21st Century Adult Cancer Sourcebook: Anal Cancer, Cancer of the Anus - Clinical Data for Patients, Families, and Physicians
Edition 1.0 - September 2011
National Cancer Institute
Smashwords Edition
Copyright 2011 Progressive Management
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From our Guide to Leading Medical Websites, here are three valuable sites with authoritative cancer information:
OncoLink * http://www.oncolink.upenn.edu/
eMedicine.com * http://www.emedicine.com/
American Cancer Society (ACS) * http://www.cancer.org/
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PART ONE
Chapter 1A: Anal Cancer Patient Information
Chapter 2A: Anal Cancer Health Professional Information
Chapter 3A: Anal Cancer NCI Drug Information
Chapter 4A: Anal Cancer Clinical Trials
PART TWO
Chapter 1B: Levels of Evidence for Adult and Pediatric Cancer Treatment Studies (NCI)
Chapter 2B: Glossary of Clinical Trial Terms
Chapter 3B: Clinical Trials Background Information
Chapter 4B: Cancer Clinical Trials -The Basic Workbook
Chapter 5B: Cancer Clinical Trials - The In-Depth Program
Chapter 6B: Clinical Trials at NIH
Chapter 7B: How To Find A Cancer Treatment Trial: A Ten Step Guide
Chapter 8B: Taking Part in Cancer Treatment Research Studies
Chapter 9B: Cancer Clinical Trials
Chapter 10B: Access to Investigational Drugs
Chapter 12B: Taking Time: Support for People with Cancer
Chapter 13B: Facing Forward - Life After Cancer Treatment
Chapter 14B: Chemotherapy and You
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PART ONE
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Chapter 1A: Anal Cancer Patient Information
Anal Cancer Treatment
Last Modified: 07/20/2011
Patient Version
General Information About Anal Cancer
Key Points for This Section
* Anal cancer is a disease in which malignant (cancer) cells form in the tissues of the anus.
* Being infected with the human papillomavirus (HPV) can affect the risk of developing anal cancer.
* Possible signs of anal cancer include bleeding from the anus or rectum or a lump near the anus.
* Tests that examine the rectum and anus are used to detect (find) and diagnose anal cancer.
* Certain factors affect the prognosis (chance of recovery) and treatment options.
Anal cancer is a disease in which malignant (cancer) cells form in the tissues of the anus.
The anus is the end of the large intestine, below the rectum, through which stool (solid waste) leaves the body. The anus is formed partly from the outer, skin layers of the body and partly from the intestine. Two ring-like muscles, called sphincter muscles, open and close the anal opening to let stool pass out of the body. The anal canal, the part of the anus between the rectum and the anal opening, is about 1½ inches long.
The skin around the outside of the anus is called the perianal area. Tumors in this area are skin tumors, not anal cancer.
Being infected with the human papillomavirus (HPV) can affect the risk of developing anal cancer.
Risk factors include the following:
* Being over 50 years old.
* Being infected with human papillomavirus (HPV).
* Having many sexual partners.
* Having receptive anal intercourse (anal sex).
* Frequent anal redness, swelling, and soreness.
* Having anal fistulas (abnormal openings).
* Smoking cigarettes.
Possible signs of anal cancer include bleeding from the anus or rectum or a lump near the anus.
These and other symptoms may be caused by anal cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
* Bleeding from the anus or rectum.
* Pain or pressure in the area around the anus.
* Itching or discharge from the anus.
* A lump near the anus.
* A change in bowel habits.
Tests that examine the rectum and anus are used to detect (find) and diagnose anal cancer.
The following tests and procedures may be used:
* Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
* Digital rectal examination (DRE): An exam of the anus and rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual.
* Anoscopy: An exam of the anus and lower rectum using a short, lighted tube called an anoscope.
* Proctoscopy: An exam of the rectum using a short, lighted tube called a proctoscope.
* Endo-anal or endorectal ultrasound: A procedure in which an ultrasound transducer (probe) is inserted into the anus or rectum and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
* Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If an abnormal area is seen during the anoscopy, a biopsy may be done at that time.
Certain factors affect the prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) depends on the following:
* The size of the tumor.
* Where the tumor is in the anus.
* Whether the cancer has spread to the lymph nodes.
The treatment options depend on the following:
* The stage of the cancer.
* Where the tumor is in the anus.
* Whether the patient has human immunodeficiency virus (HIV).
* Whether cancer remains after initial treatment or has recurred.
Glossary Terms
abnormal (ab-NOR-mul) * Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
anal (AY-nul) * Having to do with the anus. The anus is the opening of the rectum (last part of the large intestine) to the outside of the body.
anus (AY-nus) * The opening of the rectum to the outside of the body.
biopsy (BY-op-see) * The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
bowel (BOW-ul) * The long, tube-shaped organ in the abdomen that completes the process of digestion. The bowel has two parts, the small bowel and the large bowel. Also called intestine.
cancer (KAN-ser) * A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
cell (sel) * The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
digital rectal examination (DIH-jih-tul REK-tul eg-ZA-mih-NAY-shun)
* An examination in which a doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities. Also called DRE.
human immunodeficiency virus (HYOO-mun IH-myoo-noh-dih-FIH-shun-see VY-rus) * The cause of acquired immunodeficiency syndrome (AIDS). Also called HIV.
human papillomavirus (HYOO-mun PA-pih-LOH-muh-VY-rus) * A type of virus that can cause abnormal tissue growth (for example, warts) and other changes to cells. Infection for a long time with certain types of human papillomavirus can cause cervical cancer. Human papillomavirus may also play a role in some other types of cancer, such as anal, vaginal, vulvar, penile, oropharyngeal, and squamous cell skin cancers. Also called HPV.
infection (in-FEK-shun) * Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.
large intestine (larj in-TES-tin) * The long, tube-like organ that is connected to the small intestine at one end and the anus at the other. The large intestine has four parts: cecum, colon, rectum, and anal canal. Partly digested food moves through the cecum into the colon, where water and some nutrients and electrolytes are removed. The remaining material, solid waste called stool, moves through the colon, is stored in the rectum, and leaves the body through the anal canal and anus.
lymph node (limf node) * A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
organ (OR-gun) * A part of the body that performs a specific function. For example, the heart is an organ.
pathologist (puh-THAH-loh-jist) * A doctor who identifies diseases by studying cells and tissues under a microscope.
physical examination (FIH-zih-kul eg-ZA-mih-NAY-shun) * An exam of the body to check for general signs of disease.
proctoscopy (prok-TOS-koh-pee) * Examination of the rectum using a proctoscope, inserted into the rectum. A proctoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
prognosis (prog-NO-sis) * The likely outcome or course of a disease; the chance of recovery or recurrence.
rectum (REK-tum) * The last several inches of the large intestine closest to the anus.
recurrent cancer (ree-KER-ent KAN-ser) * Cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body. Also called recurrence.
risk factor (... FAK-ter) * Something that increases the chance of developing a disease. Some examples of risk factors for cancer are age, a family history of certain cancers, use of tobacco products, being exposed to radiation or certain chemicals, infection with certain viruses or bacteria, and certain genetic changes.
sonogram (SAH-noh-gram) * A computer picture of areas inside the body created by bouncing high-energy sound waves (ultrasound) off internal tissues or organs. Also called ultrasonogram.
sphincter (SFINK-ter) * A ring-shaped muscle that relaxes or tightens to open or close a passage or opening in the body. Examples are the anal sphincter (around the opening of the anus) and the pyloric sphincter (at the lower opening of the stomach).
stage * The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
stool (stool) * The material in a bowel movement. Stool is made up of undigested food, bacteria, mucus, and cells from the lining of the intestines. Also called feces.
symptom (SIMP-tum) * An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
tissue (TIH-shoo) * A group or layer of cells that work together to perform a specific function.
tumor (TOO-mer) * An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
ultrasound (UL-truh-SOWND) * A procedure in which high-energy sound waves are bounced off internal tissues or organs and make echoes. The echo patterns are shown on the screen of an ultrasound machine, forming a picture of body tissues called a sonogram. Also called ultrasonography.
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Stages of Anal Cancer
Key Points for This Section
* After anal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the anus or to other parts of the body.
* There are three ways that cancer spreads in the body.
* The following stages are used for anal cancer:
* Stage 0 (Carcinoma in Situ)
* Stage I
* Stage II
* Stage IIIA
* Stage IIIB
* Stage IV
After anal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the anus or to other parts of the body.
The process used to find out if cancer has spread within the anus or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests may be used in the staging process:
* CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. For anal cancer, a CT scan of the pelvis and abdomen may be done.
* Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
* Endo-anal or endorectal ultrasound: A procedure in which an ultrasound transducer (probe) is inserted into the anus or rectum and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
* Through tissue. Cancer invades the surrounding normal tissue.
* Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
* Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for anal cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the innermost lining of the anus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Pea, peanut, walnut, and lime show tumor sizes.
Stage I
In stage I, cancer has formed and the tumor is 2 centimeters or smaller.
Stage II
In stage II, the tumor is larger than 2 centimeters.
Stage IIIA
In stage IIIA, the tumor may be any size and has spread to either:
* lymph nodes near the rectum; or
* nearby organs, such as the vagina, urethra, and bladder.
Stage IIIB
In stage IIIB, the tumor may be any size and has spread:
* to nearby organs and to lymph nodes near the rectum; or
* to lymph nodes on one side of the pelvis and/or groin, and may have spread to nearby organs; or
* to lymph nodes near the rectum and in the groin, and/or to lymph nodes on both sides of the pelvis and/or groin, and may have spread to nearby organs.
Stage IV
In stage IV, the tumor may be any size and cancer may have spread to lymph nodes or nearby organs and has spread to distant parts of the body.
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Recurrent Anal Cancer
Recurrent anal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the anus or in other parts of the body.
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Treatment Option Overview
Key Points for This Section
* There are different types of treatment for patients with anal cancer.
* Three types of standard treatment are used:
* Radiation therapy
* Chemotherapy
* Surgery
* Having the human immunodeficiency virus can affect treatment of anal cancer.
* New types of treatment are being tested in clinical trials.
* Radiosensitizers
* Patients may want to think about taking part in a clinical trial.
* Patients can enter clinical trials before, during, or after starting their cancer treatment.
* Follow-up tests may be needed.
There are different types of treatment for patients with anal cancer.
Different types of treatments are available for patients with anal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Three types of standard treatment are used:
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Surgery
* Local resection: A surgical procedure in which the tumor is cut from the anus along with some of the healthy tissue around it. Local resection may be used if the cancer is small and has not spread. This procedure may save the sphincter muscles so the patient can still control bowel movements. Tumors that develop in the lower part of the anus can often be removed with local resection.
* Abdominoperineal resection: A surgical procedure in which the anus, the rectum, and part of the sigmoid colon are removed through an incision made in the abdomen. The doctor sews the end of the intestine to an opening, called a stoma, made in the surface of the abdomen so body waste can be collected in a disposable bag outside of the body. This is called a colostomy. Lymph nodes that contain cancer may also be removed during this operation.
* Anal cancer surgery with colostomy. The anus, rectum, and part of the colon are removed, a stoma is created, and a colostomy bag is attached to the stoma.
Having the human immunodeficiency virus can affect treatment of anal cancer.
Cancer therapy can further damage the already weakened immune systems of patients who have the human immunodeficiency virus (HIV). For this reason, patients who have anal cancer and HIV are usually treated with lower doses of anticancer drugs and radiation than patients who do not have HIV.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site 1.
Radiosensitizers
Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Glossary Terms
abdomen (AB-doh-men) * The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
abdominoperineal resection (ab-DAH-mih-noh-PAYR-ih-NEE-ul ree-SEK-shun) * Surgery to remove the anus, the rectum, and part of the sigmoid colon through an incision made in the abdomen. The end of the intestine is attached to an opening in the surface of the abdomen and body waste is collected in a disposable bag outside of the body. This opening is called a colostomy. Lymph nodes that contain cancer may also be removed during this operation.
anal (AY-nul) * Having to do with the anus. The anus is the opening of the rectum (last part of the large intestine) to the outside of the body.
anus (AY-nus) * The opening of the rectum to the outside of the body.
bowel (BOW-ul) * The long, tube-shaped organ in the abdomen that completes the process of digestion. The bowel has two parts, the small bowel and the large bowel. Also called intestine.
catheter (KA-theh-ter) * A flexible tube used to deliver fluids into or withdraw fluids from the body.
cell (sel) * The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
cerebrospinal fluid (seh-REE-broh-SPY-nul FLOO-id) * The fluid that flows in and around the hollow spaces of the brain and spinal cord, and between two of the meninges (the thin layers of tissue that cover and protect the brain and spinal cord). Cerebrospinal fluid is made by tissue called the choroid plexus in the ventricles (hollow spaces) in the brain. Also called CSF.
chemotherapy (KEE-moh-THAYR-uh-pee) * Treatment with drugs that kill cancer cells.
clinical trial (KLIH-nih-kul TRY-ul) * A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.
colostomy (koh-LOS-toh-mee) * An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed.
diagnosis (DY-ug-NOH-sis) * The process of identifying a disease, such as cancer, from its signs and symptoms.
dose (dose) * The amount of medicine taken, or radiation given, at one time.
drug (drug) * Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.
external radiation therapy (...RAY-dee-AY-shun THAYR-uh-pee) * A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.
follow-up (FAH-loh-up) * Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.
human immunodeficiency virus (HYOO-mun IH-myoo-noh-dih-FIH-shun-see VY-rus) * The cause of acquired immunodeficiency syndrome (AIDS). Also called HIV.
immune system (ih-MYOON SIS-tem) * The complex group of organs and cells that defends the body against infections and other diseases.
incision (in-SIH-zhun) * A cut made in the body to perform surgery.
injection (in-JEK-shun) * Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
internal radiation therapy (in-TER-nul RAY-dee-AY-shun THAYR-uh-pee) * A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, implant radiation therapy, and radiation brachytherapy.
intestine (in-TES-tin) * The long, tube-shaped organ in the abdomen that completes the process of digestion. The intestine has two parts, the small intestine and the large intestine. Also called bowel.
local therapy (LOH-kul THAYR-uh-pee) * Treatment that affects cells in the tumor and the area close to it.
lymph node (limf node) * A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
NCI * NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. It conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://www.cancer.gov. Also called National Cancer Institute.
organ (OR-gun) * A part of the body that performs a specific function. For example, the heart is an organ.
radiation (RAY-dee-AY-shun) * Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).
radiation therapy (RAY-dee-AY-shun THAYR-uh-pee) * The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.
radioactive seed (RAY-dee-oh-AK-tiv...) * A small, radioactive pellet that is placed in or near a tumor. Cancer cells are killed by the energy given off as the radioactive material breaks down and becomes more stable.
radiosensitizer (RAY-dee-oh-SEN-sih-TY-zer) * A drug that makes tumor cells more sensitive to radiation therapy.
rectum (REK-tum) * The last several inches of the large intestine closest to the anus.
recur * To come back or to return.
regional chemotherapy (REE-juh-nul KEE-moh-THAYR-uh-pee) * Treatment with anticancer drugs directed to a specific area of the body.
resection (ree-SEK-shun) * Surgery to remove tissue or part or all of an organ.
side effect (side eh-FEKT) * A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.
sigmoid colon (SIG-moyd KOH-lun) * The S-shaped section of the colon that connects to the rectum.
sphincter (SFINK-ter) * A ring-shaped muscle that relaxes or tightens to open or close a passage or opening in the body. Examples are the anal sphincter (around the opening of the anus) and the pyloric sphincter (at the lower opening of the stomach).
stage * The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
standard therapy (... THAYR-uh-pee) * Treatment that experts agree is appropriate, accepted, and widely used. Also called best practice, standard medical care, and standard of care.
stoma (STOH-muh) * A surgically created opening from an area inside the body to the outside.
surgery (SER-juh-ree) * A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.
systemic chemotherapy (sis-TEH-mik KEE-moh-THAYR-uh-pee) * Treatment with anticancer drugs that travel through the blood to cells all over the body.
therapy (THAYR-uh-pee) * Treatment.
tissue (TIH-shoo) * A group or layer of cells that work together to perform a specific function.
tumor (TOO-mer) * An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
x-ray (EX-ray) * A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.
Table of Links
1 http://cancer.gov/clinicaltrials
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Treatment Options by Stage
Stage 0 (Carcinoma in Situ)
Stage I Anal Cancer
Stage II Anal Cancer
Stage IIIA Anal Cancer
Stage IIIB Anal Cancer
Stage IV Anal Cancer
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Stage 0 (Carcinoma in Situ)
Treatment of stage 0 is usually local resection.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage 0 anal cancer 1. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site 2.
Stage I Anal Cancer
Treatment of stage I anal cancer may include the following:
* Local resection.
* External-beam radiation therapy with or without chemotherapy. If cancer remains after treatment, additional chemotherapy and radiation therapy may be given to avoid the need for a permanent colostomy.
* Internal radiation therapy.
* Abdominoperineal resection, if cancer remains or comes back after treatment with radiation therapy and chemotherapy.
* Internal radiation therapy for cancer that remains after treatment with external-beam radiation therapy.
Patients who have had treatment that saves the sphincter muscles may receive follow-up exams every 3 months for the first 2 years, including rectal exams with endoscopy and biopsy, as needed.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I anal cancer 3. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site 2.
Stage II Anal Cancer
Treatment of stage II anal cancer may include the following:
* Local resection.
* External-beam radiation therapy with chemotherapy. If cancer remains after treatment, additional chemotherapy and radiation therapy may be given to avoid the need for a permanent colostomy.
* Internal radiation therapy.
* Abdominoperineal resection, if cancer remains or comes back after treatment with radiation therapy and chemotherapy.
* A clinical trial of new treatment options.
Patients who have had treatment that saves the sphincter muscles may receive follow-up exams every 3 months for the first 2 years, including rectal exams with endoscopy and biopsy, as needed.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage II anal cancer 4. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site 2.
Stage IIIA Anal Cancer
Treatment of stage IIIA anal cancer may include the following:
* External-beam radiation therapy with chemotherapy. If cancer remains after treatment, additional chemotherapy and radiation therapy may be given to avoid the need for a permanent colostomy.
* Internal radiation therapy.
* Abdominoperineal resection, if cancer remains or comes back after treatment with chemotherapy and radiation therapy.
* A clinical trial of new treatment options.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IIIA anal cancer 5. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site 2.
Stage IIIB Anal Cancer
Treatment of stage IIIB anal cancer may include the following:
* External-beam radiation therapy with chemotherapy.
* Local resection or abdominoperineal resection, if cancer remains or comes back after treatment with chemotherapy and radiation therapy. Lymph nodes may also be removed.
* A clinical trial of new treatment options.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IIIB anal cancer 6. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site 2.
Stage IV Anal Cancer
Treatment of stage IV anal cancer may include the following:
* Surgery as palliative therapy to relieve symptoms and improve the quality of life.
* Radiation therapy as palliative therapy.
* Chemotherapy with radiation therapy as palliative therapy.
* A clinical trial of new treatment options.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV anal cancer 7. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site 2.
Glossary Terms
abdominoperineal resection (ab-DAH-mih-noh-PAYR-ih-NEE-ul ree-SEK-shun) * Surgery to remove the anus, the rectum, and part of the sigmoid colon through an incision made in the abdomen. The end of the intestine is attached to an opening in the surface of the abdomen and body waste is collected in a disposable bag outside of the body. This opening is called a colostomy. Lymph nodes that contain cancer may also be removed during this operation.
biopsy (BY-op-see) * The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
chemotherapy (KEE-moh-THAYR-uh-pee) * Treatment with drugs that kill cancer cells.
clinical trial (KLIH-nih-kul TRY-ul) * A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.
colostomy (koh-LOS-toh-mee) * An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed.
digital rectal examination (DIH-jih-tul REK-tul eg-ZA-mih-NAY-shun) * An examination in which a doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities. Also called DRE.
endoscopy (en-DOS-koh-pee) * A procedure that uses an endoscope to examine the inside of the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
external radiation therapy (...RAY-dee-AY-shun THAYR-uh-pee) * A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.
external-beam radiation therapy (...RAY-dee-AY-shun THAYR-uh-pee) * A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external radiation therapy.
follow-up (FAH-loh-up) * Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.
internal radiation therapy (in-TER-nul RAY-dee-AY-shun THAYR-uh-pee) * A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, implant radiation therapy, and radiation brachytherapy.
local therapy (LOH-kul THAYR-uh-pee) * Treatment that affects cells in the tumor and the area close to it.