How is anal cancer treated?
Anal cancer is different from colon and rectal cancer and has a different treatment pathway.
It is a rare disease, so it is important that your treatment should be managed by a specialist anal cancer consultant within the hospital colorectal bowel cancer team, as part of a multi-disciplinary treatment approach. Some hospitals don’t have this type of specialist team, so you may have to travel to another hospital to get the treatment you need. If there is anything you don’t understand about your diagnosis or the treatment pathway being recommended by your consultant, you should always ask for a clearer explanation and more time to decide if you need it.Your doctor may offer you entry into a clinical trial or research project, as work to improve treatment options is on-going. Anal cancer which has not spread is often treated successfully by a combination of chemotherapy and radiotherapy (chemoradiotherapy) given either one after the other, or at the same time.
Three types of standard treatment are used:
Radiotherapy for anal cancer
You may be given radiotherapy:
Radiotherapy is often the first treatment used in anal cancer, with or without chemotherapy. Radiotherapy uses repeated treatments of high energy X-rays in small doses to kill cancer cells. The treatments are given Monday to Friday over a period of 5 – 6 weeks, and usually as an out-patient.
External radiotherapy means radiotherapy beamed from the outside of your body.
Internal radiotherapy (brachytherapy) means radioactive material is placed next to the tumour, inside the body. You may have either type or a combination of both as treatment for anal cancer.
Side-effects of radiotherapy
Radiotherapy can cause temporary but significant redness and tenderness of the area treated, which develops gradually after several sessions. Your radiographer looks out for these reactions, but you should also let them know if you feel any soreness. It is quite common for the skin to get very sore; it may peel, but it should heal quickly. Skin reactions usually settle down two to four weeks after treatment finishes. You may find it more comfortable to wear loose fitting clothes made of natural fibres, until your skin is less sensitive again. You may also be given painkillers to take over this period. Advice about skin care varies between different hospitals and it is best to follow the instructions given by your own treatment unit. Unless prescribed by your radiotherapist, you should not use creams or dressings on the treatment area. Talcum powder contains tiny metal particles that can make the soreness worse, and should not be used.
Radiotherapy treatment to the anal area can also cause narrowing of the vagina in women. Using a vaginal dilator will help prevent shrinkage of the skin, which tightens as it heals. Used regularly, the dilator helps to gently stretch the vaginal wall. You are recommended to continue using a vaginal dilator indefinitely after the first six weeks of your treatment to keep everything flexible and comfortable for sexual activity (if wished) and for medical examinations. Vaginal dryness can also be a problem, but it can be alleviated with special creams or gels prescribed by your doctor. If the tumour has caused loss of proper control over the bowels (leakage) your doctor may advise formation of a stoma before starting radiotherapy.
Chemotherapy is usually offered alongside radiotherapy as it can enhance the effect of radiotherapy (chemoradiation). The most common chemotherapy you will be offered is Mitomycin-C in combination with 5FU (fluorouracil). This is given intravenously (into your vein). Sometimes a drug called capecitabine is taken as a tablet instead of 5FU. A typical cycle of treatment would be five
weeks, with chemotherapy being given during the first and fifth week alongside radiotherapy. Some people experience side-effects from this treatment. The most common side-effects of Mitomycin-C include feeling sick (nausea) and being sick (vomiting). You may also experience changes to how your bowel works, such as diarrhoea or passing more wind. You are likely to feel very tired during the treatment, as it can affect your blood cell count and make you anaemic and prone to infections, and you may notice you bruise more easily. Chemotherapy can cause mouth ulcers and soreness, and this may put you off eating, although this is an important time to eat well. Other side-effects include hair loss or thinning of hair. Less common side-effects are kidney and liver problems, skin rashes and fertility problems.
Your medical team will offer advice as to how you can aim to prevent or minimise side-effects. Regular blood tests to check liver and kidney function will be done to identify any problems early. Your team may suggest that you eat regular, small meals, take nutrition supplements, use mouthwashes, and take medication to control bowel function and stop you being sick. It is very important you let the team know of any changes or side-effects – you will be given a direct contact number to call.
Surgery may be considered by your specialist anal multi-disciplinary team, depending on the size and spread of the cancer. Surgery may be used to remove small tumours. It may also be used if the treatment doesn’t completely cure the cancer or if there are signs that the cancer has returned. Occasionally it is used to relieve symptoms before treatment can begin.