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Anal cancer, an uncommon cancer, is a disease
in which cancer (malignant) cells are found in the
anus. The anus is the opening at the end of the
rectum (the end part of the large intestine)
through which body waste passes. Cancer in the
outer part of the anus is more likely to occur in
men; cancer of the inner part of the rectum (anal
canal) is more likely to occur in women. If the
anus is often red, swollen, and sore, there is a
greater chance of getting anal cancer. Tumors
found in the area of skin with hair on it just
outside the anus are skin tumors, not anal cancer.
A doctor should be seen if one or more of the
following symptoms appear: bleeding from the
rectum (even a small amount), pain or pressure in
the area around the anus, itching or discharge
from the anus, or a lump near the anus.
If there are signs of cancer, a doctor will
usually examine the outside part of the anus and
give a patient a rectal examination. In a rectal
examination, a doctor, wearing thin gloves, puts a
greased finger into the rectum and gently feels
for lumps. The doctor may also check any material
on the glove to see if there is blood in it. The
doctor may give the patient general anesthesia,
medicine that puts patients to sleep, to continue
the examination if pain is felt during it. The
doctor may cut out a small piece of tissue and
look at it under a microscope to see if there are
any cancer cells. This procedure is called a
biopsy.
The prognosis (chance of recovery) and choice of
treatment depend on the stage of the cancer
(whether it is just in the anus or has spread to
other places in the body) and the patient's
general health.
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STAGE EXPLANATION
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Stages of anal cancer
Once anal cancer is found (diagnosed), more tests
will be done to find out if cancer cells have
spread to other parts of the body. This testing is
called staging. To plan treatment, a doctor needs
to know the stage of the disease. The following
stages are used for anal cancer.
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Stage 0 or carcinoma in situ
Stage 0 anal cancer is very early cancer. The
cancer is found only in the top layer of anal
tissue.
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Stage I
The cancer has spread beyond the top layer of anal
tissue, is smaller than 2 centimeters in diameter
(less than 1 inch), but has not spread to the
muscle tissue of the sphincter.
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Stage II
Cancer has spread beyond the top layer of anal
tissue and is larger than 2 centimeters in
diameter, but has not spread to nearby organs or
lymph nodes (small, bean-shaped structures found
throughout the body that produce and store
infection-fighting cells).
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Stage IIIA
Cancer has spread to the lymph nodes around the
rectum or to nearby organs such as the vagina or
bladder.
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Stage IIIB
Cancer has spread to the lymph nodes in the middle
of the abdomen or in the groin, or the cancer has
spread to both nearby organs and the lymph nodes
around the rectum.
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Stage IV
Cancer has spread to distant lymph nodes within
the abdomen or to organs in other parts of the
body.
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Recurrent
Recurrent disease means that the cancer has come
back (recurred) after it has been treated. It may
come back in the anus or in another part of the
body.
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TREATMENT OPTION OVERVIEW
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How anal cancer is treated
There are treatments for all patients with anal
cancer. Three kinds of treatment are used:
surgery (taking out the cancer in an operation)
radiation therapy (using high-dose x-rays or other
high-energy rays to kill cancer cells)
chemotherapy (using drugs to kill cancer cells)
Surgery is a common way to diagnose and treat anal
cancer. A doctor may take out the cancer using one
of the following methods:
Local resection is an operation that takes out
only the cancer. Often the ring of muscle around
the anus that opens and closes it (the sphincter
muscle) can be saved during surgery so that you
will be able to pass the body wastes as before.
Abdominoperineal resection is an operation in
which the doctor removes the anus and the lower
part of the rectum by cutting into the abdomen and
the perineum, which is the space between the anus
and the scrotum (in men) or the anus and the vulva
(in women). A doctor will then make an opening
(stoma) on the outside of the body for waste to
pass out of the body. This opening is called a
colostomy. Although this operation was once
commonly used for anal cancer, it is not used as
much today because radiation therapy with or
without chemotherapy is an equally effective
treatment option but does not require a colostomy.
If a patient has a colostomy, a special bag will
need to be worn to collect body wastes. This bag,
which sticks to the skin around the stoma with a
special glue, can be thrown away after it is used.
This bag does not show under clothing, and most
people take care of these bags themselves. Lymph
nodes may also be taken out at the same time or in
a separate operation (lymph node dissection).
Radiation therapy uses x-rays or other high-energy
rays to kill cancer cells and shrink tumors.
Radiation may come from a machine outside the body
(external radiation therapy) or from putting
materials that produce radiation (radioisotopes)
through thin plastic tubes in the area where the
cancer cells are found (internal radiation
therapy). Radiation can be used alone or in
addition to other treatments.
Chemotherapy uses drugs to kill cancer cells.
Chemotherapy may be taken by pill, or it may be
put into the body by a needle in a vein or muscle.
Chemotherapy is called a systemic treatment
because the drugs enter the bloodstream, travel
through the body, and can kill cancer cells
throughout the body. Some chemotherapy drugs can
also make cancer cells more sensitive to radiation
therapy. Radiation therapy and chemotherapy can be
used together to shrink tumors and make an
abdominoperineal resection unnecessary. When only
limited surgery is required, the sphincter muscle
can often be saved.
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Treatment by stage
Treatments for anal cancer depend on the type of
disease, stage of disease, and the patient's age
and general health.
Standard treatment may be considered, based on its
effectiveness in patients in past studies, or
participation in a clinical trial. Not all
patients are cured with standard therapy, and some
standard treatments may have more side effects
than are desired. For these reasons, clinical
trials are designed to find better ways to treat
cancer patients and are based on the most
up-to-date information. Clinical trials are
ongoing in most parts of the country for most
stages of anal cancer. For more information about
clinical trials, call the Cancer Information
Service at 1-800-4-CANCER (1-800-422-6237); TTY at
1-800-332-8615.
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STAGE 0 ANAL CANCER
Treatment will probably be simple surgery to
remove all of the cancer.
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STAGE I ANAL CANCER
Treatment may be one of the following:
1. Simple surgery to remove all of the cancer.
2. Radiation therapy with or without chemotherapy.
Some patients may also receive therapy that
involves placing radioactive substances in the
tissues surrounding the cancer to destroy the
cancer (interstitial radiation therapy).
3. If cancer cells remain following therapy,
surgery removing the anus and lower part of the
rectum may be performed. An opening will be made
for waste to pass of out the body (colostomy) into
a disposable bag attached near the colostomy
(colostomy bag).
4. If cancer cells remain following therapy,
additional chemotherapy plus radiation therapy may
be performed.
5. Radiation therapy followed by interstitial
radiation therapy.
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STAGE II ANAL CANCER
Treatment may be one of the following:
1. Simple surgery to remove all of the cancer.
2. Radiation therapy plus chemotherapy. Some
patients may also receive therapy that involves
placing radioactive substances in the tissues
surrounding the cancer to destroy the cancer
(interstitial radiation therapy).
3. If cancer cells remain following therapy,
surgery removing the anus and lower part of the
rectum may be performed. An opening will be made
for waste to pass of out the body (colostomy) into
a disposable bag attached near the colostomy
(colostomy bag).
4. If cancer cells remain following therapy,
additional chemotherapy plus radiation therapy may
be performed.
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STAGE IIIA ANAL CANCER
Treatment may be one of the following:
1. Radiation therapy plus chemotherapy.
2. Additional radiation therapy following previous
treatment.
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STAGE IIIB ANAL CANCER
Treatment will probably be radiation therapy plus
chemotherapy followed by surgery. Depending on how
much cancer remains following chemotherapy and
radiation, surgery to remove the cancer or surgery
to remove the anus and the lower part of the
rectum (abdominoperineal resection) may be done.
During surgery, the lymph nodes in the groin may
be removed (lymph node dissection).
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STAGE IV ANAL CANCER
Treatment may be one of the following:
1. Surgery to relieve symptoms caused by the
cancer.
2. Radiation therapy to relieve symptoms caused by
the cancer.
3. Chemotherapy and radiation therapy to relieve
symptoms caused by the cancer.
4. A clinical trial evaluating new treatments.
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RECURRENT ANAL CANCER
The choice of treatment will be based on what
treatment the patient received when the cancer was
first treated. If the patient was treated with
surgery, radiation therapy may be given if the
cancer recurs. If the patient were treated with
radiation, surgery may be used if the cancer
recurs. Clinical trials are studying new
chemotherapy drugs with or without radiation
therapy. The patient may also receive additional
chemotherapy and radiation therapy. |
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