My anal cancer treatment journey
Anal Cancer Treatment
We make every effort to preserve the sphincter without affecting control of bowel movements, and we use all means possible to decrease the risk of a colostomy. However, if a colostomy is needed, highly qualified nurses help you make the transition and maintain your quality of life.
If you have anal cancer that has spread and/or have HIV or AIDS, we offer the most advanced treatments, as well as clinical trials of new agents.
Our Anal Cancer Treatments
Anal cancer often can be treated successfully with chemotherapy combined with radiation therapy. If the cancer has spread (metastasized), a combination of therapies including surgery as well as participation in a clinical trial may be suggested.
The team of specialists focusing on your care will discuss with you the best options to treat it. This depends on several factors, including:
- The stage of anal cancer
- Location of the tumor in the anus
- If you have human immunodeficiency virus (HIV) or other immunosuppressed condition
- If the cancer has just been diagnosed or if it has returned after being treated
- Your age and general health
Your treatment for anal cancer will be customized to your particular needs. Treatments for anal cancer, which may be used to fight the cancer or help relieve symptoms, may include:
Surgery
Anal cancer surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure. MD Anderson surgeons perform a large number of surgeries for anal cancer each year, using the most advanced techniques.
If surgery is needed to treat anal cancer, your surgeon may use one of the following procedures:
Local resection: The tumor, along with some of the tissue around it, is surgically removed.
Abdominoperineal resection (APR): The anus, the rectum and part of the colon are removed through an incision in the abdomen. The end of the intestine is attached to an opening (stoma) in the abdomen. Body waste leaves this opening and is collected in a plastic bag outside the body. This also is called a colostomy.
Chemotherapy
MD Anderson offers the most up-to-date and effective chemotherapy options to treat anal cancer.
Radiation Therapy
New radiation therapy techniques allow MD Anderson doctors to target anal cancer tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.
Some anal cancers can be treated with intensity modulated radiation therapy (IMRT). This technique precisely targets the cancer and causes less damage to healthy tissue.
Targeted Therapies
MD Anderson is leading into the future of cancer treatment by developing innovative targeted therapies. These agents are specially designed to treat each cancer¡¯s specific genetic/molecular profile to help your body fight the disease. Many of the doctors who treat cancer at MD Anderson are dedicated researchers who have pioneered and actively lead national and international clinical trials with novel targeted agents.
Learn more about anal cancer:
Rectal cancer surgery: Your treatment options and what to expect
Rectal cancer can impact many of the body¡¯s most basic functions. So, it¡¯s important to find a surgeon who understands the balance between treating your cancer and preserving the body's functions and quality of life.
To learn about the different types of rectal surgery and what to expect, we spoke with a colon and rectal cancer surgeon.
What types of surgery are used to treat rectal cancer?
There are three types of surgery used to treat rectal cancer.
- Transanal local excision: This procedure treats very early-stage rectal cancers. During this procedure, a surgeon removes a small area of the rectum wall that contains the early tumor through instruments that are passed through the anus.?
- Proctectomy: During this surgery, a surgeon removes all or part of the rectum that contains the tumor. Usually, the colon can be brought down and connected to the remaining rectum or directly to the anus in sphincter-preserving surgery. This allows the patient to retain bowel passage through the anus, although the stool frequency and patterns will likely be different. Often to protect the new connection, the surgeon will make a temporary diverting ileostomy bag, a plastic bag that collects waste from the digestive tract and needs to be emptied throughout the day. This is done to divert the stool away from the colon and give the new connection the best chance to heal. If the sphincter can¡¯t be preserved, the surgeon will create a permanent colostomy and insert a colostomy bag, a plastic bag that collects waste from the digestive tract and needs to be emptied throughout the day.
- Pelvic exenteration: This type of surgery is needed if rectal cancer has spread to the surrounding organs within the pelvis. During this highly specialized operation, surgeons will remove the rectum containing the tumor and any part of any adjacent organs that may be also directly involved by the tumor ¡ª including other bowel or intestine, reproductive organs, bladder, bone or other tissue ¡ª and then perform the reconstruction. Patients who have had a pelvic exenteration often need a colostomy bag.
What is recovery from rectal cancer surgery like? What can patients expect?
Your recovery depends on what type of surgery you undergo. Patients who have a proctectomy typically stay in the hospital for two to five days, or they may have to stay until they have a bowel movement. Patients are usually up and walking around about 24 hours after surgery. Typically, bowel function will return about two to three days following surgery. Pain is the strongest for the first 48 hours and then begins to subside. MD Anderson surgery teams rely on an enhanced recovery process that helps patients recover faster and limit their use of pain medication.
For patients who have undergone a pelvic exenteration, the recovery process is slower. Typically, these patients stay in the hospital for two to three weeks and spend the following months getting their strength back by working with a physical therapist.
Patients who have had a temporary ileostomy or permanent colostomy as a part of their proctectomy or pelvic exenteration may need to stay in the hospital longer as they adjust to using the ostomy bag.
What is life like after rectal cancer surgery? Do patients with an ileostomy or colostomy bag need to make dietary changes?
An ostomy bag may be temporary. Patients may only need it for two to six months, or it may be permanent. Your care team will work with you to show you how to empty the bag and make any other changes. Having an ostomy will require some adjustment and adaptation. However, most importantly, contrary to common belief, patients with ostomy bags can resume an active lifestyle and get back to activities they enjoyed before surgery.
Read how one young patient has learned to live with her ostomy bag.
What other methods are used to treat rectal cancer?
Many rectal cancer patients will need additional treatments, typically a combination of chemotherapy and radiation and typically before surgery. For rectal cancer, it¡¯s important to see a specialized care team with experience treating rectal cancer and who understand all aspects of your rectal cancer treatment. When you¡¯re choosing a care team, look for one that will coordinate your care and enable you to receive the best treatment possible.
Overall, the cancer stage determines the type of treatments a rectal cancer patient received. But an experienced team also takes into account the patient¡¯s tumor molecular characteristics and personal wishes to design a personalized treatment regimen. In addition, MD Anderson is conducting clinical trials to use liquid biopsies to more accurately determine what next steps to take. The biopsies show how cancer has impacted the bloodstream and helps guide the use of chemotherapy after surgery.
1 in 4 new cases of rectal cancer in the U.S. is diagnosed at or under age 50. What should young rectal cancer patients know?
Young rectal cancer patients face a unique set of challenges. They have so many years left ahead of them, but they¡¯re facing big changes as survivors. For these patients, it¡¯s particularly important to select a cancer center like MD Anderson where the doctors are not only experts in treating rectal cancer, but also understand what¡¯s critical to a young patient. At MD Anderson, one-third of all of our new colorectal cancer patients are younger than age 50. ?Programs like MD Anderson¡¯s Young-Onset Colorectal Cancer Program provide cancer care and connect patients to services they may need in addition to treatment, including genetic testing and counseling, fertility services, wound ostomy service, supportive care and connection to our Adolescent and Young Adult Oncology Program.
What should patients preparing for rectal cancer surgery know?
Look for a care team where the surgeons both perform a high number of rectal cancer surgeries and are also experts in treating rectal cancer and in understanding the best coordination of surgery with other treatments, such as chemotherapy and radiation.
Rectal cancer impacts an area that is key to many bodily functions, so it¡¯s essential to seek a care team that truly understands it and with whom you feel comfortable discussing your worries and concerns. ?
Often, we see patients who first underwent surgery at another hospital. In many cases, the patient¡¯s cancer has returned and they now need a pelvic exenteration. While MD Anderson surgeons are skilled at performing this complicated surgery, it would be easier on the patient if they sought care from leading experts first. It might be difficult to decide to have more of the rectum removed initially, but it¡¯s better in the long run. At MD Anderson, our doctors understand how to balance this.
or by calling 1-877-632-6789.
What is a total pelvic exenteration?
¡°Exenteration¡± refers to a complex surgery in which organs, bones and other structures are removed from the pelvis in order to treat cancer. A pelvic exenteration might involve the bladder, rectum, anus and/or sacrum (tailbone), as well as the prostate gland in men and the vagina and/or uterus in women.??
While this procedure may sound fairly extreme, it is often the best ¡ª and only potentially curative ¡ª option for some types of cancer. It also provides the best possible chance of long-term cancer control.?
But which cancers does a pelvic exenteration typically treat? What makes you a good candidate for one? How will it affect your sex life and bathroom habits? And, what else should you know about this life-changing operation? Read on for answers.?
Which cancers is a total pelvic exenteration used most frequently to treat?
A total pelvic exenteration (TPE) is most commonly used for locally advanced rectal cancer?or another type of cancer that involves the rectum. This is because of the way cancer grows and spreads in the rectum. But TPE is also used to treat:?
In fact, pelvic exenteration was originally designed to treat recurrent cervical cancer. It originated as an operation for this gynecologic cancer because the cervix is located in the center of the pelvis. In the days before HPV vaccinations prevented most cervical cancers and radiation therapy was used to treat it, cervical cancer often grew into the structures around it. This procedure was seen as a way of clearing it out.?
Are there different types of exenterations?
An exenteration used to treat rectal cancer usually involves the removal of the rectum, plus something else. That could be the bladder, the bone behind the rectum (the sacrum), or any of the other structures surrounding it that are not normally removed during rectal surgery. Generally speaking, though, there are three types of exenterations:
Anterior exenteration
In a male, this entails removing the bladder and the prostate, but leaving the rectum intact. In a female, this involves removing the bladder, uterus and possibly the vagina, but leaving the rectum intact.??
Posterior exenteration
This involves the removal of the rectum and sacrum, as well as the uterus (if present) and possibly part of the vagina in a female.?
Total pelvic exenteration
In a male, this involves removal of the rectum, bladder and prostate. In a female, this normally entails the removal of the rectum, bladder and uterus (if present) and can also include the vagina.?
Which patients make the best candidates for an exenteration?
Ideally, we want you to be at your very fittest before an exenteration. That way, you¡¯ll have some strength in reserve if any complications arise. So, any therapies we might recommend before that are all part of a plan to get your body prepared for surgery, not to help you avoid it.??
Your best chance for a cure is when we can do a TPE early as a planned part of your treatment, rather than waiting to do it as a last resort when systemic treatments are no longer working. But a TPE is a long and very complex operation, and the recovery can be prolonged. Not all patients will be able to undergo it. So, the first thing we ask is, ¡°Do you have a cancer that¡¯s resectable?¡± That is: ¡°Can your tumor be removed with surgery? Then, your surgeon will determine if you are fit enough to undergo it.??
Unfortunately, a lot of patients are told elsewhere that this type of surgery is impossible, even when their cancer is not metastatic and is still potentially curable. They only come to MD Anderson after other treatments have failed. Other patients are so leery of the procedure itself that they¡¯ll try almost anything to avoid it.?
The trouble is that while chemotherapy and radiation therapy can sometimes slow a cancer¡¯s growth, the problems caused by a locally advanced tumor in the pelvis often become worse. These can include severe pain, obstructions, infections, blood supply problems, and nerve damage. All of those may end up becoming much bigger issues than they would¡¯ve been if someone had gotten the surgery earlier.?