Anal Cancer (cont.)
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
- Anal cancer facts*
- Anal anatomy
- What is anal cancer?
- What are anal cancer statistics?
- What are the risk factors for anal cancer?
- What are the symptoms and signs of anal cancer?
- What are the different types of anal cancer?
- Anal cancer screening and early detection
- How is anal cancer diagnosed?
- Anal cancer staging
- What types of doctors treat anal cancer?
- What is the treatment for anal cancer?
- Radiation therapy
- Combination chemotherapy and radiation therapy
- How is stage IV anal cancer or metastasis treated?
- Can anal cancer be prevented?
- What is the prognosis for anal cancer?
- Where can one find information about clinical trials for anal cancer?
- Find a local Oncologist in your town
What types of doctors treat anal cancer?
Anal cancers often need a "team" of doctors that collaborate in the treatment of anal cancers. Usually the doctors on a person's team work out of the same institution or hospital and have had experience in treating cancer patients together. Team members often include two or more of the following doctors:
- Primary care physician (PCP)
- General surgeon (best if he or she has special training in colon and rectal disease surgery
- Radiation oncologist
- Medical oncologist
These physicians will be able to design a specific treatment protocol that best suits the patient and his or her cancer.
What is the treatment for anal cancer?
Anal cancer is treated with a variety of therapies including surgery, radiation, chemotherapy, or a combination of these.
Historically, all but the smallest anal cancers were treated with a radical surgery called abdominoperineal resection leading to a permanent end colostomy. About 70% of patients survived more than 5 years in limited studies of this approach. This is no longer the primary treatment of choice. Chemotherapy and radiation are now favored.
A limited resection of small stage I cancers can be curative for these small cancers of the anal margin or perianal skin when the anal sphincter is not involved. Radical resection today is reserved for some cases of residual or recurrent cancer in the anal canal after non-operative treatment. Other nonsurgical approaches (involving chemotherapy with a radiation boost or radioactive seed applications) may be used to avoid colostomy in those circumstances.
Radiation therapy alone for localized anal cancer may confer a greater than a 70% likelihood of 5 year survival. The high doses of radiation used (over 60 Gy [Gy is a unit of energy absorbed from ionizing radiation or 1 joule/Kg of matter]) can lead to significant tissue damage and scarring sometimes necessitating colostomy surgery for control and repair. This approach is not favored today.
Combination chemotherapy and radiation therapy
Today the optimal primary therapy for stage I, II, IIIA, and IIIB anal cancers that are too large for potentially curative local resection is the combination of lower doses of radiation therapy (45 to 60 Gy) combined with two older chemotherapy drugs, 5-FU and Mitomycin C. The combination treatment results in 5-year colostomy free survival of over 75% of stage I, 65% of stage II, and 40% to 50% of stage 3 anal cancer cases. Anal cancers that are located in an area where they cannot be resected may benefit from combination therapy.
Salvage chemotherapy with an alternative regimen of 5-FU and cisplatin combined with a radiation boost can be used for residual or recurrent local disease to avoid radical surgery. Radioactive seed implants can be used to establish local control for residual or recurrent disease to avoid radical surgery.
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