Treatment
Anal cancer can usually be treated and cured successfully if caught early. There are three primary treatments for anal cancer: chemotherapy and radiation (chemoradiation) which is the standard treatment; surgery mainly is indicated for persistent disease after chemoradiation or for when the disease comes back (recurrence). Surgery can be utilized for very small tumors with no spread to lymph nodes but in general chemoradiation is preferred for anal canal cancer. However, if the cancer is in the skin outside the anus and it is small, surgery is indicated. Chemoradiation (a combination of chemotherapy and radiation therapy) is usually given to treat anal cancer if it has not spread to distant organs in the body.
Chemotherapy
Chemotherapy is the use of drugs to target rapidly growing cells in an effort to eliminate cancer cells. Doctors often combine chemotherapy with radiation therapy (chemoradiation) to treat anal cancer. Chemoradiation can often cure anal cancer without surgery. Your doctor may also give a combination of different chemotherapy drugs, followed by radiation therapy, or adjuvant chemotherapy to kill any remaining cancer cells after surgery. Chemotherapy alone may also be used when the cancer has spread to other parts of the body and cannot be treated with surgery or radiation alone.
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Radiation Therapy
Radiation therapy uses waves of high-energy waves to target and kill cancer cells. In external beam radiation, a large machine delivers radiation to your tumor from outside the body. Your doctor may administer 3D-CRT or IMRT, which shape and adjust the radiation beams to minimize damage to healthy tissue and reduce side effects. For anal cancer, your doctor may also be able to administer external radiation using a small device placed in the anus for very small tumors. This allows the radiation to target the cancer without affecting the skin and nearby tissue.
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Chemoradiation
Chemoradiation is a combination of chemotherapy and radiation therapy. Combining these two treatments makes both more effective. Doctors commonly give chemoradiation as the primary treatment for anal canal cancer. This treatment can often cure the disease and preserve bowel control.
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Local resection surgery
Your doctor will use a surgical instrument to cut the tumor along with a margin of healthy tissue from the anus. In general, this procedure is indicated for small tumor outside the anal canal (in the skin around the anus) or very small anal canal cancers, although chemoradiation is preferred for the latter.
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Abdominoperineal resection (APR)
Your doctor will remove your anus, rectum, and part of your colon through an incision in your abdomen. Your doctor will then attach the end of your intestine to an opening (stoma) in your abdomen, so waste can leave your body (colostomy). This procedure rarely needs to be used unless other treatments don't work or your cancer recurs. Your doctor will also remove nearby lymph nodes to check for cancer spread.
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Targeted Therapy
Some cases of colorectal cancer contain cells that overexpress the various proteins important in growth and spread of the tumor cells. These cause the cancer to grow more aggressively. Targeted therapy may potentially “target” these cells by stopping or slowing the growth of colorectal cancer.
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Immunotherapy
Immunotherapy uses the agents given through a vein to stimulate your body's own immune system to fight against cancer. Substances made by the body or in a laboratory are used to boost, direct, or restore the body's natural defense against cancer. Recent clinical trial results have shown some benefit of immunotherapy for patients with stage IV anal cancer. Often, the side effects of immunotherapy are better tolerated by patients than chemotherapy.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation, especially clinical trials using immunotherapy drugs.
