High Resolution Anoscopy, or HRA, is a procedure that allows for the examination and evaluation of the anus. This procedure helps diagnose and treat anal conditions, including anal cancer and anal dysplasia, a pre-cancerous condition occurring when the cells lining the anal canal undergo abnormal changes. Anal cancer, though rare, is increasing, and occurs when cells within the tissues of the anus become cancerous. While the cause of anal cancer is not entirely known, 91% of anal cancers have been linked to human papillomavirus (HPV) infection, a common sexually transmitted disease. Many cases of anal cancer are diagnosed in early stages when the cancer is most treatable with a higher chance of survival. HRA is an in-office procedure that differs from a colonoscopy. HRA examines the anal canal with a high-resolution magnifying instrument to:
Used in the surveillance of anal dysplasia and the detection of anal cancer, HRA is typically recommended for patients who have received abnormal results from other screenings, including an anal Pap test or anal cytology, or are considered high risk. Individuals at increased risk for anal cancer should speak with a physician about screening options, including HRA. Risk factors for anal cancer include patients who:
The examination typically lasts 20-30 minutes, with patients positioned on their stomach or left side. The anoscope, a thin, short, hollow tube, is coated with an anesthetic cream and inserted just inside the anus.
Dye will be applied using a coated cotton swab allowing examination of the interior of the anus using a magnifying camera to allow high resolution visualization of anal tissue. The camera magnifies the area, allowing your physician to detect any abnormal tissue that is not visible to the naked eye.
If abnormal tissue is found, the patient will be given numbing medication to minimize discomfort, and the tissue will be biopsied and sent to a pathologist for further examination and can be treated if precancerous cells are found.
No special preparation is needed for this procedure; however, the following tips are suggested:
If you experience a biopsy during your HRA, a small amount of bleeding is normal for one to two days. If bleeding becomes heavy or a fever greater than 101° develops, call your doctor. Do not insert anything into your anus until the bleeding has completely stopped.
For one to two days after your procedure:
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