[MOL] Educational Series- Anal-2 [00528] Medicine On Line


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[MOL] Educational Series- Anal-2



Educational Series: Anal Cancer
 

What is anal cancer?

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.
 
 

STAGE EXPLANATION
 

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.
 

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.
 

Stage I

The cancer has spread beyond the top layer of anal tissue and is smaller than 2 centimeters
(less than 1 inch).
 

Stage II

Cancer has spread beyond the top layer of anal tissue and is larger than 2 centimeters (about
1 inch), but it has not spread to nearby organs or lymph nodes. (Lymph nodes are small,
bean-shaped structures found throughout the body. They produce and store
infection-fighting cells.)
 

Stage IIIA

Cancer has spread to the lymph nodes around the rectum or to nearby organs such as the
vagina or bladder.
 

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.
 

Stage IV

Cancer has spread to distant lymph nodes within the abdomen or to organs in other parts of
the body.
 

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.
 
 

TREATMENT OPTION OVERVIEW
 

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.
 

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.
 
 

STAGE 0 ANAL CANCER

Treatment will probably be local resection.
 
 

STAGE I ANAL CANCER

Treatment may be one of the following:

     1. Local resection (for some small tumors).

     2. External radiation therapy with chemotherapy. Some patients may also receive
     internal radiation therapy.

     3. If cancer cells remain following therapy, additional chemotherapy and radiation
     therapy may be needed.

     4. If cancer cells remain following therapy, surgery may be needed to remove cancer
     in the anal canal.
 
 

STAGE II ANAL CANCER

Treatment may be one of the following:

     1. Local resection (for small tumors).

     2. External radiation therapy with chemotherapy. Some patients may also receive
     internal radiation therapy.

     3. If cancer cells remain following therapy, additional chemotherapy and radiation
     therapy may be needed.

     4. If cancer cells remain following therapy, surgery may be needed to remove cancer
     in the anal canal.
 
 

STAGE IIIA ANAL CANCER

Treatment may be one of the following:

     1. Radiation therapy with chemotherapy.

     2. Depending on how much cancer remains following the initial radiation therapy and
     chemotherapy, additional radiation therapy and chemotherapy may be given.

     3. Surgery. Depending on how much cancer remains following chemotherapy and
     radiation, local resection or surgery may be done to remove cancer in the anal canal.

     4. Surgery (resection) followed by radiation therapy.

     5. Surgery followed by chemotherapy if chemotherapy has not been used prior to
     surgery.
 
 

STAGE IIIB ANAL CANCER

Treatment will probably be radiation therapy and chemotherapy followed by surgery.
Depending on how much cancer remains following chemotherapy and radiation, local
resection 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).
 
 

STAGE IV ANAL CANCER

Treatment may be one of the following:

     1. Surgery to relieve symptoms.

     2. Radiation therapy to relieve symptoms.

     3. Chemotherapy and radiation therapy to relieve symptoms.

     4. Clinical trials.
 
 

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.