Treatments for stage 1 anal cancer
You may be offered surgery as the main treatment for stage 1 anal cancer if the tumour is small and it isn’t in the anal sphincter. The surgeon will do a wide local excision to remove the tumour and a small amount of tissue around it (called the surgical margin). Sometimes more surgery is needed to remove any cancer left behind or if cancer cells are found in the surgical margin.
An abdominoperineal resection may be done if chemoradiation was the main treatment but it didn’t destroy all the cancer cells. This surgery removes the rectum, anus, anal sphincter and muscles around the anus.
Chemoradiation may be offered as the main treatment for stage 1 anal cancer if the tumour is too large to be completely removed by surgery or the tumour is in the anal sphincter. This treatment combines chemotherapy with radiation therapy. The 2 treatments are given during the same time period. Some types of chemotherapy make radiation therapy more effective.
Chemoradiation is usually given as daily treatments of external beam radiation therapy for 5–6 weeks. The drugs most commonly given during this time period are 5-fluorouracil (5-FU, Adrucil) and mitomycin (Mutamycin). Sometimes capecitabine (Xeloda) is used instead of 5-fluorouracil.
Sometimes more treatment is given if chemoradiation didn’t destroy all the cancer cells. This may be called salvage therapy. It is usually chemotherapy alone or with radiation therapy. The chemotherapy drugs used most often in salvage therapy are 5-fluorouracil and cisplatin (Platinol AQ). When more radiation therapy is given, it’s called a radiation boost.
Alberta Health Services. Anal Canal Cancer Clinical Practice Guideline GI-001. version 4 ed. 2013: http://www.albertahealthservices.ca/hp/if-hp-cancer-guide-gi001-anal-canal.pdf.
American Society of Clinical Oncology. Anal Cancer. 2014: http://www.cancer.net/cancer-types/anal-cancer.
BC Cancer Agency (BCCA). Cancer Management Guidelines: Anus. 2012: http://www.bccancer.bc.ca/health-professionals/professional-resources/cancer-management-guidelines/gastrointestinal/anus#.
Cancer Care Ontario. Evidence-Based Series 2-8: Management of Squamous Cell Cancer of the Anal Canal. version 2 ed. 2013: https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=43166.
Czito BG, Ahmed S, Kalady M, Eng C . Cancer of the Anal Region. DeVita VT Jr, Lawrence TS, Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015: 61:842-856.
National Cancer Institute. Anal Cancer Treatment (PDQ®) Health Professional Version. 2014: http://www.cancer.gov/cancertopics/pdq/treatment/anal/HealthProfessional/page1/AllPages.
National Comprehensive Cancer Network. Anal Carcinoma. version 2 ed. National Comprehensive Cancer Network; 2015: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site.
Penn Medicine. Anal Cancer: The Basics. University of Pennsylvania; 2015: http://www.oncolink.org/includes/print_article.cfm?Page=2&id=9497&section=cancer_types.