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
How is stage IV anal cancer or metastasis treated?
Today there is no standard chemotherapy with curative potential for metastatic disease. Local symptom control, referred to as palliative care, is extremely important.
Rare patients with stage IV disease have truly localized metastatic disease for which surgery to remove the metastasis could theoretically be curative. This option should be considered in those unusual cases. The disease is rare enough that there are no studies specifically supporting or refuting this approach.
Patients with stage IV disease are excellent candidates for clinical trials if they are well enough and give truly informed consent. A clinical trial is a research study investigating new approaches to treatment which may benefit the patient and help develop treatments for those patients who develop this disease in the future.
Thus for most patients with stage IV disease the treatment options include:
- Palliative surgery
- Palliative radiation therapy
- Palliative combined chemotherapy and radiation
- Clinical trials
Can anal cancer be prevented?
About 90% of anal squamous cell carcinoma occurs in patients with detectable evidence of human papilloma virus (HPV) infection.
Preventive steps of demonstrable benefit include:
- Receive HPV vaccination
- Avoidance of high risk behaviors which increase the risk of or facilitate the acquisition of HPV infection such as having multiple sexual partners and engaging in receptive anal intercourse
- Perform anal pap testing in patients with a past history of carcinomas of the cervix, vagina, or vulva (These increase the risk of anal cancer three-fold. Detection and treatment of precancerous lesions can reduce the risk that these patients will require treatment for anal cancer in the future.)
- Stop smoking, since smoking increases the risk of anal cancer
- Avoid high risk behaviors for the acquisition of HIV disease (Chronic immunosuppression in men who have sex with men increases the risk of anal cancer 30-fold.)
- Carefully monitor transplant recipients on immunosuppressant drugs with anal pap smears as discussed (Transplant recipients have a three-fold increased risk of anal cancer.)
What is the prognosis for anal cancer?
Anal cancer is usually curable when found localized. Early detection remains the key to long-term survival as it is in many forms of cancer. The 5-year survival rates by anal cancer stage and cell type include:
- Squamous cell carcinomas: 71% for stage I, 64% for stage II, 48% for stage IIIA, 43% for stage IIIB, and 21% for stage IV
- Non-squamous carcinomas: 59% for stage I, 53% for stage II, 38% for stage IIIA, 24% for stage IIIB, and 7% for stage IV
Where can one find information about clinical trials for anal cancer?
There is ongoing research in the treatment of anal cancer. Visit ClinicalTrials.gov for information on clinical trials and patient eligibility.
“NCCN Clinical Practice Guidelines in Oncology: Anal Carcinoma.” Version 2.2015.
“PDQ National Cancer Institute Summaries: Anal Cancer.” Updated 2015.
“Anal Cancer.” American Cancer Society.
Edge, S.B., et al. “Anal Cancer.” AJCC Cancer Staging Manual. 7th ed. Springer. New York, NY. 2010.
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