Susie Sanchez has lived. 

And she’s been sure to do so in every sense of the word. 

She has lived the dream, and even called her 2014 memoir “The Dream Lived.” Now, Sanchez, 47, has lived through six weeks of chemotherapy and radiation for anal cancer.

She doesn’t plan on stopping there.

Ten years ago, the Hollister resident was ecstatic when she made the National Football League Raiderette team. She was 37. She was also a wife, a mother of three, and a new grandmother. Since the words ‘Raiderette,’ ‘cheerleader,’ and ‘grandmother’ are not commonly seen together, she gained national attention after the Hollister Free Lance did a story on her.

“I had such a huge platform,” Sanchez said of her one season with the team. “I’d always asked myself, ‘What was the point of that huge platform?’ And then I got this diagnosis.”

HPV

Sanchez was diagnosed in March with squamous cell carcinoma of the anus. According to the Anal Cancer Foundation, the disease is mostly caused by human papillomavirus (HPV) and it estimates that over 93% of anal cancer cases are caused by HPV. Approximately 9,090 people will be diagnosed with anal cancer in the United States each year. 

“I just couldn’t get over it,” Sanchez recalled. “HPV? I thought, ‘I don’t have HPV—especially in my anus.’” 

Sanchez had just had her annual cervical pap smear in June 2020, which came back negative for HPV. She has been with the same partner, her husband Charlie, for nearly 30 years, and has maintained a healthy lifestyle. 

According to an article in Very Well Health, factors that increase a person’s risk for developing anal cancer include: 

• having receptive anal sex
• smoking 
• having a high number of sexual partners 
• having genital warts 
• HIV infection—particularly one that has caused moderate to severe immunosuppression, even if several years in the past

Though Sanchez didn’t fit the criteria for being at risk for anal cancer, in August 2020 she began experiencing an uncomfortable itch around her anus—“a booty itch,” she called it. 

She became alarmed three months later. After having a bowel movement, she found some blood on the toilet paper after wiping. Assuming it was a hemorrhoid, she saw her gynecologist again, and was diagnosed with an anal fissure. 

After a prescribed topical ointment didn’t stop the itching, she saw a proctologist in Los Gatos in March. She expected the same diagnosis, but better medication for her anal fissure. 

“A really odd experience of just seeing a doctor for a cream became a serious conversation,” she said.

‘We are misdiagnosed’

The proctologist asked Sanchez when she had her last rectum pap smear for the HPV virus. “‘Rectum pap smear?” she recalled asking. “‘I just got my cervical pap smear in June, and I don’t have HPV.” But before Sanchez even finished changing back into her clothes, the doctor said, “‘I would really just like to do a biopsy right now if you’d let me.’”

Sanchez agreed, and was diagnosed with atypical anal fissure. She was told it could be from an STD, ulcer, Crohn’s Disease, or anal cancer. The latter cause caught Sanchez’s attention, but not enough to where she considered it likely. 

Five days later, a phone call delivered unexpected news.

“‘You have squamous cell carcinoma; anal cancer,’” she recounted. “‘Most likely from the HPV virus.’ I just melted. I went numb. I didn’t hear anything after that. I heard ‘early stage,’ ‘most likely,’ and ‘this is treatable.’” 

The diagnosis was such a surprise that Sanchez began researching information on her cancer type. 

“Every survivor on the Anal Cancer Foundation website that I’ve found was a ‘hemorrhoid misdiagnosed,’ or a ‘fissure misdiagnosed’” she said. “We are misdiagnosed with this illness. When the hemorrhoid cream is no longer working for the hemorrhoid, you need to go get a rectum pap smear. You need a proctologist.” 

Sanchez’s radiation oncologist, Dr. Rakesh Patel, director of radiation oncology at Good Samaritan Hospital in Los Gatos, said that though rectal pap smears are uncommon procedures, “I think that we’re going to see more and more of them.” He also said that, at this time, rectal pap smears are not covered by insurance companies. 

Hollister obstetrician and gynecologist, Dr. Mohammad A. Barra, who has practiced in Hollister since 1985 and is also a member of the American Board of Obstetrics and Gynecology, said that gynecologists have not had the same protocol for inspecting the rectum and anus as they have for the cervix. 

“With the cervix, if the virus is present, then there is a small abnormality of the cell,” Barra said. “Even if the cervix looks normal, we are able to enlarge the picture of the cervix through a microscope and see if there are any abnormalities. We are noticing that there’s been a decrease in cervical cancer because we are checking more. At the same time, there’s been an increase of anal cancer and rectal cancer, because there’s no protocol to check for it.”

Barra said that it has yet to be determined if checking patients with a rectal swab would be as reliable as checking the cervix in the same manner. 

Getting vaccinated

Planned Parenthood states that people ages 9-45 can get the HPV vaccine, however, it recommends that children wait until age 11 or 12 to be vaccinated.

According to the Planned Parenthood website, “The HPV vaccine is given in a series of shots. For people ages 15-45, the HPV vaccine is three separate shots. The second shot is given two months after the first, and the third shot is given four months after the second shot. So, in all, it takes about six months to get all three shots. For people ages 9-14, you only need to get two shots. The second shot is given six months after the first shot.”  

Planned Parenthood also notes that HPV is a group of more than 200 viruses, with the four most concerning being the HPV types 16 and 18 (the two types that cause 80% of cervical cancer cases) and HPV types 6 and 11, which cause 90% of genital warts cases. It also mentioned there are five types of HPV (types 31, 33, 45, 52, and 58) that can lead to cancer of the cervix, anus, vulva/vagina, penis, or throat.

Much like the chicken pox can remain dormant and lead to shingles later in life, so can HPV strains.

“Maybe you were exposed one time, and you didn’t do anything for 10 or 15 years, it could still stay in your body,” Barra said. “If you have a positive HPV, it may not be your current partner. It can stay dormant in the body and then all of a sudden show up. It doesn’t go away. It just kind of hides in the body.”

“People always ask me, ‘how can I help you?’” Sanchez said. “I tell them to go tell 10 people, to tell 10 people to tell 10 people to get their youth vaccinated. Because that’s how you can help me. This diagnosis—there’s a reason. I’m not sure why God had to give it to me, but there’s a reason.”

More treatment

Sanchez completed concurrent cancer treatment, a radiation/chemo combination on June 24. In six months, doctors will check to see if the tumor is gone. If not, her next level of treatment will be surgery.

“And that’s when you’ll be permanently bagged, where you’ll have to have a colposcopy bag for life, that sits on the outside,” Sanchez said.

She also said that since she had pelvic radiation, she will most likely experience early menopause. She will also need to do Kegel exercises for the rest of her life.

The American Cancer Society states that with pelvic radiation, the vagina can shorten or narrow. Patients may need to rely on a vaginal dilator—a plastic or rubber tube—to stretch, or open, the vagina and help relax the vaginal muscles used with Kegel exercises.  

“The take-home lesson is everybody should take the opportunity to get vaccinated against HPV,” Barra said. “Even if you missed it early on, you can get it all the way up to age 45. It will still help you—it may prevent you from getting the most damaging strains of the virus. People, especially young people who may be having oral sex, should be aware of any warts. If you see any warts, you should think about being HPV tested. Anybody who has a sore in the anal area should be checked for anal cancer. Girls should be vaccinated and boys should be vaccinated so we can have herd immunity.”

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