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National Cancer Institute

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Anal cancer


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is anal cancer?
STAGE EXPLANATION
Stages of anal cancer
Stage 0 or carcinoma in situ
Stage I
Stage II
Stage IIIA
Stage IIIB
Stage IV
Recurrent
TREATMENT OPTION OVERVIEW
How anal cancer is treated
Treatment by stage
STAGE 0 ANAL CANCER
STAGE I ANAL CANCER
STAGE II ANAL CANCER
STAGE IIIA ANAL CANCER
STAGE IIIB ANAL CANCER
STAGE IV ANAL CANCER
RECURRENT ANAL CANCER
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


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, is smaller than 2 centimeters in diameter (less than 1 inch), but has not spread to the muscle tissue of the sphincter.


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).


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 is a common way to diagnose and treat anal cancer. A doctor may take out the cancer using one of the following methods:

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 simple surgery to remove all of the cancer.


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.


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.


STAGE IIIA ANAL CANCER

Treatment may be one of the following:

1. Radiation therapy plus chemotherapy.

2. Additional radiation therapy following previous treatment.


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).


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.


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.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about anal cancer, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, you can speak with a trained information specialist who can answer your questions.

The Cancer Information Service also has a variety of booklets that are available to the public and can be sent on request. The following general booklets on questions related to cancer may be helpful:

What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again

There are many other places where people can get material and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 07/1999


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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