As Farrah Fawcett appeared on her TV screen, Jill De Nardo shook her head in sad disbelief.
As a teenager she’d been enthralled by the actress in the TV show Charlie’s Angels. Now she was watching a documentary charting the Hollywood star’s harrowing battle with the rare cancer that killed her in June 2009.
“When I heard the words ‘anal cancer’ my instant thought was ‘she must have had a really kinky sex life to get that’,” Jill admits.
But just 12 months later, the mum-of-three, then aged 51, received the same devastating diagnosis.
Jill had lived a quiet life in Buxton, Derbyshire, married to Tony, now 59, bringing up their children, Will, Ellie and Joe, then aged 21, 19 and 17, and working as a civil servant.
Conscious of the taboo associated with anal cancer, Jill kept the diagnosis secret from all but her closest family.
But she says Ellie made her face reality when she said: “People need to know about this. Everybody has a bottom. Anyone can get this cancer.”
Although anal cancer is still relatively rare, Cancer Research UK says cases have quadrupled since the mid 1970s with figures dramatically higher for women – 1.8 per 100,000 compared to 1.2 per 100,000 males.
Around 1,200 people a year are diagnosed, with approximately six deaths a week – and there’s been a quadrupling of cases since the 70s.
In August 2009, Jill first noticed bleeding from her back passage after going to the toilet. “I’ve always been very ‘bowel aware’,” she explains. “We have a family history of bowel cancer so I’m on a screening programme and am vigilant about any changes.”
Since having children, Jill, 55, had suffered from occasional haemorrhoids – swollen veins in the anus. “But this was different,” she says. “The bleeding was heavier and there was no discomfort or obvious swellings.”
Jill’s GP shared her concerns, admitting she could “feel something” during an examination. Jill had a sigmoidoscopy – an examination of the rectum and lower bowel – at Stepping Hill Hospital in Stockport, Gtr Manchester, where “everything was fine.”
Six weeks later, as part of her routine bowel screening programme, Jill underwent a colonoscopy – where a camera is inserted into the upper bowel to detect any changes. Again, the results came back clear.
However, the bleeding continued. “After six months, my sister Penny warned that I might become anaemic and should have the piles treated,” she says.
But because of the previous all-clear Jill’s appointment wasn’t fast-tracked. It was May before a consultant took a biopsy.
“Deep down I must have suspected something was wrong as I took Tony with me to get the results,” she explains.
The consultant revealed that Jill’s haemorrhoid was, in fact, stage two anal cancer. “I’ve still no idea how it was missed in the two previous examinations,” she says. “The only possible explanation is that clinicians were so focused on my bowel that they overlooked the anal area.”
Jill was referred to Manchester’s specialist cancer treatment centre, The Christie, for six weeks of combined chemotherapy and radiotherapy.
“The radiotherapy was intense over the genital area – so I experienced quite a bit of burning and blistering,” says Jill. “But no matter how sore I felt I made a point of wearing lipstick, bangles and bright colours every day to make myself feel better.”
Thankfully, the discomfort was short-lived and the treatment was successful – with Jill now undergoing regular checks. “It was only afterwards that I realised how silly it was to be so secretive about anal cancer. The more I learned, the more I realised Ellie was right – I did need to be more open.”
Nine out of 10 cases of anal cancer are caused by human papilloma – an increasingly prevalent virus. Experts say 80% of sexually active adults are exposed to it at some point and a third of the population carry it.
“Most will live long, healthy lives,” says Jill. “But a tiny percentage will develop acancer linked to the virus. Anal cancer is one. Others are cervical, vulval, penile, head, neck and throat.
“Many people assume – as I did – that anal cancer only affects those who have been promiscuous or had unprotected or anal sex. But it can affect anyone who has been sexually active.”
With Jill’s encouragement, Ellie launched the Behind Cancer Campaign. Then they were approached by The HPV and Anal Cancer Foundation to join forces.
“One of the key messages is that HPV-linked cancer is both preventable – which is why we’re campaigning for the HPV vaccination to be offered to teenage boys as well as girls – and highly treatable if caught early.”
Experts warn that it will be decades before we start to see cases falling.
“Even if we start vaccinating girls and boys now against HPV, the benefits won’t be seen for at least 20 years,” says consultant clinical oncologist Dr Duncan Gilbert. Meanwhile, David Winterflood, of the HPV and Anal Cancer Foundation, says sufferers frequently experience shame and social isolation, due to misconceptions and ignorance about the cause of the disease and how it is transmitted.
“Not that long ago people were embarrassed to talk about breast, bowel, prostate and testicular cancer, says Jill.
“Thankfully, that’s all changed. It would be great to see that happen with anal cancer, too.”