Standard Treatment Abdominal-perineal resection was the treatment of choice in the past, and is still appropriate when the anal cancer has caused a draining fistula through the wall of the vagina or destroyed the anal sphincter so that the patient is incontinent. Experience with radiation and chemotherapy has shown that, provided the patient is not incontinent and does not have a fistula, even quite large tumors can be eradicated and anorectal function maintained. Surgery is reserved to treat cancers that do not respond completely.
Five-Year Survival 50 percent
Stage IIIB
TNM Any T, N1-3, M0
The cancer has spread to the lymph nodes along the rectal wall and/or along the inner pelvic walls and/or the groin. Metastatic nodes are a poor prognostic sign, although cure is still possible.
Standard Treatment Options include combination chemotherapy and radiation therapy as described above, followed by surgical removal of any disease that does not regress at either the primary site or in the regional nodes. If pelvic wall nodes or nodes along the wall of the rectum do not respond to radiation and chemotherapy, it is usually necessary to perform radical surgery , removing the anus and rectum and creating the need for a colostomy . Residual groin (inguinal) nodes can be removed without operating on the primary anal tumor region.
