Gastrointestinal (GI) Oncology Program

Anal Cancer

What Is Anal Cancer? | Risk Factors | Stages and Treatment Options | About Clinical Trials | Greenebaum Cancer Center

Stages and Treatment Options

If a patient has been diagnosed with anal cancer, the doctor will order more tests to see how far the cancer has spread. This process, called staging, helps the doctor to plan the patient's treatment. The following stages are used to describe anal cancer:

Stage 0: The cancer is found only in the top layer of anal tissue. During this stage, treatment will probably be simple surgery to remove all of the cancer.

Stage I: The cancer has spread beyond the top layer of anal tissue, is smaller than two centimeters in diameter (less than one inch), and has not spread to the muscle tissue of the sphincter. During this stage, treatment may be one of the following:

Simple surgery to remove all of the cancer.
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).
If cancer cells remain following therapy, surgery to remove the anus and the lower part of the rectum may be performed. An opening will be made for waste to pass out of the body (colostomy) into a disposable bag attached near the colostomy (colostomy bag).
If cancer cells remain following therapy, additional chemotherapy plus radiation therapy may be performed.
Standard radiation therapy may be given followed by interstitial radiation therapy.

Stage II:The cancer has spread beyond the top layer of anal tissue and is larger than two centimeters in diameter, but it has not spread to nearby organs or lymph nodes (small, bean-shaped structures found throughout the body that produce and store infection-fighting cells). During this stage, treatment may be one of the following:

Simple surgery to remove all of the cancer.
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).
If cancer cells remain following therapy, surgery to remove the anus and the lower part of the rectum may be performed. An opening will be made for waste to pass out of the body (colostomy) into a disposable bag attached near the colostomy (colostomy bag).
If cancer cells remain following therapy, additional chemotherapy plus radiation therapy may be performed.

Stage IIIA: The cancer has spread to the lymph nodes around the rectum or to nearby organs such as the vagina or bladder. During this stage, treatment may be one of the following:

Radiation therapy plus chemotherapy
Surgery to remove the lining around the colon and stomach, plus removal of the lymph nodes followed by radiation therapy

Stage IIIB: The 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. During this stage, 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: The cancer has spread to distant lymph nodes within the abdomen or to organs in other parts of the body. During this stage, treatment may be one of the following:

Surgery to relieve symptoms caused by the cancer
Radiation therapy to relieve symptoms caused by the cancer
Chemotherapy and radiation therapy to relieve symptoms caused by the cancer
A clinical trial evaluating new treatments

Recurrent: Recurrent cancer is cancer that has come back (recurred) after it has been treated. It may come back in the anus or in another part of the body. During this stage, 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 patient was treated with radiation, surgery may be used. Clinical trials are studying the use of new chemotherapy drugs given with or without radiation therapy.

About the Treatments and Side Effects

There are three primary treatment options for patients with anal cancer: surgery, radiation therapy, and chemotherapy.

Surgery

Surgery is a common treatment for anal cancer. A doctor may take out the cancer using one of the following methods:

Local Resectionis an operation in which only the cancer is removed. Often the ring of muscle around the anus that opens and closes it (the sphincter muscle) can be saved so that the patient will be able to pass body wastes as before.
Abdominoperineal Resectionis 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 between 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. Lymph nodes may also be taken out at the same time or in a separate operation (lymph node dissection). This operation is not used as much today because radiation therapy with or without chemotherapy is an equally effective treatment option that does not require a colostomy.
Side effects of surgery:The side effects of surgery depend on the location of the tumor and the type of operation, among other factors. Although patients are often uncomfortable during the first few days after surgery, this pain can usually be controlled with medicine. The recovery period after an operation varies from patient to patient.

Radiation Therapy

Radiation therapy, also called radiotherapy, uses high-energy rays to damage cancer cells and stop them from growing and dividing. It is a local therapy that only affects cancer cells in the treated area. Radiation may come from a machine (external radiation) or from an implant placed directly into or near a tumor (internal radiation).

Side effects of radiation therapy: The most common side effects of radiation therapy are tiredness, skin reactions in the treated areas (such as a rash or redness), and loss of appetite. Radiation therapy may also cause a decrease in the number of white blood cells that help protect the body against infection. Most of these side effects can be treated or controlled and in most cases they are not permanent.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Most anticancer drugs are injected into a vein (IV) or a muscle; some are given by mouth. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles: A treatment period is followed by a recovery period, then another treatment period, and so on.

Side effects of chemotherapy:Chemotherapy drugs generally fight rapidly dividing cells in the body. Cells that divide rapidly include both the targeted cancer cells and healthy cells in the blood, digestive tract, and hair follicles. Depending on which anticancer drugs a patient receives, he or she may experience symptoms when healthy cells are damaged along with the cancer cells.

If healthy blood cells are destroyed by chemotherapy, the patient may be more susceptible to infections, bruising or bleeding, and fatigue. When cells in the hair roots or digestive tract are affected by anticancer drugs, the patient may have hair loss, nausea, vomiting, or mouth sores. Not all chemotherapy patients develop all of these side effects, and the symptoms usually go away during the recovery period or after the treatments are done. Doctors can prescribe medicines and other treatments to control most of the symptoms.

This page was last updated on: February 6, 2008.

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