How is anal cancer treated?
A biopsy of the cancer
Anoscopy which is where a small telescope is put into the anal canal to view the cancer and a rectal examination
HIV test
Gynaecological exam for women, plus a smear test
Lymph node evaluation
Tests
After being diagnosed with anal cancer, tests will determine how big the cancer is and if it has spread to other parts of the body. You will likely have several tests and appointments to attend. The following tests may be carried out:
Biopsy or fine needle aspirate of any suspicious lymph nodes
CT or MRI scans of the chest, abdomen and pelvis
PET scan
Fertility discussion and referral in appropriate patients - see Fertility after Anal Cancer [link to other section]
Staging & treatment
There are different stages of anal cancer, and this will determine the treatment plan and prognosis.
Stage 0 is where the cancer cells are only present in the first layer of cells lining the anus and is treated with wide local excision.
Stage I is where the cancer is not more than 2cm in size and has not spread to the lymph nodes or other parts of the body and is treated with chemotherapy and radiation.
Stage II is where the cancer is 2 cm to 5cm in size (but does not invade nearby organs) or where the cancer has spread to the lymph nodes (but not to other parts of the body) and is treated with chemotherapy and radiation.
Stage III is where the cancer is larger than 5 cm, or has invaded nearby organs, with or without involvement of nearby lymph nodes but has not spread to other parts of the body and is treated with chemotherapy and radiation.
Stage IV is where the cancer has spread to distant organs most commonly the liver or lungs. It is often treated with chemotherapy first followed by radiation.
Learn more from the National Comprehensive Cancer Network
Surgery for anal cancer
If anal cancer is caught very early at a pre-invasive stage then it may be possible to surgically remove the cancer with clear margins provided the anal sphincter is able to be left intact. Most people with anal cancer will not be diagnosed early enough for this type of surgery to be an option.
There are other scenarios where surgery is advised for anal cancer. An ostomy is where an operation is performed to bring the bowel opening to the abdomen. In anal cancer treatment these ostomies may be permanent or occasionally reversed. A few people will need an ostomy during treatment because of pain and then may be able to have this reversed after treatment.
Some people need to undergo an abdominal-perineal resection (APR). This is recommended if the initial chemotherapy and radiotherapy has not caused the cancer to go away but there is no spread to other locations. An APR is a big operation and involves removing the anus and rectum and sometimes some of the local lymph nodes and will result in a permanent ostomy which is called a colostomy. You will get support from the ostomy nurses along with Ostomy NZ.
Chemotherapy for anal cancer
Anal cancer is frequently treated with a combination of chemotherapy and radiotherapy.
Chemotherapy drugs are generally given as an infusion over 4 days, usually via an indwelling catheter called a PICC line that is placed in a vein above your elbow. The most commonly prescribed chemotherapy drugs are Mitomycin-C and 5FU or Mitomycin-C and capecitabine.
The side effects from chemotherapy drugs are uncommon, but may include mouth ulcers, fatigue rarely nausea and vomiting and hair thinning. You will be given very effective medications to prevent nausea.
Tips for managing chemotherapy:
Use a mouthwash made from bicarbonate of soda and a soft toothbrush to help minimise mouth ulcers.
Stay away from sick people as the chemotherapy will suppress your immune system.
Eat soft, bland foods, or a meal replacement drink, if your mouth is sore.
Radiation for anal cancer
Radiation is usually delivered five days per week for about six weeks, and each treatment takes about 15 minutes. You lie still on a treatment table and the radiation machine rotates around to deliver the treatment. The treatment isn’t painful at the time, however the side effects from radiation get progressively worse as the weeks go on. The effects may peak one to two weeks after radiation is completed, but usually subside over the next several weeks as the skin heals.
The effects include diarrhoea, pain in the gut and anus, skin irritation, pain during bowel movements and when passing urine, nausea and tiredness. Your radiation oncologist will give you creams, pain medication and advice to help you manage these symptoms.
Tips for managing radiation therapy:
Wear loose clothing or maybe go commando
Use all the creams provided by your medical team and keep them in the loop about how you are feeling
Keep a water bottle in the toilet to use instead of toilet paper
Have warm baths with bicarbonate of soda or salt
Prognosis
The chances of being alive five years after the diagnosis of anal cancer depends on the stage of the cancer at the time of diagnosis. American Cancer Society figures show if anal cancer is diagnosed when it hasn’t spread beyond the anal area then 82% of people are alive at 5 years. If anal cancer has spread to nearby lymph nodes or structures the five year survival is 66%. If anal cancer has spread to distant organs (such as the lungs or liver) the survival rate is 35%. It’s important to note that these figures are an average and don’t necessarily reflect any one person’s outcome.