The sort of therapy treatment recommended by your cancer care team is determined by the type of anal cancer and, where it is located, and how far it has spread (the stage).
Perianal tumours (formerly known as anal margin cancers) are treated differently than anal canal malignancies in some cases.
At this point, the pre-cancer cells are still only in the anus’s inner lining and have not spread to deeper layers.
Surgery can frequently fully eradicate stage 0 cancers (local resection). The objective is to remove all of the pre-cancer tissue as well as a margin of healthy tissue around it. Chemotherapy and radiation treatment are rarely required.
Stages I and II
These tumours have progressed to the anal wall but have not spread to adjacent organs or lymph nodes.
Surgery (local resection) may be performed to remove some tiny tumours that do not affect the sphincter muscle (typically less than 2 centimetres or 1 inch). This may be followed by chemo and radiation treatment in some situations.These tumours have progressed to the anal wall but have not spread to adjacent organs or lymph nodes.
Surgery (local resection) may be performed to remove some tiny tumours that do not affect the sphincter muscle (typically less than 2 centimetres or 1 inch). This may be followed by chemo and radiation treatment in some situations.If the cancer does not fully disappear after chemoradiation, further therapy may be required. However, it is crucial to note that the full benefits of chemoradiation may take months to manifest. As a result, it is critical to maintain follow-up consultations with your doctors in order to monitor the malignancy by digital rectal examination and anoscopy.If cancer is still detected after 6 months, further therapy is frequently required. Most of the time, an abdominoperineal resection (APR) operation is indicated. In certain situations, just a local resection is required.
Stages IIIA, IIIB, and IIIC
These tumours have spread to adjacent organs or lymph nodes, but have not migrated to distant areas of the body.In most situations, radiation therapy coupled with chemo will be the first treatment (chemoradiation). Both treatments are administered concurrently during chemoradiation. Typically, the treatment is 5-FU with mitomycin. This chemo combination is generally administered during the first week of therapy and then again during the fifth week. For 5 to 7 weeks, the radiation is administered daily, Monday through Friday.If any cancer persists after chemoradiation, it may be continuously monitored for up to 6 months since the full benefits of treatment might take months.
If additional therapy is required because all of the malignancy has not disappeared after 6 months, an abdominoperineal resection (APR) surgery may be advised.
Cancer has spread to distant organs at this stage. Anal cancer usually travels to the liver first, although it can also spread to the lungs, bones, and distant lymph nodes.
These tumours are extremely unlikely to be cured by treatment. Instead, therapy aims to keep the disease under control for as long as feasible while also alleviating symptoms as much as possible.or cancer that has progressed to the bones, brain, or spinal cord, radiation may be administered alone. It might potentially be utilised to treat cancer that has spread to distant lymph nodes.Immunotherapy may be an option for certain advanced anal tumours that have progressed after treatment.
Because these tumours can be difficult to treat, you may wish to consider participating in a clinical trial of a newer treatment.When cancer recurs after therapy, it is referred to as recurrent cancer. Recurrence might be local (in or near the same location where it began) or remote (spread to organs like the lungs or liver).
If cancer reappears in the anus or surrounding lymph nodes following therapy, the treatment will be the same as it was the first time. For example, if you only underwent surgery, you may undergo radiation treatment plus chemo (chemoradiotherapy).
For some patients, the cancer will reappear in different parts of the body or in different organs. The liver and lungs are the most often affected organs. Chemotherapy is generally the major treatment for this. Chemotherapy may not cure cancer, but it can frequently help manage it and alleviate any symptoms it is causing. In certain situations, surgery or radiation therapy may be used to treat these malignancies.
Surgery for Anal Cancer
In most situations, surgery is not the first line of defence against anal cancer. The sort of surgery required for those who require surgery is determined by the nature and location of the tumour.
A local resection is a surgical procedure that eliminates only the tumour and a tiny quantity of normal tissue around it. If the tumour is small and has not progressed to adjacent tissues or lymph nodes, it is most commonly used to treat malignancies of the perianal region (also known as the anal margin).Local resection, in most cases, protects the sphincter muscles, which block faeces from coming out until they relax after a bowel movement. This enables a person to move their bowels properly following surgery.
Resection of the abdomen and perineum
Abdominoperineal resection (APR) was a standard treatment for anal cancer in the past, but doctors have discovered that it can nearly always be avoided by combining radiation therapy and chemotherapy instead. APR is now only used if other therapies have failed or if the cancer has returned following therapy. An APR is a significant operation. To remove the anus, rectum, and sigmoid colon, the surgeon makes one incision (cut) in the abdomen (belly) and another around the anus. The surgeon may additionally remove some of the surrounding lymph nodes in the groyne area (called a lymph node dissection), however this can be done later if necessary. Because the anus (and the anal sphincter) are removed, a new entrance must be created for faeces to exit the body. To do this, the end of the colon is connected to a tiny hole (called a stoma) created on the abdomen. A bag to collect faeces is attached to the body above the entrance. This is referred to as a colostomy.
Radiation Therapy for Anal Cancer
To destroy cancer cells, radiation treatment employs high-energy x-rays or particles. Radiation therapy may be utilised depending on the stage of the anal cancer and other factors:
In addition to chemotherapy, which is used as the primary treatment for the majority of anal malignancies (This is called chemoradiation.)
After surgery if the doctor is concerned that all of the cancer might not have been removed. This might be seen in cancers of the perianal area.
After surgery for some cancers of the perianal area (anal margin) that are at a high risk of coming back
To help treat cancer that has come back in the groin lymph nodes after initial treatment
Different types of radiation treatment are used to treat anal cancer
Radiation treatment of various sorts can be used to treat anal cancer. There are two primary kinds:
1.Radiation treatment using an external beam
2.Brachytherapy is a type of physical therapy (internal radiation therapy)
External-beam radiation treatment is a type of radiation therapy that uses a beam of
External-beam radiation treatment (EBRT) directs radiation from outside the body to the tumour. This is the most common form of radiation treatment used to treat anal cancer or its spread to other organs.The treatment is similar to receiving an x-ray, except the radiation dose is higher. The technique is painless, and each treatment just takes a few minutes. Radiation treatments to the anal region are typically administered 5 days per week for 5 to 7 weeks, however this might vary depending on the kind of EBRT and the purpose for administration.
Newer methods enable doctors to deliver greater doses of radiation to cancer while limiting radiation exposure to adjacent healthy tissues.
Special computers are used in three-dimensional conformal radiation treatment (3D-CRT) to precisely pinpoint the site of the tumour. The radiation beams are then shaped and targeted towards the tumour from various angles. As a result, they are less likely to cause harm to normal tissues.
Intensity-modulated radiation treatment (IMRT) is a sort of 3D therapy and the most often used type of EBRT for anal cancer. It employs a computer-controlled equipment that spins around you while delivering radiation. The intensity (strength) of the beams may be modified in addition to shaping and directing them from various angles. This helps to restrict the amount of dosage that reaches normal tissues and may decrease some adverse effects.
SBRT (stereotactic body radiation treatment) is a kind of radiation that may be utilised if anal cancer has returned in the same location or in adjacent lymph nodes. It may also be considered for cancers that have only migrated to a limited number of other areas of the body, such as the brain.
Instead than administering a modest dosage of radiation every day for several weeks, SBRT employs highly concentrated beams of high-dose radiation administered in fewer (typically one to five) sessions. Several beams are directed towards the tumour from various angles. You will lie in a specifically constructed body frame for each treatment, which will keep you motionless and in the precise appropriate location during treatment.
Brachytherapy is a type of alternative medicine (internal radiation)
Brachytherapy is not often used to treat anal cancer. When it is utilised, it is generally administered as a radiation boost along with external radiation when a tumour does not react to conventional chemoradiation (chemo plus external radiation).Brachytherapy entails inserting tiny amounts of radioactive material into or around the tumour. It concentrates the radiation on the tumour to reduce radiation harm to normal surrounding tissue. Brachytherapy may be divided into two types: interstitial radiation and intracavitary radiation.