Anal Intraepithelial Neoplasia (AIN)

Anal intraepithelial neoplasia starts with HPV and can develop into anal cancer. In this condition, the cells in your anus — the last part of your intestine — begin to develop abnormally and may multiply more quickly than usual. You may notice small signs such as pain, itching, bleeding or tiny lumps. Often, however, AIN develops quietly, without any noticeable warning.

We start testing by using a swab in the back passage to obtain cells (cytology). We then send this sample to the lab for high-risk HPV testing. Results will show if HPV 16, the main cause of anal cancers, or other HPV types are present.

The combination of the swab and a digital anorectal exam (DARE) of your anus to check for  any lumps is our standard screening procedure. We often follow this screening with a high-resolution anoscopy (HRA) to make sure there is no AIN visible inside or outside your anus.

Private testing close to home

If you have been exposed to or diagnosed with HPV, it’s worth booking an appointment. We offer private AIN screening, which is not yet widely available across the U.K. You receive access to early detection without a wait.

Our team uses high-resolution anoscopy to carefully examine the anal canal. Your consultant will use two tools: an anoscope (a small, hollow tube with a light) and colposcope, which magnifies the area to help us better detect tiny tissue changes.

They will also apply a cotton swab coated with a mild solution of acetic acid to the canal. This makes abnormal cells turn white and become more visible. Sometimes they will also use iodine to help distinguish precancerous changes from benign (non-cancerous) ones.

If testing shows you have AIN, our team will work with you to build a highly tailored treatment plan. You will receive the most effective care for your situation. This may include:

• Ablation therapy: This involves laser treatments, electrocautery or topical solutions to remove abnormal cells.
• Active surveillance: We keep a close eye on any changes that could signal progression to anal cancer or recurrence of AIN after treatment. This includes taking small biopsies if needed and repeating the anal swab.
• We do most of these tests and treatments in the clinic with local anaesthesia (numbing). To treat advanced AIN, early cancers — or to rule out the possibility of cancer — we may need to carry out a procedure under general anaesthetic.

Not all AIN progresses to cancer. Your consultant will honestly discuss your individual risk and work with you to customise your treatment and any needed surveillance.

When you need cancer treatment

If AIN progresses to anal cancer, we will ensure you get the necessary scans and will discuss your treatment plan with other Cleveland Clinic London specialists at our weekly expert multidisciplinary team (MDT) meeting.

You will undergo local surgery (excision) for very small cancers, such as those we often detect through HRA. If you require more involved anal cancer treatment, we work with our trusted partner, The London Clinic. There, you may receive treatment, including chemotherapy and external beam radiation therapy (EBRT), ensuring you have speedy access to the most effective care.

Once your treatment at The London Clinic is complete, you will return to Cleveland Clinic London for ongoing surveillance and follow-up, including HRA.

Paying for Private AIN Care at Cleveland Clinic London

After your initial consultation, you will receive an estimate of expected costs so you can plan the financial aspect of your care upfront — and feel confident in your decisions.

You can choose to pay using private medical insurance or our self-pay services. If it helps, our partner Chrysalis Finance can arrange instalment plans, making it easier to manage the cost of your care.

What’s Next?

Learning that you might have AIN and be at a higher risk of anal cancer can be unsettling. The best first step is to book a screening. We can help you obtain the answers you need and develop a treatment plan if testing indicates one is necessary. Our team will be with you all along the way, providing expert care and support.

Contact us on +44 20 3423 7500 for more information about anal cancer services.