Standard Treatment
CANCER OF THE YEAR – PHASE II
Anal cancer stage II were 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 for continued vigilance with rectal examination every 3 months during the first 2 years and endoscopy / biopsy when indicated after completion of therapy for sphincter preservation.
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. All other types of anal canal cancer in stage II complicating
the anal sphincter or are too large for complete local excision external radiation therapy plus 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 evaluation.
Selected tumors are also candidates to receive interstitial irradiation.
3. The Radical resection is reserved for the canal cancer
residual or recurrent anal after nonoperative therapy.
4. Alternately, salvage chemotherapy with fluorouracil and
cisplatin combined with a radiation boost may avoid a permanent colostomy in selected patients with small amounts of residual tumor.
CANCER OF THE YEAR – STAGE IIIA
In most cases of anal cancer in stage IIIA presents clinically as stage II and IIIA is determined that the presence of perirectal nodal disease or adjacent organ complication of clinically apparent. Endorectal or endoanal ultrasound may aid in the classification of the stage prior to treatment.
Standard treatment options:
1. Disease treatment as for stage I and II, using radiation therapy plus
chemotherapy.
2. Abdominoperitoneal resection combined with resection of lymph
femoral nodes, inguinal, groin, and iliac, followed by postoperative radiotherapy.
CANCER OF THE YEAR – PHASE IIIB
The presence of inguinal nodes that are complicated with metastatic disease (unilateral or bilateral) is a poor prognostic sign, although it is possible to achieve the cure of the disease at this time. Because of the poor prognosis associated with this stage, patients should be included in clinical trials whenever possible.
Standard treatment options:
Radiotherapy plus chemotherapy (as described for phase II) with surgical resection of residual disease at the primary site (local or abdominoperineal resection) and unilateral or bilateral dissection, both superficial and deep inguinal nodes to the residual or recurrent tumors.
CANCER OF THE YEAR – PHASE IV
Patients who are at this stage should be considered candidates for clinical trials. There is no standard chemotherapy for patients with metastatic disease. Palliation of symptoms caused by the primary lesion is of vital importance.
Standard treatment options:
1. Palliative surgery.
2. Palliative irradiation.
3. Combined chemotherapy and palliative radiotherapy.
4. Clinical trials.
CANCER OF THE YEAR – RECURRENT
Local recurrences after treatment with radiotherapy and chemotherapy or surgery as primary treatment can be controlled through the use of alternative treatment (surgical resection after radiation and vice versa) is being explored in clinical trials using radiotherapy chemotherapy and / or radiosensitizers to improve local control.