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- • Large tumors, or those that have invaded adjacent organs such as the vagina or prostate, can sometimes be
- treated with preservation of anal function. Radical surgery may be needed if the patient is already incontinent
- or if the cancer is not eradicated by radiation and chemotherapy .
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- Options by Lymph Node Status The lymph nodes in the groin (inguinal), pelvis and perirectal area may become involved by anal cancer.
- • When primary tumors are less than 2 cm (1 in.), nodes are not usually treated unless they are clearly involved.
- • When primary lesions are larger than 2 cm (1 in.), groin, pelvic and perirectal nodes are included
- prophylactically in the area treated with radiation therapy .
- • When lymph nodes are shown to be involved by cancer (for example, by biopsy), the initial treatment is
- usually chemotherapy and radiotherapy , as for the primary tumor.
- • Groin dissection has no prophylactic role, but is done for metastatic node involvement, usually after radiation
- and chemotherapy if there is residual cancer, or occasionally before radiation and chemotherapy.
- • If pelvic or perirectal node metastases are detected after radiation and chemotherapy, the nodes are surgically
- removed. This usually requires an abdominal-perineal resection and colostomy .
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