Treatment of Anal Cancer

Pancreatic Cancer Slideshow

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

Much public attention was directed toward anal cancer with the illness of actress Farrah Fawcett, who died on June 25, 2009, due to complications of the disease. Fawcett was diagnosed with anal cancer in 2006 and underwent treatments in both the U.S. and Germany. Her struggle with the cancer was the subject of a television documentary that aired on NBC in May 2009.

The treatment of cancer of the anus is different than the treatment of cancers around the anus. True anal cancers arise from the lining cells of the anus, the last portion of the gastrointestinal tract after the rectum. Cancers that arise outside of the anus in the skin are termed perianal skin cancers or anal margin cancers. These are treated as skin cancers and not as true anal cancers.

Although anal cancer is rare (comprising only 1.8% of all malignancies of the digestive tract), its incidence is on the rise. While the exact cause of anal cancer hasn't been determined, researchers have shown that it is highly associated with human papillomavirus (HPV) infection. HPV is the virus that is known to cause cervical cancer in women.

As with any cancer, treatment is dependent upon the type, size, and extent of spread (stage) of the particular tumor as well as the overall health status of the patient. Surgery is no longer the standard treatment for most forms of anal cancer, although this option was used routinely in the past. Formerly, anal cancers were treated with a surgical procedure known as abdominoperineal resection (APR). The procedure required removal of the anorectum and the creation of a permanent colostomy, an opening made in the abdomen through which feces pass out of the body to be collected in a special bag attached to the body.

Surgery is typically only used as a first-line treatment for small anal cancers that do not involve the anal sphincter muscles. In these cases, local resection (removal of only the tumor plus a small margin of healthy surrounding tissue) can be curative. If the tumor involves the anal sphincter or is too extensive to be cured by local resection, the recommended treatment (for squamous cell cancers, the most common type of anal cancer) involves a combination of external beam radiation therapy along with chemotherapeutic drugs and is referred to as chemoradiotherapy. When these treatments are not sufficient and there is recurrent or residual tumor present, surgery (including the APR procedure) may be recommended.

Finally, clinical trials may be another treatment option for people with anal cancer. Participating in a clinical trial is part of the cancer research process and helps determine whether newer or alternative cancer treatments are more effective than the current or standard treatments. Clinical trials may be available for people who were recently diagnosed, for those who have already begun standard treatments, or for those with advanced disease that has not responded to conventional treatments. Information about clinical trials is available from the National Cancer Institute (NCI) Web site, which includes a search feature for ongoing clinical trials. Your doctor can also help you find available clinical trials and help you decide if this treatment option is right for you.