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Information from PDQ for Patients
Anal cancer
208/00022
** DESCRIPTION **
-- What is anal cancer? --
Anal cancer, an uncommon cancer, is a disease in which cancer (malignant) cells
are found in the anus. The anus is the opening at the end of the rectum (the
end part of the large intestine) through which body waste passes. Cancer in
the outer part of the anus is more likely to occur in men; cancer of the inner
part of the rectum (anal canal) is more likely to occur in women. If the anus
is often red, swollen, and sore, there is a greater chance of getting anal
cancer. Tumors found in the area of skin with hair on it just outside the anus
are skin tumors, not anal cancer.
A doctor should be seen if one or more of the following symptoms appear:
bleeding from the rectum (even a small amount), pain or pressure in the area
around the anus, itching or discharge from the anus, or a lump near the anus.
If there are signs of cancer, a doctor will usually examine the outside part of
the anus and give a patient a rectal examination. In a rectal examination, a
doctor, wearing thin gloves, puts a greased finger into the rectum and gently
feels for lumps. The doctor may also check any material on the glove to see if
there is blood in it. The doctor may give the patient general anesthesia,
medicine that puts patients to sleep, to continue the examination if pain is
felt during it. The doctor may cut out a small piece of tissue and look at it
under a microscope to see if there are any cancer cells. This procedure is
called a biopsy.
The prognosis (chance of recovery) and choice of treatment depend on the stage
of the cancer (whether it is just in the anus or has spread to other places in
the body) and the patient's general health.
** STAGE EXPLANATION **
-- Stages of anal cancer --
Once anal cancer is found (diagnosed), more tests will be done to find out if
cancer cells have spread to other parts of the body. This testing is called
staging. To plan treatment, a doctor needs to know the stage of the disease.
The following stages are used for anal cancer.
-- Stage 0 or carcinoma in situ --
Stage 0 anal cancer is very early cancer. The cancer is found only in the top
layer of anal tissue.
-- Stage I --
The cancer has spread beyond the top layer of anal tissue, is smaller than 2
centimeters in diameter (less than 1 inch), but has not spread to the muscle
tissue of the sphincter.
-- Stage II --
Cancer has spread beyond the top layer of anal tissue and is larger than 2
centimeters in diameter, but has not spread to nearby organs or lymph nodes
(small, bean-shaped structures found throughout the body that produce and store
infection-fighting cells).
-- Stage IIIA --
Cancer has spread to the lymph nodes around the rectum or to nearby organs such
as the vagina or bladder.
-- Stage IIIB --
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.
-- Stage IV --
Cancer has spread to distant lymph nodes within the abdomen or to organs in
other parts of the body.
-- Recurrent --
Recurrent disease means that the cancer has come back (recurred) after it has
been treated. It may come back in the anus or in another part of the body.
** TREATMENT OPTION OVERVIEW **
-- How anal cancer is treated --
There are treatments for all patients with anal cancer. Three kinds of
treatment are used:
- surgery (taking out the cancer in an operation)
- radiation therapy (using high-dose x-rays or other high-energy rays to kill
cancer cells)
- chemotherapy (using drugs to kill cancer cells)
Surgery is a common way to diagnose and treat anal cancer. A doctor may take
out the cancer using one of the following methods:
- Local resection is an operation that takes out only the cancer. Often the
ring of muscle around the anus that opens and closes it (the sphincter
muscle) can be saved during surgery so that you will be able to pass the
body wastes as before.
- Abdominoperineal resection is 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
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. Although this operation was once commonly
used for anal cancer, it is not used as much today because radiation
therapy with or without chemotherapy is an equally effective treatment
option but does not require a colostomy. If a patient has a colostomy, a
special bag will need to be worn to collect body wastes. This bag, which
sticks to the skin around the stoma with a special glue, can be thrown away
after it is used. This bag does not show under clothing, and most people
take care of these bags themselves. Lymph nodes may also be taken out at
the same time or in a separate operation (lymph node dissection).
Radiation therapy uses x-rays or other high-energy rays to kill cancer cells
and shrink tumors. Radiation may come from a machine outside the body
(external radiation therapy) or from putting materials that produce radiation
(radioisotopes) through thin plastic tubes in the area where the cancer cells
are found (internal radiation therapy). Radiation can be used alone or in
addition to other treatments.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by
pill, or it may be put into the body by a needle in a vein or muscle.
Chemotherapy is called a systemic treatment because the drugs enter the
bloodstream, travel through the body, and can kill cancer cells throughout the
body. Some chemotherapy drugs can also make cancer cells more sensitive to
radiation therapy. Radiation therapy and chemotherapy can be used together to
shrink tumors and make an abdominoperineal resection unnecessary. When only
limited surgery is required, the sphincter muscle can often be saved.
-- Treatment by stage --
Treatments for anal cancer depend on the type of disease, stage of disease, and
the patient's age and general health.
Standard treatment may be considered, based on its effectiveness in patients in
past studies, or participation in a clinical trial. Not all patients are cured
with standard therapy, and some standard treatments may have more side effects
than are desired. For these reasons, clinical trials are designed to find
better ways to treat cancer patients and are based on the most up-to-date
information. Clinical trials are ongoing in most parts of the country for most
stages of anal cancer. For more information about clinical trials, call the
Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at
1-800-332-8615.
** STAGE 0 ANAL CANCER **
Treatment will probably be local resection to remove all of the cancer.
** STAGE I ANAL CANCER **
Treatment may be one of the following:
1. Local resection to remove all of the cancer.
2. 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).
3. If cancer cells remain following therapy, surgery removing the anus and
lower part of the rectum may be performed. An opening will be made for
waste to pass of out the body (colostomy) into a disposable bag attached
near the colostomy (colostomy bag).
4. If cancer cells remain following therapy, additional chemotherapy plus
radiation therapy may be performed.
5. Radiation therapy followed by interstitial radiation therapy.
** STAGE II ANAL CANCER **
Treatment may be one of the following:
1. Local resection to remove all of the cancer.
2. Radiation therapy plus 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).
3. If cancer cells remain following therapy, surgery removing the anus and
lower part of the rectum may be performed. An opening will be made for
waste to pass of out the body (colostomy) into a disposable bag attached
near the colostomy (colostomy bag).
4. If cancer cells remain following therapy, additional chemotherapy plus
radiation therapy may be performed.
** STAGE IIIA ANAL CANCER **
Treatment may be one of the following:
1. Radiation therapy plus chemotherapy.
2. Surgery to remove the lining around the colon and stomach plus removal of
the lymph nodes followed by radiation therapy.
** STAGE IIIB ANAL CANCER **
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 ANAL CANCER **
Treatment may be one of the following:
1. Surgery to relieve symptoms caused by the cancer.
2. Radiation therapy to relieve symptoms caused by the cancer.
3. Chemotherapy and radiation therapy to relieve symptoms caused by the
cancer.
4. A clinical trial evaluating new treatments.
** RECURRENT ANAL CANCER **
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 cancer recurs. If the patient were
treated with radiation, surgery may be used if the cancer recurs. Clinical
trials are studying new chemotherapy drugs with or without radiation therapy.
The patient may also receive additional chemotherapy and radiation therapy.
** TO LEARN MORE **
Call
For more information, U.S. residents may call the National Cancer Institute's
(NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237)
Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing
callers with TTY equipment may call 1-800-332-8615. The call is free and a
trained Cancer Information Specialist is available to answer your questions.
Web sites and Organizations
The NCI's Cancer.gov Web site (http://cancer.gov) provides online access to
information on cancer, clinical trials, and other Web sites and organizations
that offer support and resources for cancer patients and their families. There
are also many other places where people can get materials and information about
cancer treatment and services. Local hospitals may have information on local
and regional agencies that offer information about finances, getting to and
from treatment, receiving care at home, and dealing with problems associated
with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health professionals,
and the public. These publications discuss types of cancer, methods of cancer
treatment, coping with cancer, and clinical trials. Some publications provide
information on tests for cancer, cancer causes and prevention, cancer
statistics, and NCI research activities. NCI materials on these and other
topics may be ordered online or printed directly from the NCI Publications
Locator (https://cissecure.nci.nih.gov/ncipubs). These materials can also be
ordered by telephone from the Cancer Information Service toll-free at
1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
LiveHelp
The NCI's LiveHelp service, a program available on several of the Institute's
Web sites, provides Internet users with the ability to chat online with an
Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m.
Eastern time, Monday through Friday. Information Specialists can help Internet
users find information on NCI Web sites and answer questions about cancer.
Write
For more information from the NCI, please write to this address:
National Cancer Institute
Office of Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
** ABOUT PDQ **
PDQ is a comprehensive cancer database available on Cancer.gov.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information
database. Most of the information contained in PDQ is available online at
Cancer.gov (http://cancer.gov), the NCI's Web site. PDQ is provided as a
service of the NCI. The NCI is part of the National Institutes of Health, the
federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on
cancer prevention, detection, genetics, treatment, supportive care, and
complementary and alternative medicine. Most summaries are available in two
versions. The health professional versions provide detailed information
written in technical language. The patient versions are written in
easy-to-understand, non-technical language. Both versions provide current and
accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and
reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are
responsible for writing and maintaining the cancer information summaries. The
summaries are reviewed regularly and changes are made as new information
becomes available. The date on each summary ("Date Last Modified") indicates
the time of the most recent change.
PDQ also contains information on clinical trials.
Before starting treatment, patients may want to think about taking part in a
clinical trial. A clinical trial is a study to answer a scientific question,
such as whether one treatment is better than another. Trials are based on past
studies and what has been learned in the laboratory. Each trial answers
certain scientific questions in order to find new and better ways to help
cancer patients. During treatment clinical trials, information is collected
about new treatments, the risks involved, and how well they do or do not work.
If a clinical trial shows that a new treatment is better than one currently
being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online at
Cancer.gov (http://cancer.gov/clinical_trials). Descriptions of the trials are
available in health professional and patient versions. Many cancer doctors who
take part in clinical trials are also listed in PDQ. For more information,
call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at
1-800-332-8615.
Date Last Modified: 09/2002
******************************************************************************
* If you want to know more about cancer and how it is treated, or if you *
* if you wish to know about clinical trials for your type of cancer, you *
* can call the NCI's Cancer Information Service at 1-800-422-6237, toll *
* free. A trained information specialist can talk with you and answer *
* your questions. *
******************************************************************************
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This information has been brought to you by
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