Treatments for Anal Cancer

Executive Summary

The different types of standard treatments for anal cancer are explained in detail. Standard treatments are used along with the integration of effective treatment planning. Clinical trials are used as an innovative treatment approach that uses the combination of different therapies and drugs for treating anal cancer. Surgery, radiation therapy, and chemotherapy are the common type of treatment used for treating anal cancer. Palliative care is also used for treating anal cancer patients who are going through emotional, social, and biological distress.

How is Anal Cancer Treated?

Different types of standard treatments are used for treating anal cancer ​1​. “Standard treatment” means the most well-known treatment. Consider clinical trials as an alternative when making treatment planning decisions. A clinical study is a study that tests a new treatment direction. Medics want to know if the new treatment is safe, effective, and probably better than the standard treatment. Clinical trials can test new drugs, new combinations of common treatments, or further doses of legal drugs and other treatments. Clinical trials are an option for the treatment and care of all stages of cancer. The doctor can help you consider all your treatment options.

In cancer treatment, different doctors often work together to create an overall anal cancer treatment plan for a patient that combines different types of treatment ​2​. This is known as an interdisciplinary team. The cancer treatment team includes a variety of other medical professionals, including medical assistants, nurses, oncology nurses, social workers, pharmacists, counsellors, nutritionists, and more. Below are common treatments for anal cancer. Your care plan also includes the treatment of symptoms and side effects that are an essential part of cancer treatment. There are three main types of treatment for anal cancer: surgery, radiation therapy, and chemotherapy ​3​.

Therapy options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, patient preferences and general health. Take the time to check all treatment options and ask questions. These types of discussions are known as “joint decision making.” Shared decision-making means that you and your doctor work together to select a treatment that meets your treatment goals. Collaborative decision-making is especially important for anal cancer because of the variety of treatment options. Talk to your doctor about the goals of each treatment and what to expect during treatment, including possible bowel, urinary, and sexual side effects for a particular treatment regimen.

Surgery

Surgery is the removal of the tumor and surrounding healthy tissue during surgery. The sort of surgery for anal cancer depends on the tumor stage. A surgical oncologist is a doctor who specializes in the surgical therapy of cancer. Surgery for anal cancer can also be performed by a colon surgeon who specializes in the colon or rectal surgery. Carcinoma in situ or early-stage cancer can often be treated by removing abnormal cells and a small area of ​​healthy tissue called the margin. The patient should then undergo regular follow-up tests to find and remove new abnormal cells. Before this, most patients with late-stage squamous cell carcinoma of the anus underwent surgery before effective chemotherapy, and radiation therapy for anal cancer was developed.

However, studies have shown similar cure rates between surgical treatment and a combination of radiation and chemotherapy. Currently, most patients receive biopsy (which may require surgical intervention, see diagnosis) followed by chemotherapy and radiation treatment without further surgery.

Many patients can avoid significant surgery with this type of combination therapy. Surgery may be recommended if the patient cannot receive chemotherapy or radiation therapy. Surgery may also be recommended if cancer persists after the first treatment or recurs after complete treatments for anal cancer. Persistent or recurrent tumours can be treated with abdominal perineal resection, which surgically removes parts of the anus, rectum, and colon. With this procedure, the patient requires a colostomy and an abdominal wall opening to collect faeces in the bag. This procedure can also remove a lymph node known as lymph node dissection. Before surgery, communication with the health care team about the possible side effects of the particular surgery is considered as an important plan to undergo.

Radiation therapy

Radiation treatment uses high-energy x-rays or other particles to eradicate cancer cells. Doctors who specialize in radiation therapy to treat cancer are called radiation oncologists. The most common type of radiation therapy is extracorporeal radiation therapy, exposure to radiation from extracorporeal machines. If radiation therapy is given at the implant, talk about internal radiation therapy or brachytherapy. A treatment plan or schedule usually consists of several treatments performed during a set period. Radiation treatment for anal cancer is often combined with chemotherapy. Patients typically receive radiation therapy daily for 5-6 weeks from Monday to Friday.

Skin irritation may require a few days’ breaks from radiation therapy. Side effects of radiation therapy include fatigue, mild to severe skin reactions, upset stomach, urinary tract symptoms, temporary anal inflammation, loose stools, and discomfort during defecation. Damage to the anal tissue can lead to scar tissue formation and impaired bowel function. Most of the side effects disappear as soon as the treatments for anal cancer is over. Communication with the radiation oncologist about possible side effects and how to reduce or mitigate them is an important approach.

Chemotherapy

Chemotherapy is usually a drug to destroy cancer cells by preventing them from growing, dividing, and making more cells. The drug can be put into the bloodstream to reach cancer cells throughout the body. Administering medications in this way is called systemic therapy. These drugs are usually prescribed by an oncologist, a doctor specializing in cancer drug treatments for anal cancer. The drug is often given via an intravenous (IV) tube inserted into a vein with a needle or as a tablet or capsule that is swallowed (orally). If you are taking oral medications, be sure to ask your medical team how to store and handle them safely. Chemotherapy or chemotherapy regimens usually consist of several cycles over a set period. A person can receive one drug or a combination of different medications at a time. Chemotherapy for anal cancer usually consists of a variety of drugs.

A typical drug for anal cancer is a combination of fluorouracil (5FU, Adrucil) and mitomycin C (Mitozytrex, Mutamycin) or cisplatin (Platinol). Chemotherapy, as mentioned above, is particularly effective in treating anal cancer when given in combination with radiation therapy. The combination treatment allows low doses of radiation and increases the likelihood of destruction of the tumour. Side effects of chemotherapy show variations as per the individual and the amount used. Still, they are fatigue, decreased blood count (including cells that fight infection and stop bleeding and anaemia), disease risk, nausea and vomiting, loss of appetite. , Diarrhea, etc. And mouth pain (mucositis). These side effects usually disappear after treatment is complete.

The drugs used to treat cancer are constantly being evaluated. Talking to your doctor is often the best way to learn more about the medications prescribed for you, their purpose, and possible side effects and drug interactions. It is also important to tell your doctor if you are taking other prescriptions or over-the-counter medications or supplements. Herbs, supplements and other medicines can interact with anticancer drugs, causing unwanted side effects and diminished efficacy.

Biological, emotional, and social effects of such cancers

The treatment of cancer often results in evolving physical symptoms and side effects along with emotional, social, and economic consequences. Treating all these effects is known as palliative care or supportive care. It is an essential part of your treatment and is included with treatments designed to delay, stop, or eliminate cancer. Palliative care focuses on improving health during treatment by managing symptoms and assisting patients with other non-medical needs and their families. Anyone can receive this type of treatment, regardless of age, type of cancer, or stage.

And it often works best when started shortly after the diagnosis of cancer. People who receive palliative care for cancer treatment often say they have fewer severe symptoms, a better quality of life, and are happy with the treatment. Palliative care is very different and often includes medication, diet changes, relaxation techniques, emotional and psychological support, and other treatments. You can also get the same palliative treatments to get rid of cancer, such as chemotherapy, surgery, and radiation therapy.

Discuss the goals of each treatment in the recommended treatment plan with your doctor before starting treatment. We also need to discuss the potential side effects of specific treatment plans and palliative treatment options. Many patients also benefit from talking to social workers and joining support groups. Talk to your doctor about these resources as well. During treatment, your medical team may ask you to answer questions about your symptoms and side effects and explain any problems. Be sure to inform the health team if you have any issues. This helps the medical team manage symptoms and side effects as soon as possible. It also helps prevent more severe problems in the future.

Metastatic Anal Cancer

When cancer spreads from where it started to another part of the body, doctors call it metastatic cancer. Hence, it is recommended to consult a doctor who has experience in treatments for anal cancer. Doctors may have different opinions regarding the implementation of the best standard treatment plan. Clinical trials are also an option. Find out more about getting a second opinion before starting treatment to be happy with your treatment plan. Treatment plans involve the combination of surgery, radiation therapy, and medication. There may be clinical trials to consider. Palliative care is also essential to reduce symptoms and side effects. For most people, diagnosing metastatic cancer is very stressful and challenging. The patient and their family are encouraged to talk to your doctor, nurse, social worker, or another health team member about your feelings. It is also effective to communicate with other patients, for example, through support groups or other peer support programs.

Remission and the chance of recurrence of Anal Cancer

Remission is when cancer cannot be detected in the body, and there are no symptoms. This is sometimes referred to as “no signs of illness” or NED. Remissions can be temporary or permanent. Due to this uncertainty, many people are afraid that cancer will come back. Many remissions are endless, but it is essential to talk to your doctor about the possibility of cancer coming back. Knowing the risk of recurrence and treatment options can help you feel more prepared if cancer recurs. If cancer has recurred after the first treatment, it is called recurrent cancer. It can recur at the exact location (so-called local recurrence), near (regional recurrence), or another location (distant recurrence).

A new test cycle is restarted when this happens, learning as much as possible about the iterations. After this test is done, you and your doctor will discuss your treatment options. Treatment plans often include the above treatments such as surgery, chemotherapy, and radiation therapy, which can be used in different combinations or at different paces. Doctors may suggest clinical trials to find new ways to treat this type of recurrent cancer. Regardless of which treatment plan you choose, palliative care is vital to alleviate symptoms and side effects. People with recurrent cancer may experience emotions such as distrust and fear. We encourage the patient to talk to their health team about these feelings and support dealing with them.

References

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    Durot C, Dohan A, Boudiaf M, Servois V, Soyer P, Hoeffel C. Cancer of the Anal Canal: Diagnosis, Staging and Follow-Up with MRI. Korean J Radiol. 2017;18(6):946-956. doi:10.3348/kjr.2017.18.6.946
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    Glynne-Jones R, Saleem W, Harrison M, Mawdsley S, Hall M. Background and Current Treatment of Squamous Cell Carcinoma of the Anus. Oncol Ther. 2016;4(2):135-172. doi:10.1007/s40487-016-0024-0