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High Resolution Anoscopy (HRA) Center

Anal cancer is rare, but the number of diagnoses is rising. Johns Hopkins’ multidisciplinary group of practitioners evaluates anal lesions with high resolution anoscopy (HRA), which may be used along with a biopsy to confirm a diagnosis.

Your doctor may refer you to our clinic if you have an undiagnosed anal lump, bump or lesion, or if you have had an anal Pap test that shows abnormal changes in the cells in the lining of the anal canal (anal dysplasia).

Testing may be recommended if you are living with human papillomavirus (HPV), or if you have a weakened immune system or other risk factors for anal dysplasia or anal cancer.

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Why Choose Johns Hopkins High Resolution Anoscopy Center

Doctor discussing procedure with patient
  • Our clinic’s focus on anal cancer screening makes it unique in the Baltimore area.
  • The team offers you diverse expertise, including specialists in infectious disease, internal medicine and colorectal surgery. We work closely with the Johns Hopkins transplant team and Chase Brexton Health Care.
  • We know that every individual is unique, and we work together with you to determine the most appropriate tests, based on your situation.
  • If the tests show that you have anal cancer, we can provide therapy for low-grade (mild) tumors or refer you to surgical treatment experts at Johns Hopkins for more invasive cancers.

How to Prepare for Your Appointment and What to Expect

  • For 24 hours before your visit:
    • Do not have anal sex.
    • Do not put anything, including medications or products, into your anus.
    • Do not douche or use enemas.
  • When you visit our clinic, we will talk to you about your general health and your risk factors for anal cancer.
  • After you have changed into a gown, the doctor will examine your anal area.
  • The doctor may perform a digital rectal exam by inserting a lubricated, gloved finger into the anus and rectum and feeling for any lumps or masses.
  • The doctor may perform an anal Pap test, even if you had one before. A cotton swab is used to collect cells from the anal canal.

The Anoscope Exam

  • The HRA procedure itself takes about 20 or 30 minutes, and we perform the test at our center. After treating the anal area with a numbing gel, the doctor will insert a plastic instrument called an anoscope into the anus and rectum. The doctor looks through the anoscope with a colposcope to examine the lining of the anus, and may take pictures of spots that look abnormal.
  • If the doctor sees or feels an abnormal area, a biopsy may be performed. After applying numbing medicine, a small amount of tissue from the suspicious area will be removed. Sometimes this procedure causes some bleeding — the doctor may use an instrument to apply heat to stop the bleeding.
  • The sample is sent to a pathology laboratory, where doctors look at it under a microscope.

After the Procedure

After your biopsy, your anus will need to heal during the next several days. You may experience some bleeding and discomfort, especially after a bowel movement.

To help relieve discomfort:

  • Take acetaminophen or ibuprofen as directed.
  • Avoid constipation by drinking plenty of water and eating a diet high in fiber. Ask the doctor if you can take fiber supplements or stool softeners.
  • Soak the anal area in hot water (a sitz bath).
  • Avoid excessive wiping after bowel movements — use your hands and plain water to cleanse the anal area in the shower, or use a medicated pad to protect your skin.
  • Use medicated topical creams and suppositories as recommended by your doctor.

It is important to prevent infection at the biopsy site. For at least one week after your biopsy:

  • Do not have anal sex or insert anything into the anus, including fingers, suppositories or sex toys.
  • Do not lift anything heavier than 20 pounds.
  • Shower only: Do not take tub baths.

Call the clinic right away or go to the emergency room if you have heavy bleeding, severe pain or a fever higher than 101 degrees.

We will call you when we receive test results, usually in one to two weeks after the biopsy. The lab results will help us develop a management plan, which may include:

  • Observation (watchful waiting and regular follow-up)
  • Topical treatment (you can apply this at home)
  • Ablation — using heat to destroy abnormal tissue
  • Referral to a surgeon

Meet the Experts

Our team provides services at Green Spring Station, Lutherville, as well as Johns Hopkins Outpatient Center in Baltimore, Maryland. 

Green Spring Station, Lutherville

Johns Hopkins Outpatient Center, Baltimore