Anal cancer stage I was formerly treated with abdominoperineal resection. Current therapies in preserving the sphincter include wide local excision of the perianal skin or anal margin for small tumors, or definitive chemoradiation (fluorouracil, and mitomycin) for cancers of the anal canal. Salvage chemoradiation therapy (fluorouracil and cisplatin plus a radiation boost) may avoid permanent colostomy in patients with residual tumor after undergoing initial nonoperative therapy. Radical resection is reserved for patients with incomplete responses or recurrent disease. It is therefore important continuous surveillance with rectal examination every three months during the first two years and endoscopy / biopsy when indicated after completion of sphincter-preserving therapy.

Standard treatment options:

1. Small tumors of the perianal skin or anal margin not involving the anal sphincter may be adequately treated with local resection.

2. As evidenced in RTOG-9208 and RTOG-8314, all other types of cancer of the anal canal which stage I involving the anal sphincter or are too large for complete local excision receive external beam radiotherapy (EBRT) with or without chemotherapy.

Chemotherapy with fluorouracil and mitomycin combined with primary radiation therapy appears more effective than radiotherapy alone. The optimal dose of radiation with concurrent chemotherapy is under clinical evaluation (RTOG 9811).

Selected tumors are also suitable for interstitial radiation therapy.

3. The Radical resection is reserved for residual cancer or recurrent anal canal after nonoperative therapy.

4. Alternately, salvage chemotherapy with fluorouracil and cisplatin combined with a radiation boost may avoid permanent colostomy in selected patients with small amounts of residual tumor following initial nonoperative therapy.

5. Iridium-192 interstitial after EBRT may convert some patients with residual disease in patients who respond to treatment in a comprehensive manner.

Clinical Trials

Consult the Register of Clinical Trials NCI’s PDQ Cancer (NCI’s PDQ Cancer Clinical Trials Registry) to enter clinical trials performed in the United States and are accepting patients. To search, use the English word stage I anal cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

The skin around the outside of the anus is called the perianal area. Tumors in this area are skin tumors, not anal cancer.

Being infected with the human papillomavirus (HPV, for its acronym in English) may influence the risk of anal cancer.

Among the risk factors include:

* Having more than 50 years of age.
* Being infected with human papillomavirus (HPV, for its acronym in English).
* Sexual promiscuity.
* Having passive anal intercourse (anal sex).
* Redness, swelling and discomfort often the anus.
* Having anal fistulas (abnormal openings).
* Smoking cigarettes.

Signs that may indicate anal cancer include bleeding from the anus or rectum or a lump near the anus.

These and other symptoms may be caused by anal cancer. There is the possibility that other conditions may cause the same symptoms. You must see a doctor if any of the following problems:

* Bleeding from the anus or rectum.
* Pain or pressure in the area around the anus.
* Itching or discharge from the anus.
* Mass near the anus.
* Change in bowel habits.

To detect (find) and diagnose anal cancer tests are used to examine the rectum and anus.

You can use the following tests and procedures:

* Physical exam and history: An exam of the body to check general health and identify any signs of illness such as lumps or anything else that seems unusual. Also be taken on the patient’s health habits, history of illnesses and treatments applied in each case.
* Digital rectal exam (DRE, for its acronym in English): examination of the anus and rectum. The doctor or nurse inserts a gloved finger lubricated at the bottom of the right feeling for lumps or anything else that seems unusual.
* Anoscopy: examination of the anus and lower rectum using a short tube called anoscope light.
* Proctoscopy: examination of the rectum using a short tube called proctoscope light.
* Anal or endorectal ultrasound: A procedure in which the introduction of a transducer (probe) ultrasound in the anus or rectum and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. These echoes form a picture of body tissues called a sonogram.
* Biopsy: The removal of cells or tissues so that a pathologist to observe under a microscope and determine if there are signs of cancer. If you notice an abnormal area during anoscopy, you can perform a biopsy at that time.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends upon the following:

* Size of the tumor.
* Where in the anus is located tumor.
* If the cancer has spread to lymph nodes.

Treatment options depend on the following:

* The stage of cancer.
* Where in the anus is located tumor.
* If the patient has human immunodeficiency virus (HIV).
* If cancer remains after initial treatment or if the cancer has recurred.

Anal cancer is an uncommon malignancy that represents only a small percentage (4%) of all cancers of the lower digestive tract. Some clinical trials have evaluated the role of chemotherapy, radiotherapy and surgery in the treatment of this disease. If you need information about ongoing clinical trials of the NCI.

In general, the risk of anal cancer is increasing, and there is evidence that individuals with human papillomavirus and gay men in particular are at increased risk of autism.

CELLULAR CLASSIFICATION
Squamous cell carcinomas (epidermoid) constitute the vast majority of all primary cancers of the anus, forming the rest are an important subgroup of tumors cloacógenos (basaloid transitional cell). These two histologic variants are associated with human papillomavirus infection. [1] Adenocarcinomas from anal glands or fistulae formation and melanomas are rare. This summary does not include information on the treatment of anal melanoma.

Cancer of the anus is a rare malignancy, representing only a small percentage (4%) of all cancers of the lower digestive tract

In general, the risk of anal cancer is increasing, and there is evidence that individuals with human papillomavirus and gay men in particular are at increased risk of autism.

Squamous cell carcinomas (SCC) represent the vast majority of all primary cancers of the anus, forming the rest is an important subgroup of tumors cloacogenic (basaloid transitional cell). These two histologic variants are associated with human papillomavirus infection

STAGES

Stage 0

* The anal cancer Stage 0 is carcinoma in situ. Diagnosed only rarely is a very early cancer that has not spread below the limiting membrane of the first layer of anal tissue

Stage I

* The anal cancer is stage I cancer that is 2 centimeters or less in greatest dimension and that has not spread anywhere else

Stage II

* The anal cancer is stage II cancer that is larger than 2 centimeters and that does not complicate adjacent organs or lymph nodes.

Stage IIIA

* The anal cancer in stage IIIA is cancer that has spread to lymph nodes or organs adjacent perirectal

Stage IIIB

* The cancer is stage IIIB anal cancer that has spread to the internal iliac or inguinal nodes (unilateral or bilateral) or has spread to surrounding organs so as to perirectal lymph nodes

Stage IV

* The anal cancer corresponds to stage IV cancer that has spread to distant lymph nodes within the abdomen or other organs.

TREATMENT

Previously it was thought that abdominoperineal resection leading to permanent colostomy was required for all but small anal tumors located below the dentate line, treatment with which approximately 70% of patients survived 5 years. Radiation therapy alone may lead to a survival rate over 5 years at 70%, although high doses (6,000 cGy or more) may cause necrosis or fibrosis.