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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65778_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65778_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65778_"><span class="title" itemprop="name">Anal Cancer Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Health Professional Version</div><p class="contrib-group"><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: February 4, 2016.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062898__323">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of anal cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.</p><p id="CDR0000062898__324">This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p></div><div id="CDR0000062898__1"><h2 id="_CDR0000062898__1_">General Information About Anal Cancer </h2><div id="CDR0000062898__139"><h3>Incidence and Mortality</h3><p id="CDR0000062898__101">Estimated new cases and deaths from anal, anal canal, and anorectal cancer in the United States in 2016:[<a class="bk_pop" href="#CDR0000062898_rl_1_1">1</a>]</p><ul id="CDR0000062898__102"><li class="half_rhythm"><div>New cases: 8,080.</div></li><li class="half_rhythm"><div>Deaths: 1,080.</div></li></ul></div><div id="CDR0000062898__301"><h3>Prognosis and Survival</h3><p id="CDR0000062898__2">Anal cancer is usually curable. The three major prognostic factors are
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site (anal canal vs. perianal skin), size (primary tumors <2
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cm in size have better prognoses), and nodal status.
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</p><p id="CDR0000062898__3">Anal cancer is an uncommon malignancy and accounts for only a small percentage
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(4%) of all cancers of the lower alimentary tract. Clinical trials such as EST-7283R, for example, have
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evaluated the roles of chemotherapy, radiation therapy, and surgery in the
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treatment of this disease.[<a class="bk_pop" href="#CDR0000062898_rl_1_2">2</a>,<a class="bk_pop" href="#CDR0000062898_rl_1_3">3</a>] Information about ongoing clinical trials is
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available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.
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</p></div><div id="CDR0000062898__302"><h3>Risk Factors</h3><p id="CDR0000062898__4">Overall, the risk of anal cancer is rising with data suggesting that
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persons engaging in certain sexual practices, such as receptive anal intercourse, or persons with a high lifetime number of sexual partners are at an increased risk of anal cancer. These practices may have led to an increase in the number of individuals at risk for infection with human papillomavirus (HPV); HPV infection is strongly associated with anal cancer development and may be a necessary step in its carcinogenesis.[<a class="bk_pop" href="#CDR0000062898_rl_1_4">4</a>-<a class="bk_pop" href="#CDR0000062898_rl_1_7">7</a>]
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</p></div><div id="CDR0000062898__318"><h3>Related Summaries</h3><p id="CDR0000062898__319">Other PDQ summaries containing information related to anal cancer include the following:</p><ul id="CDR0000062898__320"><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000755833/">Anal Cancer Prevention</a></div></li></ul></div><div id="CDR0000062898_rl_1"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062898_rl_1_1">American Cancer Society: Cancer Facts and Figures 2016. Atlanta, Ga: American Cancer Society, 2016. <a href="http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed December 8, 2016.</div></li><li><div class="bk_ref" id="CDR0000062898_rl_1_2">Martenson JA, Lipsitz SR, Lefkopoulou M, et al.: Results of combined modality therapy for patients with anal cancer (E7283). An Eastern Cooperative Oncology Group study. Cancer 76 (10): 1731-6, 1995. [<a href="https://pubmed.ncbi.nlm.nih.gov/8625041" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8625041</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_1_3">Fuchshuber PR, Rodriguez-Bigas M, Weber T, et al.: Anal canal and perianal epidermoid cancers. J Am Coll Surg 185 (5): 494-505, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9358099" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9358099</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_1_4">Johnson LG, Madeleine MM, Newcomer LM, et al.: Anal cancer incidence and survival: the surveillance, epidemiology, and end results experience, 1973-2000. Cancer 101 (2): 281-8, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15241824" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15241824</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_1_5">Daling JR, Weiss NS, Hislop TG, et al.: Sexual practices, sexually transmitted diseases, and the incidence of anal cancer. N Engl J Med 317 (16): 973-7, 1987. [<a href="https://pubmed.ncbi.nlm.nih.gov/2821396" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2821396</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_1_6">Palefsky JM, Holly EA, Gonzales J, et al.: Detection of human papillomavirus DNA in anal intraepithelial neoplasia and anal cancer. Cancer Res 51 (3): 1014-9, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/1846314" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1846314</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_1_7">Ryan DP, Compton CC, Mayer RJ: Carcinoma of the anal canal. N Engl J Med 342 (11): 792-800, 2000. [<a href="https://pubmed.ncbi.nlm.nih.gov/10717015" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10717015</span></a>]</div></li></ol></div></div><div id="CDR0000062898__5"><h2 id="_CDR0000062898__5_">Cellular Classification of Anal Cancer</h2><p id="CDR0000062898__6">Squamous cell (epidermoid) carcinomas make up the majority of all primary
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cancers of the anus. The important subset of cloacogenic (basaloid
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transitional cell) tumors constitutes the remainder. These two histologic
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variants are associated with human papillomavirus infection.[<a class="bk_pop" href="#CDR0000062898_rl_5_1">1</a>]
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Adenocarcinomas from anal glands or fistulae formation and melanomas are rare.
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Treatment of anal melanoma is not included in this summary.
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</p><div id="CDR0000062898_rl_5"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062898_rl_5_1">Palefsky JM, Holly EA, Gonzales J, et al.: Detection of human papillomavirus DNA in anal intraepithelial neoplasia and anal cancer. Cancer Res 51 (3): 1014-9, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/1846314" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1846314</span></a>]</div></li></ol></div></div><div id="CDR0000062898__7"><h2 id="_CDR0000062898__7_">Stage Information for Anal Cancer</h2><p id="CDR0000062898__8">The anal canal extends from the rectum to the perianal skin and is lined by a
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mucous membrane that covers the internal sphincter. The following is a staging
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system for anal canal cancer that has been described by the American Joint
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Committee on Cancer (AJCC) and the International Union Against Cancer.[<a class="bk_pop" href="#CDR0000062898_rl_7_1">1</a>]
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Tumors of the anal margin (below the anal verge and involving the perianal
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hair-bearing skin) are classified with skin tumors.
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</p><div id="CDR0000062898__138"><h3>Definitions of TNM</h3><p id="CDR0000062898__133">The following is a staging
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system for anal canal cancer that has been described by the AJCC and the International Union Against Cancer.[<a class="bk_pop" href="#CDR0000062898_rl_7_1">1</a>]</p><div id="CDR0000062898__132" class="table"><h3><span class="title">Table 1. Primary Tumor (T)<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65778.2/table/CDR0000062898__132/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062898__132_lrgtbl__"><table class="no_margin"><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">TX</td><td colspan="1" rowspan="1" style="vertical-align:top;">Primary tumor cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T0</td><td colspan="1" rowspan="1" style="vertical-align:top;">No evidence of primary tumor.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Tis</td><td colspan="1" rowspan="1" style="vertical-align:top;">Carcinoma <i>in situ</i> (i.e., Bowen disease, high-grade squamous intraepithelial lesion, and anal intraepithelial neoplasia II–III.)</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T1</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor ≤2 cm in greatest dimension.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T2</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor >2 cm but ≤5 cm in greatest dimension.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor >5 cm in greatest dimension.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor of any size invades adjacent organ(s), e.g., vagina, urethra, and bladder.<sup>b</sup></td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Anus. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 165-73.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>b</sup>Direct invasion of the rectal wall, perirectal skin, subcutaneous tissue, or the sphincter muscle(s) is not classified as T4.</p></div></dd></dl></div></div></div><div id="CDR0000062898__127" class="table"><h3><span class="title">Table 2. Regional Lymph Nodes (N)<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65778.2/table/CDR0000062898__127/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062898__127_lrgtbl__"><table class="no_margin"><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">NX</td><td colspan="1" rowspan="1" style="vertical-align:top;">Regional lymph nodes cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastases in perirectal lymph node(s).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastases in unilateral internal iliac and/or inguinal lymph node(s).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N3</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastases in perirectal and inguinal lymph nodes and/or bilateral internal iliac and/or inguinal lymph nodes.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Anus. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 165-73. </p></div></dd></dl></div></div></div><div id="CDR0000062898__128" class="table"><h3><span class="title">Table 3. Distant Metastasis (M)<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65778.2/table/CDR0000062898__128/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062898__128_lrgtbl__"><table class="no_margin"><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M1</td><td colspan="1" rowspan="1" style="vertical-align:top;">Distant metastasis.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Anus. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 165-73.</p></div></dd></dl></div></div></div><div id="CDR0000062898__129" class="table"><h3><span class="title">Table 4. Anatomic Stage/Prognostic Groups<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65778.2/table/CDR0000062898__129/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062898__129_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">T</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">N</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">M</th></tr></thead><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">0</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tis</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">I</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="2" style="vertical-align:top;">II</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="4" style="vertical-align:top;">IIIA</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1</td><td colspan="1" rowspan="1" style="vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T2</td><td colspan="1" rowspan="1" style="vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3</td><td colspan="1" rowspan="1" style="vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="3" style="vertical-align:top;">IIIB</td><td colspan="1" rowspan="1" style="vertical-align:top;">T4</td><td colspan="1" rowspan="1" style="vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any T</td><td colspan="1" rowspan="1" style="vertical-align:top;">N2</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any T</td><td colspan="1" rowspan="1" style="vertical-align:top;">N3</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">IV</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any T</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any N</td><td colspan="1" rowspan="1" style="vertical-align:top;">M1</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Anus. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 165-73. </p></div></dd></dl></div></div></div></div><div id="CDR0000062898_rl_7"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062898_rl_7_1">Anus. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 167-169.</div></li></ol></div></div><div id="CDR0000062898__36"><h2 id="_CDR0000062898__36_">Treatment Option Overview</h2><p id="CDR0000062898__303">Abdominoperineal resection leading to permanent colostomy was previously
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thought to be required for all but small anal cancers occurring below the dentate line
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with approximately 70% of patients surviving 5 or more years in single
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institutions,[<a class="bk_pop" href="#CDR0000062898_rl_36_1">1</a>] but such surgery is no longer the treatment of choice.[<a class="bk_pop" href="#CDR0000062898_rl_36_2">2</a>,<a class="bk_pop" href="#CDR0000062898_rl_36_3">3</a>]</p><p id="CDR0000062898__37">
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Radiation therapy alone may lead to a 5-year survival rate in excess of 70%,
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but high doses (≥60 Gy) may yield necrosis or fibrosis.[<a class="bk_pop" href="#CDR0000062898_rl_36_4">4</a>]
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Chemotherapy with fluorouracil (5-FU) and cisplatin concurrent with lower-dose radiation therapy as utilized in the RTOG-8314 trial, for example, has a 5-year
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survival rate in excess of 70% with low levels of acute and chronic morbidity,
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and few patients require surgery for dermal or sphincter toxic effects.[<a class="bk_pop" href="#CDR0000062898_rl_36_5">5</a>-<a class="bk_pop" href="#CDR0000062898_rl_36_10">10</a>]
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The optimal dose of radiation with concurrent chemotherapy to optimize local
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control and minimize sphincter toxic effects has been studied in the RTOG-9208 trial, for example, and appears to
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be in the 45 Gy to 60 Gy range.[<a class="bk_pop" href="#CDR0000062898_rl_36_11">11</a>,<a class="bk_pop" href="#CDR0000062898_rl_36_12">12</a>] </p><p id="CDR0000062898__309"> The Anal Cancer Trial (ACT-1) from the United Kingdom Co-ordinating Committee on Cancer Research demonstrated the superiority of chemoradiation with 5-FU and mitomycin C (MMC) over radiation alone with regard to local failure and deaths from anal cancer.[<a class="bk_pop" href="#CDR0000062898_rl_36_13">13</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335126/" class="def">Level of evidence: 1iiB</a>] Long-term follow-up of this study has revealed 25.3 fewer patients with locoregional relapse and 12.5 fewer anal cancer deaths per 100 patients treated with chemoradiation compared with 100 patients treated with radiation alone. A 9.1% increase in nonanal cancer deaths was seen in the first 5 years following chemoradiation, which was not seen after 10 years.[<a class="bk_pop" href="#CDR0000062898_rl_36_14">14</a>] </p><p id="CDR0000062898__304">The choice of chemotherapy during concurrent chemoradiation has been the subject of several trials. Analysis of an intergroup trial that
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compared radiation therapy plus 5-FU and MMC with radiation therapy
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plus 5-FU alone in patients with anal cancer demonstrated lower colostomy rates as well as higher colostomy-free and disease-free survival (DFS)
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with the addition of MMC.[<a class="bk_pop" href="#CDR0000062898_rl_36_15">15</a>]
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</p><p id="CDR0000062898__310">A U.S. intergroup, randomized, phase III trial (<a href="http://cancer.gov/clinicaltrials/search/view?version=healthprofessional&cdrid=66667" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">RTOG 9811</a> [<a href="https://clinicaltrials.gov/show/NCT00003596" title="Study NCT00003596" ref="pagearea=body&targetsite=external&targetcat=link&targettype=clinical-trial">NCT00003596</a>]) examined whether MMC could be replaced by cisplatin in combination with 5-FU during concurrent chemoradiation.[<a class="bk_pop" href="#CDR0000062898_rl_36_16">16</a>] In the cisplatin arm of this study, two cycles of induction 5-FU and cisplatin were given before concurrent chemoradiation with 5-FU and cisplatin. The MMC arm had improved local control and colostomy-free survival, but no improvement was found in DFS or overall survival (OS).[<a class="bk_pop" href="#CDR0000062898_rl_36_16">16</a>] Long-term follow-up of the RTOG-9811 trial has been published and demonstrated superior 5-year DFS and OS.[<a class="bk_pop" href="#CDR0000062898_rl_36_17">17</a>] One potential explanation for the inferiority of the cisplatin arm is delay in time to radiation, given the induction strategy employed in this study. </p><p id="CDR0000062898__311">A strategy of maintenance chemotherapy with 5-FU and cisplatin after chemoradiation with 5-FU and MMC or 5-FU and cisplatin was evaluated in the <a href="http://cancer.gov/clinicaltrials/search/view?version=healthprofessional&cdrid=68911" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ACT-II</a> (<a href="https://clinicaltrials.gov/show/NCT00025090" title="Study NCT00025090" ref="pagearea=body&targetsite=external&targetcat=link&targettype=clinical-trial">NCT00025090</a>) trial, and 3-year progression-free survival was not improved (74% with maintenance chemotherapy vs. 73% without maintenance chemotherapy).[<a class="bk_pop" href="#CDR0000062898_rl_36_18">18</a>] Induction chemotherapy and dose intensification were examined in the <a href="http://cancer.gov/clinicaltrials/search/view?version=healthprofessional&cdrid=66744" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">UNICANCER ACCORD-03</a> (<a href="https://clinicaltrials.gov/show/NCT00003652" title="Study NCT00003652" ref="pagearea=body&targetsite=external&targetcat=link&targettype=clinical-trial">NCT00003652</a>) trial, which did not demonstrate an advantage in colostomy-free survival with induction chemotherapy with 5-FU and cisplatin or with radiation-dose intensification.[<a class="bk_pop" href="#CDR0000062898_rl_36_19">19</a>]</p><p id="CDR0000062898__305">Standard salvage
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therapy for those patients with either gross or microscopic residual disease
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following chemoradiation therapy has been abdominoperineal resection. Alternately,
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patients may be treated with additional salvage chemoradiation therapy in the form
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of 5-FU, cisplatin, and a radiation boost to potentially avoid
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permanent colostomy.[<a class="bk_pop" href="#CDR0000062898_rl_36_15">15</a>]</p><p id="CDR0000062898__38">Because of the small number of cases, information that can only come from
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patient participation in well-designed clinical trials is needed to improve the
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management of anal cancer. Patients with stages II, III, and IV disease should
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be considered candidates for clinical trials.
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Information about ongoing clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><div id="CDR0000062898__39"><h3>HIV and Anal Cancer</h3><p id="CDR0000062898__40">The tolerance of patients with human immunodeficiency virus and anal
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carcinoma to standard 5-FU and MMC chemoradiation is not well
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defined.[<a class="bk_pop" href="#CDR0000062898_rl_36_20">20</a>,<a class="bk_pop" href="#CDR0000062898_rl_36_21">21</a>] Patients with pretreatment CD4 counts of less than 200 cells/μl may
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have increased acute and late toxic effects;[<a class="bk_pop" href="#CDR0000062898_rl_36_22">22</a>,<a class="bk_pop" href="#CDR0000062898_rl_36_23">23</a>] chemoradiation doses may
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require modification in this subset of patients.
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</p></div><div id="CDR0000062898_rl_36"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062898_rl_36_1">Boman BM, Moertel CG, O'Connell MJ, et al.: Carcinoma of the anal canal. A clinical and pathologic study of 188 cases. Cancer 54 (1): 114-25, 1984. [<a href="https://pubmed.ncbi.nlm.nih.gov/6326995" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6326995</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_2">Stearns MW Jr, Quan SH: Epidermoid carcinoma of the anorectum. Surg Gynecol Obstet 131 (5): 953-7, 1970. [<a href="https://pubmed.ncbi.nlm.nih.gov/5471546" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 5471546</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_3">Cummings BJ: The Role of Radiation Therapy With 5-Fluorouracil in Anal Cancer. Semin Radiat Oncol 7 (4): 306-312, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/10717229" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10717229</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_4">Cantril ST, Green JP, Schall GL, et al.: Primary radiation therapy in the treatment of anal carcinoma. Int J Radiat Oncol Biol Phys 9 (9): 1271-8, 1983. [<a href="https://pubmed.ncbi.nlm.nih.gov/6885539" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6885539</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_5">Leichman L, Nigro N, Vaitkevicius VK, et al.: Cancer of the anal canal. Model for preoperative adjuvant combined modality therapy. Am J Med 78 (2): 211-5, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/3918441" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3918441</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_6">Sischy B: The use of radiation therapy combined with chemotherapy in the management of squamous cell carcinoma of the anus and marginally resectable adenocarcinoma of the rectum. Int J Radiat Oncol Biol Phys 11 (9): 1587-93, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/3928544" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3928544</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_7">Sischy B, Doggett RL, Krall JM, et al.: Definitive irradiation and chemotherapy for radiosensitization in management of anal carcinoma: interim report on Radiation Therapy Oncology Group study no. 8314. J Natl Cancer Inst 81 (11): 850-6, 1989. [<a href="https://pubmed.ncbi.nlm.nih.gov/2724350" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2724350</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_8">Cummings BJ: Anal cancer. Int J Radiat Oncol Biol Phys 19 (5): 1309-15, 1990. [<a href="https://pubmed.ncbi.nlm.nih.gov/2254130" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2254130</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_9">Zucali R, Doci R, Bombelli L: Combined chemotherapy--radiotherapy of anal cancer. Int J Radiat Oncol Biol Phys 19 (5): 1221-3, 1990. [<a href="https://pubmed.ncbi.nlm.nih.gov/2254116" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2254116</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_10">Fuchshuber PR, Rodriguez-Bigas M, Weber T, et al.: Anal canal and perianal epidermoid cancers. J Am Coll Surg 185 (5): 494-505, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9358099" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9358099</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_11">Fung CY, Willett CG, Efird JT, et al.: Chemoradiotherapy for anal carcinoma: what is the optimal radiation dose? Radiat Oncol Investig 2 (3): 152-6, 1994.</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_12">John M, Pajak T, Flam M, et al.: Dose Escalation in Chemoradiation for Anal Cancer: Preliminary Results of RTOG 92-08 Cancer J Sci Am 2 (4): 205-11, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/9166533" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9166533</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_13">Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet 348 (9034): 1049-54, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8874455" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8874455</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_14">Northover J, Glynne-Jones R, Sebag-Montefiore D, et al.: Chemoradiation for the treatment of epidermoid anal cancer: 13-year follow-up of the first randomised UKCCCR Anal Cancer Trial (ACT I). Br J Cancer 102 (7): 1123-8, 2010. [<a href="/pmc/articles/PMC2853094/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2853094</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20354531" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20354531</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_15">Flam M, John M, Pajak TF, et al.: Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol 14 (9): 2527-39, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8823332" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8823332</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_16">Ajani JA, Winter KA, Gunderson LL, et al.: Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA 299 (16): 1914-21, 2008. [<a href="https://pubmed.ncbi.nlm.nih.gov/18430910" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18430910</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_17">Gunderson LL, Winter KA, Ajani JA, et al.: Long-term update of US GI intergroup RTOG 98-11 phase III trial for anal carcinoma: survival, relapse, and colostomy failure with concurrent chemoradiation involving fluorouracil/mitomycin versus fluorouracil/cisplatin. J Clin Oncol 30 (35): 4344-51, 2012. [<a href="/pmc/articles/PMC3515768/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3515768</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23150707" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23150707</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_18">James RD, Glynne-Jones R, Meadows HM, et al.: Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2 × 2 factorial trial. Lancet Oncol 14 (6): 516-24, 2013. [<a href="https://pubmed.ncbi.nlm.nih.gov/23578724" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23578724</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_19">Peiffert D, Tournier-Rangeard L, Gérard JP, et al.: Induction chemotherapy and dose intensification of the radiation boost in locally advanced anal canal carcinoma: final analysis of the randomized UNICANCER ACCORD 03 trial. J Clin Oncol 30 (16): 1941-8, 2012. [<a href="https://pubmed.ncbi.nlm.nih.gov/22529257" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22529257</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_20">Holland JM, Swift PS: Tolerance of patients with human immunodeficiency virus and anal carcinoma to treatment with combined chemotherapy and radiation therapy. Radiology 193 (1): 251-4, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/8090901" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8090901</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_21">Peddada AV, Smith DE, Rao AR, et al.: Chemotherapy and low-dose radiotherapy in the treatment of HIV-infected patients with carcinoma of the anal canal. Int J Radiat Oncol Biol Phys 37 (5): 1101-5, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9169819" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9169819</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_22">Hoffman R, Welton ML, Klencke B, et al.: The significance of pretreatment CD4 count on the outcome and treatment tolerance of HIV-positive patients with anal cancer. Int J Radiat Oncol Biol Phys 44 (1): 127-31, 1999. [<a href="https://pubmed.ncbi.nlm.nih.gov/10219805" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10219805</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_36_23">Place RJ, Gregorcyk SG, Huber PJ, et al.: Outcome analysis of HIV-positive patients with anal squamous cell carcinoma. Dis Colon Rectum 44 (4): 506-12, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11330577" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11330577</span></a>]</div></li></ol></div></div><div id="CDR0000062898__42"><h2 id="_CDR0000062898__42_">Stage 0 Anal Cancer</h2><p id="CDR0000062898__87">Stage 0 anal cancer is carcinoma <i>in situ</i>. Rarely diagnosed, it is a very early
|
|
cancer that has not spread below the limiting membrane of the first layer of
|
|
anal tissue.</p><p id="CDR0000062898__43"><b>Standard treatment options:</b>
|
|
</p><p id="CDR0000062898__44">Surgical resection is used for treatment of lesions of the perianal area not
|
|
involving the anal sphincter (approach depends on the location of the lesion in
|
|
the anal canal).
|
|
</p><div id="CDR0000062898__TrialSearch_42_sid_5"><h3>Current Clinical Trials</h3><p id="CDR0000062898__TrialSearch_42_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with
|
|
<a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43540&tt=1&format=2" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage 0 anal cancer</a>. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.</p><p id="CDR0000062898__TrialSearch_42_18">General information about clinical trials is also available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div></div><div id="CDR0000062898__45"><h2 id="_CDR0000062898__45_">Stage I Anal Cancer</h2><p id="CDR0000062898__46">Stage I anal cancer was formerly treated with abdominoperineal resection.
|
|
Current sphincter-sparing therapies include wide local excision for small
|
|
tumors of the perianal skin or anal margin, or definitive chemoradiation
|
|
(fluorouracil and mitomycin C [MMC]) for cancers of the anal canal. Salvage
|
|
chemoradiation therapy (fluorouracil and cisplatin plus a radiation boost) may avoid
|
|
permanent colostomy in patients with residual tumor following initial
|
|
nonoperative therapy.[<a class="bk_pop" href="#CDR0000062898_rl_45_1">1</a>] Radical resection is reserved for patients with
|
|
incomplete responses or recurrent disease. Continued surveillance
|
|
with rectal examination every 3 months for the first 2 years and
|
|
endoscopy with biopsy when indicated after completion of sphincter-preserving
|
|
therapy is important.
|
|
</p><p id="CDR0000062898__47"><b>Standard treatment options:</b>
|
|
</p><ol id="CDR0000062898__82"><li class="half_rhythm"><div class="half_rhythm"> Small tumors of the perianal skin or anal margin not involving the anal
|
|
sphincter may be adequately treated with local resection.[<a class="bk_pop" href="#CDR0000062898_rl_45_2">2</a>]</div></li><li class="half_rhythm"><div class="half_rhythm">As evidenced in RTOG-9208 and RTOG-8314 trials, for example, all other stage I cancers of the anal canal that involve the anal sphincter
|
|
or are too large for complete local excision are treated with external-beam
|
|
radiation therapy (EBRT) with or without chemotherapy.[<a class="bk_pop" href="#CDR0000062898_rl_45_1">1</a>,<a class="bk_pop" href="#CDR0000062898_rl_45_3">3</a>-<a class="bk_pop" href="#CDR0000062898_rl_45_9">9</a>]</div><div class="half_rhythm">Chemotherapy with fluorouracil and MMC combined with primary radiation
|
|
therapy appears to be more effective than radiation therapy alone.[<a class="bk_pop" href="#CDR0000062898_rl_45_10">10</a>] The
|
|
optimal dose of radiation with concurrent chemotherapy has been evaluated, as seen in the RTOG-9208 trial, for example.[<a class="bk_pop" href="#CDR0000062898_rl_45_11">11</a>,<a class="bk_pop" href="#CDR0000062898_rl_45_12">12</a>]
|
|
</div><div class="half_rhythm">Selected tumors are also suitable for interstitial radiation therapy.[<a class="bk_pop" href="#CDR0000062898_rl_45_4">4</a>]
|
|
</div></li><li class="half_rhythm"><div class="half_rhythm">Radical resection is reserved for residual or recurrent cancer in the anal
|
|
canal after nonoperative therapy.
|
|
</div></li><li class="half_rhythm"><div class="half_rhythm">Alternately, salvage chemotherapy with fluorouracil and cisplatin combined
|
|
with a radiation boost may avoid a permanent colostomy in selected patients
|
|
with small amounts of residual tumor following initial nonoperative therapy.[<a class="bk_pop" href="#CDR0000062898_rl_45_1">1</a>]
|
|
</div></li><li class="half_rhythm"><div class="half_rhythm">Interstitial iridium-192 implantation after EBRT may convert some
|
|
patients with residual disease into complete responders.[<a class="bk_pop" href="#CDR0000062898_rl_45_13">13</a>]
|
|
</div></li></ol><div id="CDR0000062898__TrialSearch_45_sid_6"><h3>Current Clinical Trials</h3><p id="CDR0000062898__TrialSearch_45_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with
|
|
<a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=40600&tt=1&format=2" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage I anal cancer</a>. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.</p><p id="CDR0000062898__TrialSearch_45_18">General information about clinical trials is also available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000062898_rl_45"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062898_rl_45_1">Flam M, John M, Pajak TF, et al.: Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol 14 (9): 2527-39, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8823332" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8823332</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_45_2">Enker WE, Heilwell M, Janov AJ, et al.: Improved survival in epidermoid carcinoma of the anus in association with preoperative multidisciplinary therapy. Arch Surg 121 (12): 1386-90, 1986. [<a href="https://pubmed.ncbi.nlm.nih.gov/3789909" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3789909</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_45_3">Papillon J, Mayer M, Montbarbon JF, et al.: A new approach to the management of epidermoid carcinoma of the anal canal. Cancer 51 (10): 1830-7, 1983. [<a href="https://pubmed.ncbi.nlm.nih.gov/6831349" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6831349</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_45_4">Cummings B, Keane T, Thomas G, et al.: Results and toxicity of the treatment of anal canal carcinoma by radiation therapy or radiation therapy and chemotherapy. Cancer 54 (10): 2062-8, 1984. [<a href="https://pubmed.ncbi.nlm.nih.gov/6435851" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6435851</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_45_5">Leichman L, Nigro N, Vaitkevicius VK, et al.: Cancer of the anal canal. Model for preoperative adjuvant combined modality therapy. Am J Med 78 (2): 211-5, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/3918441" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3918441</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_45_6">James RD, Pointon RS, Martin S: Local radiotherapy in the management of squamous carcinoma of the anus. Br J Surg 72 (4): 282-5, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/3986477" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3986477</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_45_7">Sischy B: The use of radiation therapy combined with chemotherapy in the management of squamous cell carcinoma of the anus and marginally resectable adenocarcinoma of the rectum. Int J Radiat Oncol Biol Phys 11 (9): 1587-93, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/3928544" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3928544</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_45_8">Sischy B, Doggett RL, Krall JM, et al.: Definitive irradiation and chemotherapy for radiosensitization in management of anal carcinoma: interim report on Radiation Therapy Oncology Group study no. 8314. J Natl Cancer Inst 81 (11): 850-6, 1989. [<a href="https://pubmed.ncbi.nlm.nih.gov/2724350" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2724350</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_45_9">Mitchell SE, Mendenhall WM, Zlotecki RA, et al.: Squamous cell carcinoma of the anal canal. Int J Radiat Oncol Biol Phys 49 (4): 1007-13, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11240241" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11240241</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_45_10">Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet 348 (9034): 1049-54, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8874455" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8874455</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_45_11">Fung CY, Willett CG, Efird JT, et al.: Chemoradiotherapy for anal carcinoma: what is the optimal radiation dose? Radiat Oncol Investig 2 (3): 152-6, 1994.</div></li><li><div class="bk_ref" id="CDR0000062898_rl_45_12">John M, Pajak T, Flam M, et al.: Dose Escalation in Chemoradiation for Anal Cancer: Preliminary Results of RTOG 92-08 Cancer J Sci Am 2 (4): 205-11, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/9166533" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9166533</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_45_13">Sandhu AP, Symonds RP, Robertson AG, et al.: Interstitial iridium-192 implantation combined with external radiotherapy in anal cancer: ten years experience. Int J Radiat Oncol Biol Phys 40 (3): 575-81, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9486607" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9486607</span></a>]</div></li></ol></div></div><div id="CDR0000062898__55"><h2 id="_CDR0000062898__55_">Stage II Anal Cancer</h2><p id="CDR0000062898__56">Stage II anal cancer was formerly treated with abdominoperineal resection.
|
|
Current sphincter-sparing therapies include wide local excision for small
|
|
tumors of the perianal skin or anal margin, or definitive chemoradiation
|
|
(fluorouracil and mitomycin C [MMC]) for cancers of the anal canal. Salvage
|
|
chemotherapy (fluorouracil with cisplatin plus a radiation boost) may avoid
|
|
permanent colostomy in patients with residual tumor following initial
|
|
nonoperative therapy. Radical resection is reserved for patients with
|
|
incomplete responses or recurrent disease. Therefore, continued surveillance
|
|
with rectal examination every 3 months for the first 2 years and an
|
|
endoscopy with biopsy when indicated after completion of sphincter-preserving
|
|
therapy is important.
|
|
</p><p id="CDR0000062898__57"><b>Standard treatment options:</b>
|
|
</p><ol id="CDR0000062898__83"><li class="half_rhythm"><div class="half_rhythm">Small tumors of the perianal skin or anal margin not involving the anal
|
|
sphincter may be adequately treated with local resection.[<a class="bk_pop" href="#CDR0000062898_rl_55_1">1</a>]</div></li><li class="half_rhythm"><div class="half_rhythm"> All other stage II cancers of the anal canal that involve the anal sphincter
|
|
or are too large for complete local excision are treated with external-beam
|
|
radiation therapy plus chemotherapy as was shown in the RTOG-8314 trial, for example.[<a class="bk_pop" href="#CDR0000062898_rl_55_2">2</a>-<a class="bk_pop" href="#CDR0000062898_rl_55_8">8</a>]
|
|
</div><div class="half_rhythm">Chemotherapy with fluorouracil and MMC combined with primary radiation
|
|
therapy appears to be more effective than radiation therapy alone.[<a class="bk_pop" href="#CDR0000062898_rl_55_9">9</a>] The
|
|
optimal dose of radiation with concurrent chemotherapy was studied, as seen in the <a href="http://cancer.gov/clinicaltrials/search/view?version=healthprofessional&cdrid=66667" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">RTOG-9811</a> and RTOG-9208 trials, for example.[<a class="bk_pop" href="#CDR0000062898_rl_55_10">10</a>,<a class="bk_pop" href="#CDR0000062898_rl_55_11">11</a>]
|
|
</div><div class="half_rhythm">Selected tumors are also suitable for interstitial radiation therapy.[<a class="bk_pop" href="#CDR0000062898_rl_55_3">3</a>,<a class="bk_pop" href="#CDR0000062898_rl_55_12">12</a>]
|
|
</div></li><li class="half_rhythm"><div class="half_rhythm"> Radical resection is reserved for continued residual or recurrent cancer
|
|
in the anal canal after nonoperative therapy.
|
|
</div></li><li class="half_rhythm"><div class="half_rhythm">Alternately, salvage chemotherapy with fluorouracil and cisplatin combined
|
|
with a radiation boost may avoid a permanent colostomy in selected patients
|
|
with small amounts of residual tumor following initial nonoperative therapy.[<a class="bk_pop" href="#CDR0000062898_rl_55_8">8</a>]
|
|
</div></li></ol><div id="CDR0000062898__TrialSearch_55_sid_7"><h3>Current Clinical Trials</h3><p id="CDR0000062898__TrialSearch_55_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with
|
|
<a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=40684&tt=1&format=2" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage II anal cancer</a>. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.</p><p id="CDR0000062898__TrialSearch_55_18">General information about clinical trials is also available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000062898_rl_55"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062898_rl_55_1">Enker WE, Heilwell M, Janov AJ, et al.: Improved survival in epidermoid carcinoma of the anus in association with preoperative multidisciplinary therapy. Arch Surg 121 (12): 1386-90, 1986. [<a href="https://pubmed.ncbi.nlm.nih.gov/3789909" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3789909</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_55_2">Papillon J, Mayer M, Montbarbon JF, et al.: A new approach to the management of epidermoid carcinoma of the anal canal. Cancer 51 (10): 1830-7, 1983. [<a href="https://pubmed.ncbi.nlm.nih.gov/6831349" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6831349</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_55_3">Cummings B, Keane T, Thomas G, et al.: Results and toxicity of the treatment of anal canal carcinoma by radiation therapy or radiation therapy and chemotherapy. Cancer 54 (10): 2062-8, 1984. [<a href="https://pubmed.ncbi.nlm.nih.gov/6435851" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6435851</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_55_4">Leichman L, Nigro N, Vaitkevicius VK, et al.: Cancer of the anal canal. Model for preoperative adjuvant combined modality therapy. Am J Med 78 (2): 211-5, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/3918441" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3918441</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_55_5">James RD, Pointon RS, Martin S: Local radiotherapy in the management of squamous carcinoma of the anus. Br J Surg 72 (4): 282-5, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/3986477" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3986477</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_55_6">Sischy B: The use of radiation therapy combined with chemotherapy in the management of squamous cell carcinoma of the anus and marginally resectable adenocarcinoma of the rectum. Int J Radiat Oncol Biol Phys 11 (9): 1587-93, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/3928544" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3928544</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_55_7">Sischy B, Doggett RL, Krall JM, et al.: Definitive irradiation and chemotherapy for radiosensitization in management of anal carcinoma: interim report on Radiation Therapy Oncology Group study no. 8314. J Natl Cancer Inst 81 (11): 850-6, 1989. [<a href="https://pubmed.ncbi.nlm.nih.gov/2724350" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2724350</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_55_8">Flam M, John M, Pajak TF, et al.: Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol 14 (9): 2527-39, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8823332" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8823332</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_55_9">Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet 348 (9034): 1049-54, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8874455" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8874455</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_55_10">Fung CY, Willett CG, Efird JT, et al.: Chemoradiotherapy for anal carcinoma: what is the optimal radiation dose? Radiat Oncol Investig 2 (3): 152-6, 1994.</div></li><li><div class="bk_ref" id="CDR0000062898_rl_55_11">John M, Pajak T, Flam M, et al.: Dose Escalation in Chemoradiation for Anal Cancer: Preliminary Results of RTOG 92-08 Cancer J Sci Am 2 (4): 205-11, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/9166533" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9166533</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_55_12">Sandhu AP, Symonds RP, Robertson AG, et al.: Interstitial iridium-192 implantation combined with external radiotherapy in anal cancer: ten years experience. Int J Radiat Oncol Biol Phys 40 (3): 575-81, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9486607" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9486607</span></a>]</div></li></ol></div></div><div id="CDR0000062898__64"><h2 id="_CDR0000062898__64_">Stage IIIA Anal Cancer</h2><p id="CDR0000062898__65">Stage IIIA anal cancer presents clinically as stage II in most instances and is
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determined to be IIIA by clinically evident perirectal nodal disease or
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adjacent organ involvement. Endorectal or endoanal ultrasound may aid in
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pretreatment staging.
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</p><p id="CDR0000062898__66"><b>Standard treatment options:</b>
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</p><ol id="CDR0000062898__84"><li class="half_rhythm"><div>As shown in the RTOG-8314 trial, treatment used is the same as for stage I and II disease, including the use of radiation therapy plus
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chemotherapy.[<a class="bk_pop" href="#CDR0000062898_rl_64_1">1</a>,<a class="bk_pop" href="#CDR0000062898_rl_64_2">2</a>]
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</div></li><li class="half_rhythm"><div>Radical resection is reserved for continued residual or recurrent cancer in the anal canal after nonoperative therapy.
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</div></li></ol><div id="CDR0000062898__TrialSearch_64_sid_8"><h3>Current Clinical Trials</h3><p id="CDR0000062898__TrialSearch_64_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with
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|
<a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43700&tt=1&format=2" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage IIIA anal cancer</a>. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.</p><p id="CDR0000062898__TrialSearch_64_18">General information about clinical trials is also available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000062898_rl_64"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062898_rl_64_1">Sischy B, Doggett RL, Krall JM, et al.: Definitive irradiation and chemotherapy for radiosensitization in management of anal carcinoma: interim report on Radiation Therapy Oncology Group study no. 8314. J Natl Cancer Inst 81 (11): 850-6, 1989. [<a href="https://pubmed.ncbi.nlm.nih.gov/2724350" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2724350</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062898_rl_64_2">Flam M, John M, Pajak TF, et al.: Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol 14 (9): 2527-39, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8823332" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8823332</span></a>]</div></li></ol></div></div><div id="CDR0000062898__69"><h2 id="_CDR0000062898__69_">Stage IIIB Anal Cancer</h2><p id="CDR0000062898__70">The presence of inguinal nodes that are involved with metastatic disease
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(unilateral or bilateral) is a poor prognostic sign, though cure of this
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stage of disease is possible. Because of the poor prognosis associated with
|
|
this stage, patients should be included in clinical trials whenever possible.
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|
</p><p id="CDR0000062898__71"><b>Standard treatment options:</b>
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|
</p><ul id="CDR0000062898__86"><li class="half_rhythm"><div>Radiation therapy plus chemotherapy (as described for stage II) with surgical
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resection of residual disease at the primary site (local resection or
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abdominoperineal resection) and unilateral or bilateral superficial and deep
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|
inguinal node dissection for residual or recurrent tumor.
|
|
</div></li></ul><div id="CDR0000062898__TrialSearch_69_sid_9"><h3>Current Clinical Trials</h3><p id="CDR0000062898__TrialSearch_69_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with
|
|
<a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43710&tt=1&format=2" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage IIIB anal cancer</a>. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.</p><p id="CDR0000062898__TrialSearch_69_18">General information about clinical trials is also available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div></div><div id="CDR0000062898__73"><h2 id="_CDR0000062898__73_">Stage IV Anal Cancer</h2><p id="CDR0000062898__74">There is no standard chemotherapy for patients with metastatic disease.
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|
Palliation of symptoms from the primary lesion is of major importance. Patients in this stage should be considered candidates for clinical trials.
|
|
</p><p id="CDR0000062898__75"><b>Standard treatment options:</b>
|
|
</p><ol id="CDR0000062898__85"><li class="half_rhythm"><div>Palliative surgery.
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|
</div></li><li class="half_rhythm"><div>Palliative radiation therapy.
|
|
</div></li><li class="half_rhythm"><div> Palliative combined chemotherapy and radiation therapy.
|
|
</div></li><li class="half_rhythm"><div>Clinical trials.</div></li></ol><div id="CDR0000062898__TrialSearch_73_sid_10"><h3>Current Clinical Trials</h3><p id="CDR0000062898__TrialSearch_73_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with
|
|
<a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43438&tt=1&format=2" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage IV anal cancer</a>. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.</p><p id="CDR0000062898__TrialSearch_73_18">General information about clinical trials is also available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div></div><div id="CDR0000062898__80"><h2 id="_CDR0000062898__80_">Recurrent Anal Cancer</h2><p id="CDR0000062898__81">Local recurrences and persistent disease after treatment with radiation therapy and chemotherapy or
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|
surgery as the primary treatment may be controlled by using the alternate
|
|
treatment (surgical resection after radiation and vice versa).[<a class="bk_pop" href="#CDR0000062898_rl_80_1">1</a>] Clinical
|
|
trials are exploring the use of radiation therapy with chemotherapy and
|
|
radiosensitizers to improve local control.
|
|
</p><div id="CDR0000062898__TrialSearch_80_sid_11"><h3>Current Clinical Trials</h3><p id="CDR0000062898__TrialSearch_80_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with
|
|
<a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43482&tt=1&format=2" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">recurrent anal cancer</a>. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.</p><p id="CDR0000062898__TrialSearch_80_18">General information about clinical trials is also available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000062898_rl_80"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062898_rl_80_1">Longo WE, Vernava AM 3rd, Wade TP, et al.: Recurrent squamous cell carcinoma of the anal canal. Predictors of initial treatment failure and results of salvage therapy. Ann Surg 220 (1): 40-9, 1994. [<a href="/pmc/articles/PMC1234285/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1234285</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/8024357" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8024357</span></a>]</div></li></ol></div></div><div id="CDR0000062898__89"><h2 id="_CDR0000062898__89_">Changes to This Summary (02/04/2016)
|
|
</h2><p id="CDR0000062898__90">The PDQ cancer information summaries are reviewed regularly and updated as
|
|
new information becomes available. This section describes the latest
|
|
changes made to this summary as of the date above.
|
|
</p><p id="CDR0000062898__325"><b><a href="#CDR0000062898__1">General Information About Anal Cancer </a></b></p><p id="CDR0000062898__326">Updated <a href="#CDR0000062898__101">statistics</a> with estimated new cases and deaths for 2016 (cited American Cancer Society as reference 1).</p><p id="CDR0000062898__disclaimerHP_3">This summary is written and maintained by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>, which is
|
|
editorially independent of NCI. The summary reflects an independent review of
|
|
the literature and does not represent a policy statement of NCI or NIH. More
|
|
information about summary policies and the role of the PDQ Editorial Boards in
|
|
maintaining the PDQ summaries can be found on the <a href="#CDR0000062898__AboutThis_1">About This PDQ Summary</a> and <a href="http://www.cancer.gov/publications/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ® - NCI's Comprehensive Cancer Database</a> pages.
|
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</p></div><div id="CDR0000062898__AboutThis_1"><h2 id="_CDR0000062898__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062898__AboutThis_2"><h3>Purpose of This Summary</h3><p id="CDR0000062898__AboutThis_3">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of anal cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.</p></div><div id="CDR0000062898__AboutThis_4"><h3>Reviewers and Updates</h3><p id="CDR0000062898__AboutThis_5">This summary is reviewed regularly and updated as necessary by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p><p id="CDR0000062898__AboutThis_22"> Board members review recently published articles each month to determine whether an article should:</p><ul id="CDR0000062898__AboutThis_6"><li class="half_rhythm"><div>be discussed at a meeting,</div></li><li class="half_rhythm"><div>be cited with text, or</div></li><li class="half_rhythm"><div>replace or update an existing article that is already cited.</div></li></ul><p id="CDR0000062898__AboutThis_7">Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.</p><p>The lead reviewer for Anal Cancer Treatment is:</p><ul><li class="half_rhythm"><div>Jennifer Wo, MD (Massachusetts General Hospital)</div></li></ul><p id="CDR0000062898__AboutThis_9">Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's <a href="http://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.</p></div><div id="CDR0000062898__AboutThis_10"><h3>Levels of Evidence</h3><p id="CDR0000062898__AboutThis_11">Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a <a href="/books/n/pdqcis/CDR0000062796/">formal evidence ranking system</a> in developing its level-of-evidence designations.</p></div><div id="CDR0000062898__AboutThis_12"><h3>Permission to Use This Summary</h3><p id="CDR0000062898__AboutThis_13">PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”</p><p id="CDR0000062898__AboutThis_14">The preferred citation for this PDQ summary is:</p><p id="CDR0000062898__AboutThis_15">PDQ® Adult Treatment Editorial Board. PDQ Anal Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="http://www.cancer.gov/types/anal/hp/anal-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www.cancer.gov/types/anal/hp/anal-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389221]</p><p id="CDR0000062898__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in <a href="http://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>, a collection of over 2,000 scientific images.
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</p></div><div id="CDR0000062898__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062898__AboutThis_18">Based on the strength of the available evidence, treatment options may be described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the <a href="http://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062898__AboutThis_20"><h3>Contact Us</h3><p id="CDR0000062898__AboutThis_21">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="http://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="http://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>.</p></div></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK65778</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26389221" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26389221</a></span></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65778.2/?report=reader">PubReader</a></li><li><a href="/books/NBK65778.2/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65778" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65778" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Adult Treatment Editorial Board. Anal Cancer Treatment (PDQ®): Health Professional Version. 2016 Feb 4. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK65778.15/">NBK65778.15</a></span> January 19, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65778.14/">NBK65778.14</a></span> January 13, 2023</li><li><span class="bk_col_itm"><a href="/books/NBK65778.13/">NBK65778.13</a></span> November 4, 2022</li><li><span class="bk_col_itm"><a href="/books/NBK65778.12/">NBK65778.12</a></span> January 20, 2022</li><li><span class="bk_col_itm"><a href="/books/NBK65778.11/">NBK65778.11</a></span> June 3, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65778.10/">NBK65778.10</a></span> January 15, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65778.9/">NBK65778.9</a></span> January 22, 2020</li><li><span class="bk_col_itm"><a href="/books/NBK65778.8/">NBK65778.8</a></span> August 16, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65778.7/">NBK65778.7</a></span> January 29, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65778.6/">NBK65778.6</a></span> October 24, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65778.5/">NBK65778.5</a></span> February 1, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65778.4/">NBK65778.4</a></span> January 24, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65778.3/">NBK65778.3</a></span> January 31, 2017</li><li><span class="bk_col_itm">NBK65778.2</span> February 4, 2016 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK65778.1/">NBK65778.1</a></span> July 7, 2015</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000062898__1" ref="log$=inpage&link_id=inpage">General Information About Anal Cancer </a></li><li><a href="#CDR0000062898__5" ref="log$=inpage&link_id=inpage">Cellular Classification of Anal Cancer</a></li><li><a href="#CDR0000062898__7" ref="log$=inpage&link_id=inpage">Stage Information for Anal Cancer</a></li><li><a href="#CDR0000062898__36" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000062898__42" ref="log$=inpage&link_id=inpage">Stage 0 Anal Cancer</a></li><li><a href="#CDR0000062898__45" ref="log$=inpage&link_id=inpage">Stage I Anal Cancer</a></li><li><a href="#CDR0000062898__55" ref="log$=inpage&link_id=inpage">Stage II Anal Cancer</a></li><li><a href="#CDR0000062898__64" ref="log$=inpage&link_id=inpage">Stage IIIA Anal Cancer</a></li><li><a href="#CDR0000062898__69" ref="log$=inpage&link_id=inpage">Stage IIIB Anal Cancer</a></li><li><a href="#CDR0000062898__73" ref="log$=inpage&link_id=inpage">Stage IV Anal Cancer</a></li><li><a href="#CDR0000062898__80" ref="log$=inpage&link_id=inpage">Recurrent Anal Cancer</a></li><li><a href="#CDR0000062898__89" ref="log$=inpage&link_id=inpage">Changes to This Summary (02/04/2016)
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xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Anal Cancer Prevention (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Anal Cancer Prevention (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Screening and Prevention Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389244" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Lymphedema (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Lymphedema (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Supportive and Palliative Care Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389442" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Retinoblastoma Treatment (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Retinoblastoma Treatment (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389190" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Neuroblastoma Treatment (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Neuroblastoma Treatment (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389493" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Cervical Cancer Treatment (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Cervical Cancer Treatment (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=26389221" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=26389221" ref="ordinalpos=1&log$=relatedarticles_seeall&logdbfrom=pubmed">See all...</a></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Recent Activity</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="recent_activity" id="Shutter"></a></div><div class="portlet_content"><div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="HTDisplay" class=""><div class="action"><a 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