General information on therapy
When treating anal cancer, a distinction must be made as to whether it is anal canal cancer or anal margin cancer. The anal rim is an area of skin around the anus measuring 5 cm.
The treatment of anal cancer consists primarily of its surgical removal. However, in the case of anal canal cancer, treatment consists primarily of combined radiotherapy and chemotherapy or radiotherapy alone.
The choice of therapy is individually adapted to the tumor in question. It depends on the exact location of the cancer, the size of the tumor and the lymph node involvement. It is also decisive whether it is a first manifestation of anal cancer or whether the tumor has recurred after previous therapy.
After radiotherapy and chemotherapy, anal cancer regresses only slowly. To assess the success of the therapy, it is necessary to wait about 6 months after the end of therapy. During this time, regular checks are very important.
Surgery
The extent of the operation depends on various factors. It ranges from local removal of the cancer to removal of the entire rectum.
Small anal margin carcinomas can be excised with a knife. The resulting skin or mucosal defect can be left open or closed with sutures. However, if local surgery is not possible, the entire rectum must be removed. In general, it can be said that local surgery is no longer possible if
- the tumor is larger than 2-3 cm
- tumor residues remain after radiotherapy
- if the cancer recurs after successful treatment.
If the rectum has to be removed as a whole through an abdominal incision, the sphincter muscle is also removed at the same time. This is done for reasons of radicality, as otherwise it cannot be guaranteed that the tumor can be completely removed. This operation requires a permanent artificial anus. The anus is removed during this operation and the skin in this region is closed. This operation takes about 4-5 hours, with a hospital stay of about 10 days.
Operation information
Local removal of anal cancer
- Preparation: small enema
- Anesthesia: general anesthesia or spinal anesthesia
- Operation duration: 60 minutes
- Hospitalization: inpatient (3 days)
- Incapacity for work: 1 to 2 days
Radical removal of the rectum
- Preparation: Drainage
- Anesthesia: General anesthesia
- Operation duration: 3 to 6 hours
- Hospitalization: inpatient (7 days)
- Incapacity to work: 3 to 4 weeks
Chemotherapy
Doctors use strong cytotoxins, so-called cytostatics or chemotherapeutics. They attack cells that divide quickly – including cancer cells. However, the cells of the skin, mucous membranes and hair also divide quickly. The most well-known side effect of chemotherapy is hair loss. Cytostatic drugs always affect the entire body. They prevent the division of cancer cells or kill them.
Radiotherapy (radiation therapy)
Radio-oncologists destroy cancer cells using high-energy X-rays. It damages the genetic material of the tumor cells, and unlike healthy cells, cancer cells can hardly repair this damage. If the anal cancer is larger than 2 cm or if lymph nodes are already affected, radiotherapy is the treatment of choice in most cases in accordance with the guidelines. Radio-oncologists usually combine radiotherapy with chemotherapy for anal cancer, which is also known as radiochemotherapy. In most cases, radiochemotherapy leads to a cure.
Further details on radiotherapy for anal cancer can be found here.
