This document discusses anal cancer, including its treatment with chemo-radiation for squamous cancer of the anal canal. It describes potential side effects of pelvic radiation like diarrhea, cramps and fatigue from radiation to the small bowel, as well as urinary and rectal issues. Later stages have lower 5-year survival rates ranging from 45-86% depending on tumor size and lymph node involvement.

1. Cancer of the anus or
anal canal
 Understanding the disease
 Treatment options
 Side effects of treatment

2. Anal Cancer
This is usually squamous cancer and is
treated with chemo-radiation.
Rectal cancer is adenocarcinoma and is
treated with surgery +/- chemoradiation

5. Sentinel nodes of the anus are inguinal
nodes.

6. More advanced
case of anal
cancer that has
spread on PET
scan to para-
aortic lymph
nodes

10. PET scan showing anal cancer

14. There are different guidelines for anal canal
and anal margin , for canal more chemotherapy
plus radiation therapy (RT)

15. For anal margin, surgery may be all that is
necessary for early stages

16. CT scan is obtained at the time of
simulation
CT images are then imported
into the treatment planning
computer

17. In the simulation
process the CT
and PET scan
images are used
to create a
computer plan

18. Computer generated images of anal cancer

19. Tomotherapy for Anal Cancer

20. Tomotherapy for anal cancer, high dose to anus and groin
nodes, while avoiding the bladder and femurs

21. In the treatment
the lasers are
used to line up
the beam and the
patient receives
the radiation
treatment

22. Side Effects of Pelvic Radiation
Radiation fields
Radiation may hit the small
bowel causing some cramps,
diarrhea and fatigue
High dose area

23. Side Effects of Pelvic Radiation
Radiation fields
Radiation may hit the bladder
and rectum causing urinary
burning or frequency and ano-
rectal irritation
High dose area
In pre-menopausal women, radiation is likely to effect
ovarian function and should not be used if the woman is
pregnant

24. Survival in a large series of patients

25. Survival by Stage in a series of 270 patients
with anal cancer
5 Year Survival by Stage
T1: 86% N0: 76%
T2: 86% N1: 54%
T3: 60%
T4: 45%