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by Doc Gurley, Internist Physician on

Even now, most of Farrah Fawcett's obits genteelly - and obtusely - refer to her terminal illness as merely "cancer." Three years ago, when she was diagnosed, Farrah Fawcett's illness was marked with secrecy because of her tumor's location and type. Rectal/anal* cancer is one of the few remaining malignancies whose victims still continue to suffer twice - both from the disease, and the stigma.

Not so long ago, women similarly got tumors in their "female organs" - at least they did where I grew up in the South. That kind of secrecy left listeners not knowing even if people were talking about an above-the-waist disease, or a below-the-waist disease. We can all agree that voyeurism is an ugly human trait, and valid points could be made about whether anyone has a right to know that much detail about anyone's illness. But we have since discovered, thanks to Magic Johnson, Katie Couric, and others, that de-stigmazing body parts and illnesses can, literally, save lives.

The same is true for rectal/anal cancer. And Farrah Fawcett suffered in front of the camera, playing out her battle with disease, and even her decline - and, by doing so, outing her serious illness.

All rectal illness carries the double burden of being one of the last remaining, prudishly not-discussed "private parts." Plus there is the hushed implication of the possible role of anal sex when any rectal problems arise. And nothing is more personal for most people than their bowel habits. Doctors, too, fail their patients by not screening for rectal cancer or rectal problems appropriately, often due to their own discomfort with the issue. When it comes to the rectum, there is neither a Vagina Dialogue celebration (thank you, Eve Ensler), nor even a billboarded cartoon-penis-head anti-syphilis campaign (yeah! go SF Department of Public Health!).

Here are some rectal/anal cancer facts that we can now, thanks to Farrah and her brave coming out, hopefully begin to discuss openly:

1) Rectal/anal cancer can afflict anyone. Even beautiful supermodels.

2) There were 40,870 new cases of rectal cancer in 2009 alone. That's a lot of human suffering, much of it in silence and shame.

3) Rectal/anal PAPs can save lives - that's right, there is such a thing as a rectal/anal PAP smear. If you regularly have anal sex, or have had rectal sexually-transmitted diseases and/or rectal/anal warts, ask your doctor whether you might be a good candidate for screening.

4) The human papilloma virus is associated with increased rates of all kinds of "crotch" tumors, including rectal/anal cancers. While the recommendations for vaccination are being developed, and it's not yet clear whether or not the existing vaccines will protect against all these types of cancer long-term, it's nice to know key developments are occurring in our lifetimes.

Farrah Fawcett bravely shared her disease with us. If you hear someone saying they heard she died, maybe the best tribute to her honesty and compassion for others is for each of us to add, "yes - she died of anal cancer. What an amazing woman..."

*For all the wonderful Doc Gurley readers who wrote in - concerned that I had somehow graduated med school and even passed my Boards without ever learning the difference between a rectum and an anus - thank you. Farrah Fawcett's tumor is reported variously in the news as rectal or anal - and, while I do actually know the difference between the two, I did indeed conflate the two - deliberately, because I believe that is how the general public (and, sadly, most physicians) think of the issue - without our precise anatomic distinctions. I have merged the names, also because the point of the article was more about the secrecy and shame of anything to do with "down there" - rectum and/or anus. The issue of PAP screening and risks is an emerging field - for which the best approach is a personalized, honest and individual discussion with your doctor. The goal of this post was hopefully to get more people willing to discuss risks and screening, and to give kudos to poor Farrah Fawcett where due. THANKS AGAIN FOR WRITING!
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