Treatments for stage 3 anal cancer
Chemoradiation is the main treatment for stage 3 anal cancer. It 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 needed if the 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.
You may be offered surgery for stage 3 anal cancer if chemoradiation didn’t destroy all the cancer cells.
Abdominoperineal resection may be used to treat stage 3A or stage 3B anal cancer. This surgery removes the rectum, anus, anal sphincter and muscles around the anus.
Wide local excision may be used to remove a stage 3B anal cancer when there is only a small amount of cancer. This surgery removes the tumour along with some healthy tissue around it (called the surgical margin).
Inguinal lymph node dissection may be used to treat stage 3B anal cancer when it has spread to lymph nodes in the groin.
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.