Dear Doctor: A friend of mine was diagnosed with, and treated for, anal cancer about two years ago. She never told me the location of her cancer until recently because she thought that "anus" and "anal" were shameful words. She also let the symptoms drag on for a year or so because she thought they were due to hemorrhoids. What are the symptoms, how is this type of cancer treated, and is it on the increase?

Dear Reader: In our everyday life, we focus on our usual responsibilities: our family, our job, paying our mortgage or rent, maintaining friendships, worrying about politics, etc. This complex existence often doesn't afford us time to deal with nagging symptoms. When those symptoms occur in a part of the body that people don't like to consider, like the anus, the likelihood of a delay in diagnosis increases.

Also, anal cancer is relatively uncommon, meaning people are unlikely to suspect the disease. Each year, it's diagnosed in approximately 8,200 people in the United States, leading to about 1,100 deaths; only about 0.2 percent of the population will be diagnosed with it over their lifetime. But to answer your last question: Even though the numbers are small, yes, the rate of anal cancer is increasing. Compared to diagnoses 40 years ago, the rate of anal cancer has increased three times in men and 1.7 times in women. As with cervical cancer, infection with the human papillomavirus (HPV) increases the risk, as does homosexuality (for men), anal sex and a history of anal warts.

As for symptoms, anal bleeding occurs in 45 percent of patients but, because hemorrhoids can similarly cause bleeding, people often can ignore this sign. Anal pain or a sensation of fullness in the rectum occurs in about 30 percent of patients, and 20 percent of patients have no symptoms at all.

In the 1960s, treatment consisted of the removal of the anus and the surrounding tissues, leading to a permanent colostomy, that is, a rerouting of the colon through an opening in the abdomen. Three percent of patients died from the procedure alone.

Today, treatment consists largely of radiation and chemotherapy. The radiation therapy is generally given in 25 treatments over a period of five weeks. The chemotherapy -- typically, 5-fluorouracil and Mitomycin (or cisplatin) -- is often given on the first and fifth weeks of radiation treatment. This combined approach has decreased not only the death rate from anal cancer, but also the need for a colostomy. Today, only 14 to 35 percent of patients need a colostomy after five years. Survival rates depend on the tumor size at diagnosis. The five-year survival rate ranges from 86 percent to 42 percent, depending on the severity of the disease.

Radiation, however, has side effects, potentially leading to more frequent bowel movements, flatulence and rectal incontinence -- as well as potential impotence in men and vaginal damage in women. Newer forms of radiation therapy using computer-controlled techniques and 3-D imaging can reduce some of these side effects.

It's a testament to your friendship that your friend was finally able to share her diagnosis with you. By seeking to learn more about anal cancer, you're not only showing concern, but also helping raise awareness.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I recently read that probiotic bacteria could protect newborns from sepsis. Does that mean I should be giving probiotics to my newborn?

Dear Reader: Sepsis occurs when the body's immune response to infection goes haywire and winds up injuring its own organs and tissues. The World Health Organization estimates that neonatal sepsis, a bloodstream infection in newborns, claims the lives of up to 1 million newborns each year. About 34,000 of these cases occur in the United States. Even among infants who are properly diagnosed and receive timely medical treatment with antibiotics, the mortality rate for sepsis can reach 60 percent.

In response to this heartbreaking health crisis, researchers in the U.S. and India looked to probiotic bacteria, which have proven effective in combating other types of infections in both infants and adults. Probiotics have been successful in treating necrotizing enterocolitis, a bacterial infection that results in the death of the tissues of the intestine. It's a condition that affects mostly newborns, and researchers hoped that probiotics could turn the tide of neonatal sepsis as well.

After screening and testing close to 300 strains of bacteria, the researchers settled on Lactobacillus plantarum, a microorganism with a well-documented history of safety in fermented foods. They combined the bacterium with food sources for its survival, known as prebiotics. The final product, known as a synbiotic, was fed for one week to the 4,500 or so healthy infants taking part in the trial. They were randomly selected from 149 villages in the state of Odisha in India, where sepsis is a major cause of infant death.

The idea was that by colonizing the newborns' intestines with these beneficial bacteria, the adverse organisms that cause sepsis would fail to flourish. Researchers then followed the medical histories of the inoculated babies, as well as a control group of healthy infants who did not get the synbiotic. The result was a 40 percent drop in the rate of sepsis and death from sepsis among the infants who ingested the synbiotic.

In addition, researchers noted that of the infants who took the synbiotic, infections of the lower respiratory tract were reduced by one-third. This exciting news suggests that synbiotics may promote immunity against infections other than those that arise within the gut.

While it took us just a few hundred words to sketch out the (very) basics of these studies, the trials themselves took a decade to complete. Now the scientists say they want to know whether these results can translate to premature infants, who face a host of medical challenges. They also want to expand the sepsis trial to other parts of the world.

As for whether you should begin giving probiotics to your own baby, the science is young and many outlandish claims are being made. The American Academy of Pediatrics has thus far weighed in with a "not yet." We believe this is something you need to discuss with your pediatrician, and move forward only with his or her guidance.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I developed acute prostate problems at the early age of 29. My doctor's prescriptions didn't work, so when a neighbor recommended 50 milligrams of zinc a day for at least 30 days, I gave it a shot. I haven't had any problems since -- and that was more than 30 years ago. Why don't more people use this miracle mineral for an enlarged prostate?

Dear Reader: Before you posed this question, I had never heard of any relationship between zinc and the prostate. Like most people, I thought of zinc simply as an important element in the body -- necessary for multiple enzymatic processes involved in human metabolism. I also knew that zinc concentrates in the liver, kidney, muscle and retina and is found at very high levels in the prostate.

After some research, I also found that the content of zinc in the prostate is about 100 times that found in the bloodstream. At high tissue concentrations, zinc can inhibit the formation of dihydrotestosterone, the main hormone that leads to prostate enlargement. It has also been shown to help preserve the normal tissue structure of the prostate and to help maintain prostate function. Zinc may also increase the ability to kill bacteria that lead to infections of the prostate.

A 2016 analysis of 10 studies assessed blood levels of zinc in men with prostate cancer. Seven of the studies found low concentrations. This is notable because multiple lab studies have shown that zinc can inhibit prostate cancer growth by hindering the function of prostate cancer cells and by turning on mechanisms that lead to the death of prostate cancer cells. In Japan and China, where zinc intake is high, the rates of prostate cancer are low. But after one generation in the United States, ethnic Japanese, for example, have the same rates of prostate cancer as Caucasians in the U.S.

As for prostate enlargement, this same analysis evaluated five studies assessing a potential link between blood levels of zinc and decreased risk of prostate enlargement -- and found none. In fact, three of the five studies showed a link between higher zinc concentrations and prostate enlargement, countering the notion that zinc could decrease the enlargement of the prostate.

So, although low zinc may be linked to an increased risk of prostate cancer, the same does not hold true for a decreased risk of prostate enlargement. A laboratory study of prostate tissue did show that zinc at high doses decreases smooth muscle proliferation in the prostate and thus possibly could decrease prostate size. Further, in a 2017 Italian study, 62 patients with symptoms related to prostate enlargement were given 10 milligrams of zinc in addition to herbal extracts. After six months, a majority of men reported decreased urinary frequency, increased flow rates and less urine retained in the bladder. Note that because zinc was administered with other therapies, it is difficult to know what effect the mineral alone had.

Because you had prostate problems early in life, I suspect your prostate issues may have been related to infection, rather than the more typical prostate problems of older men. It's possible that zinc may have had an antibacterial effect of preventing further infections of the prostate. Because of decreased infections, your prostate didn't enlarge and cause future problems. Perhaps this is why zinc helped you -- and why it may be helpful to others who have early prostate infection or inflammation.

Thanks for your question. Clearly, zinc therapy for the prostate should be studied further.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)