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Anatomically,anus is the end part of large intestine just below rectum, through which the solid waste leaves the body know as stool. The anal canal, the part of the anus between the rectum and the anal opening, is about 1-1½ inches long.Depending on growth and extend of cancer it’s divided in stages

STAGE 0- (carcinoma in situ):

  • Cancer is still only in inner lining of the anus and not gown deeper.
  • It can often be removed completely by local resection (surgery).
  • In this stage radiation and chemotherapy are rarely needed.

STAGE 1 & 2

  • Growth of cancer is till anal wall but not grown into nearby organs or spread to lymph nodes
  • Surgery (local resection) can be used to remove small tumor measuring less than 1cm. That does not involve the sphincter, followed by chemo and radiation therapy.
  • The combination of radiation therapy and chemo is called as chemo-radiation therapy, its best way to treat anal cancer that can’t be removed without harming the anal sphincter.
  • In chemoradiation, the two treatments are given over the same period of time. The chemotherapy given is usually 5-FU with mitomycinC.
  • At the start of radiation treatment Mitomycin is given through intravenous injection and then again near the end at around 4 to6weeks.
  • The chemo 5-FU is basically given by a long IV infusion over 4 to 5 days and repeated in 4 to 6 weeks. Further doctor may suggest internal radiation along with external beam radiation.

If the cancer still persistseven afterchemo radiation is done, more treatment might be needed. It is important to keep in mind that it may take months to see the full effects of chemo radiation. So doctors may watch any remaining cancer for up to 6 months.

And if more treatment is needed, sometimes chemo (with or without extra radiation) may be recommended to shrink any remaining cancer. The drugs commonly used are 5-FU plus cisplatin. Second option is surgery to remove the remaining cancer.

STAGE 3A & 3B

The growth of cancer is to nearby organs or spread to nearby like lymph nodes, but they have not spread to distant parts of the body.

  • The initial treatment will be Radiation therapy combined with chemo (chemoradiation). In chemoradiation, both treatments are given over same period of time.
  • The chemo is usually 5-FU with mitomycin C.
  • Mitomycin is given through short intravenousinjection, at the start of radiation treatment and then again near the end at around 4 to6weeks.
  • The chemo 5-FU is basically given by a long IV infusion over 4 to 5 days and repeated in 4 to 6 weeks. Further doctor may suggest internal radiation along with external beam radiation.

Occasionally cancer remains after the chemoradiation, so wait and watch closely for up to 6 months because it takes time maybe months to see the full effects of treatment. If the cancer grows, more treatment is recommended. The drugs most often used are 5-FU plus cisplatin. In some cases more radiation is given as well. (This is called a radiation boost). Another option is surgery to remove the cancer. If the cancer has spread to nearby lymph nodes, they may be removed with surgical intervention is required or treated with radiation therapy.

STAGE 4

  • The spread of cancer is to distant organs or tissues. Firstly spread of anal cancer to the lungs, liver, brain, or bones but the spread can be anywhere.
  • Cure for this cancer is unlikely. But the aim should be to control extend of disease as long as possible and relieving symptoms as much as possible. Standard treatment for this is chemotheraphy, sometimes along with radiation.
  • The drugs most commonly used are 5-FU and cisplatin. Another preference is surgery in some cases, but before planning for surgery it is important that you understand goal (to prolong life, relieve symptoms, etc.) and to understand the possible risks and side effects.

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