Anal cancer

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Treatments for recurrent anal cancer

The following are treatment options for recurrent anal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. Treatment options depend on if the cancer comes back in or near the anus (called local recurrence) or if it recurs in another part of the body farther from the anus (called distant metastasis).

Local recurrence

The treatment options for a local recurrence of anal cancer depend on what was used to treat the original, or primary, tumour.

Chemoradiation is usually given if surgery was the only treatment used to remove the original tumour. This treatment gives chemotherapy during the same time period as radiation therapy. It 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.

Surgery can be done to remove a local recurrence if chemoradiation was used to treat the original tumour. An abdominoperineal resection is done to remove the rectum, anus, anal sphincter and muscles around the anus. A wide local excision may be done if there is a local recurrence of perianal skin cancer.

Chemotherapy alone can be given if chemoradiation was used to treat the original tumour and surgery can’t be done to remove the recurrence. The chemotherapy drugs used most often are 5-fluorouracil and cisplatin (Platinol AQ). They are given intravenously every 4 weeks.

Distant metastasis

There is no standard treatment for distant metastasis. The goal of treatment is to control the disease and relieve symptoms (called palliative therapy).

Chemotherapy may be given alone or as part of chemoradiation. The chemotherapy drugs used most often are 5-fluorouracil and cisplatin. They are given intravenously every 4 weeks. Treatment is usually continued as long as the cancer doesn’t grow or spread any farther and you can cope with the side effects.

Chemoradiation may be used to manage symptoms like pain and bleeding caused by an anal tumour. It gives chemotherapy during the same time period as radiation therapy. How long chemoradiation is given depends on how well symptoms are managed. It is usually given as daily treatments of external beam radiation therapy along with one of the following combinations of chemotherapy drugs:

  • 5-fluorouracil and cisplatin
  • capecitabine (Xeloda) and cisplatin

Wide local excision may be done to remove an anal tumour that causes symptoms like pain and bleeding. This surgery removes the tumour along with some healthy tissue around it (called the surgical margin).

Clinical trials

You may be asked if you want to join a clinical trial for anal cancer. Find out more about clinical trials.

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