Most anal cancer can be successfully treated without surgery using with a combination of chemotherapy and IMRT (intensity-modulated radiation therapy) through a TomoTherapy® unit. Surgery may be necessary only if the cancer recurs or the chemotherapy/radiation combination fails to control the tumor. In all cases, close coordination with the medical oncologist, the radiation oncologist and a colorectal surgeon is important to achieving a positive outcome.
IMRT Techniques to Treat Anal & Rectal Cancer
Medical College of Wisconsin physicians in the Colorectal Cancer program participated in a clinical trial that helped standardize IMRT techniques used to treat anal and rectal cancers. IMRT is an advanced method that can deliver higher doses of radiation more precisely to the tumor while avoiding surrounding tissue. Targeting the radiation precisely to the tumor helps to prevent toxicity and maximize eradication of the tumor. Reducing toxicity with IMRT treatment can mean fewer side effects from the radiation treatments and a better quality of life.
As with cervical cancer, there is a strong association with HPV — the human papillomavirus — and some anal cancers. This link is more important in people who are immune compromised due to HIV infection, immune-suppressing drugs or inflammatory bowel disease (IBD), for example.
Anal pap smears are conducted with at-risk groups and Froedtert & the Medical College of Wisconsin is the only center in the state for evaluating abnormal anal pap smears with high-resolution endoscopy. And, high-resolution endoscopy is also used for people who have had an anal cancer diagnosis in the past, even if they’re not immune-compromised.
As with rectal cancer, an accurate diagnosis from the start is essential to choosing the best treatment options for anal cancer. The type of cancer, size and exact location of the tumor all affect what treatment path would be most effective.
Following surgical resection of the primary colorectal cancer, many patients are at high risk for recurrence due to the presence of microscopic metastatic disease that is not detectable by even the most sensitive diagnostic imaging. Post-operative chemotherapy has been shown to reduce the risk for recurrence. It has been standard treatment for about 20 years.
Medical College of Wisconsin physicians have actively participated in clinical trials demonstrating benefit and leading to improvements in adjuvant chemotherapy through membership in national cooperative groups. They continue to explore new strategies in an attempt to further improve on adjuvant approaches to colorectal cancer.
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