

    I am sure this is all very stressful for you and I can understand that.  About cytology, I asked my colorectal surgeon about anal paps years ago and 1) she did not do them then and 2) at that time, she said there was only one or two labs that would even analyze them (perhaps things have changed since then with the labs, I do not know), 3) she said that if an anal pap could be done and showed suspicious cells, she would do a biopsy anyway.  She also stated that in cases where there is no evidence of a lesion or tumor, where exactly to do the swab in the anal canal would be in question (obviously, that is not your situation since you have an ulcerated area).  I think the bottom line is she was not in favor of them.  However, again, perhaps things have changed over the years, I do not know.

    I've had two biopsies done of my anal canal--the first to make the diagnosis of anal cancer, as I stated above, followed 2 years later for the condylomas that were removed under general anesthesia.  I will tell you that neither caused me any problems.  You asked if they biopsied ulcers and I think the answer to that is yes.  My tumor had "ulcerated," which was the reason it bled.  

    I'm sorry if I have not answered all of your questions, but I will say that in your situation, I would get a biopsy.  Is there a risk with getting one--yes, there are risks associated with just about any and every medical procedure, especially when sedation is necessary.  None of us are doctors here, so we can only speak from our own experiences and give our opinions.  Had I not consented to a biopsy back in 2008, I may not be here today.  That is just my two cents worth.  I wish you all the best and hope you'll keep us posted.

    Martha 

     

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