Carmel Sparke WHEN Professor Richard Hillman was a

boy , a future as one of Australia ’ s leading

anal cancer doctors was not top of his list of

dream careers .

He also never pictured himself discussing

anal cancer symptoms in front of 100

naked men gathered around a swimming

pool at a gay nudist event .

But he says he will go anywhere , anytime

to talk about the need for people to

open up about their anuses . As such , turning

up at a gay nudist event — he was fully

clothed by the way — is exactly what he has

done .

Shame and silence always render medicine

difficult . The reluctance to talk about

the body part with their GPs leads to many

patients ignoring early signs of anal cancer

and contributes to late presentations .

“ It is okay to talk about an itchy rash or a headache ,” says Professor Hillman , who

Professor Richard Hillman .

runs the anal cancer clinic at St Vincent ’ s

Hospital Sydney .

gone to her GP with a lump on her anus .

Day , he has a stall with ‘ George ’ — a latex

living with HIV , it is as common as pros-

“ But saying ‘ I have got a lump on my

She was given haemorrhoid cream

dummy with an artificial anus — where

tate or breast cancer .

bum ’ is still incredibly difficult for people .”

without an examination but returned two

he invites passers-by to put on the gloves ,

Other high-risk groups are women who

weeks later with the same lump and was

grab the lube and insert their fingers into

have had cervical HPV-related disease and

‘ Nobody really owns the anus ; no specialty has claimed responsibility .’

referred for a colonoscopy , which came back negative .

She sought a second opinion as the lump was still present . On seeing a colorectal surgeon , who examined her , she was told she had cancer , Professor Hill-

George to try to detect internal lumps and bumps .

But the shame the cancer engenders — patients will often describe their diagnosis as bowel or colon cancer — affects medicine too .

patients who have had transplants and the associated immunosuppression , especially women .

“ So if you are over the age of 50 , particularly if you are from a high-risk group , then I think you need someone

Most of his patients present with tumours larger than 5cm , often having delayed medical visits . Their five-year survival rate is about 70 % with treatment .

“ The treatment is chemoradiotherapy , which is appalling because , as you can imagine , the radiotherapy has to be really intense to get into the anal canal ,” he says .

“ You get a lot of collateral damage as it goes through the skin and the vagina and the bowel .

“ The long-term survivors have to live with that radiation damage for the rest of their lives .”

Professor Hillman refers to the case of a gynaecologist — a sensible , highly intelligent woman — who , at the age of 59 , had

man says . “ She has got understandable anger with the system . And she is an articulate healthcare professional who still had all these barriers to getting herself sorted .

“ But her case is far from unique — in fact , I think it is quite typical .

“ People think that a colonoscopy will pick up anal cancer , but it often misses the whole anus . It is a colonoscopy , not an anoscopy .

“ Unless they retroflex or bend the colonoscope , they are going to miss anal disease .”

He says he is willing to spend time spreading his message with humour given the seriousness of the subject .

At the annual Sydney Mardi Gras Fair

“ The problem is nobody really owns the anus ; no specialty has claimed responsibility .

“ While the colorectal surgeons have the biggest claim to it , most colorectal surgeons are not that interested in anal stuff ,” says Professor Hillman , whose own background is in sexual health .

He also acknowledges the challenge of diagnosis .

“ When only a small minority of the people you are seeing are at high risk , it can be a tough job for GPs filtering out what is important .”

But while anal cancer remains rare in Australia , with around 600 diagnoses each year , Professor Hillman says , within specific high-risk populations , such as those

to look at your bottom to see if there is a real lump and get it seen and referred on accordingly .”

At 67 , Professor Hillman is ready to retire , but with a waiting list of 400 patients and few doctors queueing up for his succession plan , he says he has got to continue .

“ It was not my passion as a 10-year-old boy to become an anal cancer specialist ,” he laughs .

“ But patients are just so grateful for the care you provide . Whenever you sit down with them , they feel heard . They feel comfortable . I do get enormous satisfaction out of what I do .

“ We do not like talking about bottoms ; it is almost the last taboo .”

Rada Rouse PATIENTS with uncomplicated diverticulosis are no more likely than those without the condition to experience abdominal pain or changes in bowel habits , a novel study has found .

The first population-based study in which patients with diverticulosis kept prospective diaries showed that the condition was unlikely to explain such symptoms .

The research team of Australian and Swedish gastroenterologists analysed data from 258 people who kept a detailed record of symptoms for a week and then underwent colonoscopy .

Among the study participants , 50 had one or more diverticula but none had a history of diverticulitis .

“ In this unique population-based study , diverticulosis was not associated with more frequent abdominal pain or more lower left quadrant ( LLQ ) abdominal pain overall ,” the authors wrote in Neurogastroenterology and Motility .

“ However , when individuals with diverticulosis had abdominal pain , it was more frequently located in the LLQ compared with those without diverticulosis .”

The diaries recorded any hour with pain , including severity , location and duration , as well

‘ Pain in uncomplicated diverticulosis may indeed represent IBS .’

as detailing the patients ’ bowel movements .

Diverticulosis was not linked with more frequent bowel movements , greater urgency , straining or feelings of incomplete evacuation

, the team reported .

They noted a theory that pain associated with diverticulosis may be a subset of irritable bowel syndrome ( IBS ).

But they said there were also indications that the pain differed , and some suggested it could be a distinct clinical entity .

“ Our data shows a similar prevalence of IBS and similar odds of abdominal pain among individuals with and without diverticulosis , supporting the theory that pain in uncomplicated diverticulosis may indeed represent IBS ,” wrote the team , which included Professor Nick Talley , from the University of Newcastle in NSW .

A limitation of the study was its small sample size and that its design did not allow for conclusions regarding causality , the team said .

Neurogastroenterol Motil 2025 ; 17 Feb .