Anal Cancer

Treatment

The treatment options for anal cancer include:

• Surgery: Different surgical interventions are used for treating anal cancer based on the type and stage of cancer. Some of the surgical techniques include:
  Local resection: This procedure is used in cases where the anal cancer is limited to the lining of the anal canal and has not spread to the nearby lymph nodes. The oncosurgeon removes the abnormal tissues and some nearby healthy tissues during the procedure. The local resection aims to remove the abnormal mass and preserve the function of the anal sphincter.
  Abdominoperineal resection: Abdominoperineal resection was one of the common treatments for anal cancer. However, with the advancements in chemotherapy and radiation therapy, this technique is only used in anal cancers, not responding to alternative therapies. It is a major surgery involving removing the rectum, anus, and sigmoid colon. There may also be a removal of the nearby lymph nodes (known as lymph node dissection) either during the surgery or at a later stage.
• Radiation therapy: Several types of radiation therapies are used for treating anal cancer. These include:
  External-beam radiation therapy: This therapy involves the focusing of high-energy radiations on the tumor from the device present outside the body. It is the most common radiation therapy used for managing anal cancer and its metastasis to other organs. The techniques implemented for external-beam radiation therapy include intensity-modulated radiation therapy, three-dimensional conformal radiation therapy, and stereotactic radiation therapy.
  Brachytherapy: This radiation therapy is used for anal cancer either to boost the radiation in combination with external-beam radiation therapy or when cancer does not respond to the combined treatment of chemotherapy and radiation therapy. It involves placing the source of radioactive material either near or inside the tumor. The types of brachytherapy include Intracavitary radiation or interstitial radiation brachytherapy.
• Chemotherapy: Chemotherapy is a preferred treatment option in most cases of anal cancer. This therapy is used in several situations. It can be used before the surgery (neoadjuvant therapy) either alone or in combination with radiation therapy (chemoradiation therapy). Chemotherapy may also be used after the surgery (adjuvant therapy) to kill the remaining cancer cells. If cancer recurrence occurs in the lymph nodes, chemotherapy may be delivered either alone or in combination with radiation therapy. Chemotherapy is also an option in cases of metastatic anal cancer (spread of anal cancer to lungs, liver, or other distant organs).
• Immunotherapy: Immunotherapy helps manage anal cancer by either boosting the immune system or making the cells more vulnerable to getting attacked by the immune cells. The immune cells have certain proteins that prevent them from attacking certain cells in the body. Immunotherapy drugs block these proteins and increase the spectrum of immune cell attacks. Immunotherapy drugs also interfere in the process that assists the cancer cells in evading the immune system.