Cancer of the anus or anal canal

Understanding the disease Treatment options Side effects of treatment

Anal Cancer

This is usually squamous cancer and is treated with chemo-radiation.

Rectal cancer is adenocarcinoma and is treated with surgery +/- chemoradiation

Sentinel nodes of the anus are inguinal nodes.

More advanced case of anal cancer that has spread on PET scan to para- aortic lymph nodes

PET scan showing anal cancer

There are different guidelines for anal canal and anal margin , for canal more chemotherapy plus radiation therapy (RT)

For anal margin, surgery may be all that is necessary for early stages

CT scan is obtained at the time of simulation

CT images are then imported into the treatment planning computer

In the simulation process the CT and PET scan images are used to create a computer plan

Computer generated images of anal cancer

Tomotherapy for Anal Cancer

Tomotherapy for anal cancer, high dose to anus and groin nodes, while avoiding the bladder and femurs

In the treatment the lasers are used to line up the beam and the patient receives the radiation treatment

Side Effects of Pelvic Radiation

Radiation fields

Radiation may hit the small bowel causing some cramps, diarrhea and fatigue

High dose area

Side Effects of Pelvic Radiation

Radiation fields

Radiation may hit the bladder and rectum causing urinary burning or frequency and ano-rectal irritation

High dose area

In pre-menopausal women, radiation is likely to effect ovarian function and should not be used if the woman is pregnant

Survival in a large series of patients

Survival by Stage in a series of 270 patients with anal cancer

5 Year Survival by Stage

T1: 86% N0: 76%

T2: 86% N1: 54%

T3: 60%

T4: 45%