In the case of limited anal carcinomas that have not grown deeply into the tissue, surgical removal is the therapy of choice. The cancer is cut out at a safe distance and there is usually no need for an artificial bowel outlet. The situation is different with larger tumours or those that have grown deeper into the tissue and therefore cannot be easily removed.
In these cases, treatment with radiation and chemotherapy is usually preferred to surgery. Only if this treatment is not successful or if tumour tissue grows back, a radical operation with removal of the rectum and all tissue affected by the tumour must be considered. During the operation, an artificial bowel outlet must also be created. However, such a drastic measure is avoidable in most cases.
After treatment of anal carcinoma, as with all cancers, regular follow-up examinations are important in order to be able to detect and treat tumour growth in time. In addition to a physical examination, a rectal endoscopy is performed. A tube is inserted a few centimetres through the anus and the intestinal mucosa can be assessed with a camera.
In the first 2 years after the treatment of anal carcinoma, these checks should be carried out every 3 months. If there are no abnormal findings, a six-monthly examination is sufficient thereafter. In addition, the so-called tumour markers in the blood are usually determined. If these are elevated, this can indicate renewed growth of cancer cells. However, an increase can also have other causes and the values must therefore always be considered together with the other findings.
Irradiation is an important part of the therapy for anal carcinoma. It is usually combined with chemotherapy, i.e. treatment with a cytotoxin that is administered via the blood and kills the cancer cells in particular. This combination offers the best chances of success and a cure can often be achieved.
Radiation and chemotherapy should also be carried out in the case of advanced tumours, as any subsequent surgery that may be necessary is facilitated. This is called neoadjuvant therapy. In the past, radiation alone was frequently used, but should no longer be used due to the significantly lower chances of success. Side effects of radiation therapy are often diarrhoea and urination problems, which usually subside after a few weeks.
In anal carcinoma, metastases, i.e. tumour scattering sites, are most likely to grow in the lymph nodes of the pelvis or groin. In most cases, however, the disease makes itself felt at an earlier stage through symptoms such as bleeding or pain during bowel movements. Metastases in other organs such as the lungs are very rare in anal carcinoma and usually only develop at a very advanced stage if no treatment is given. Nevertheless, in people with anal carcinoma, an imaging examination of the abdominal cavity and thorax should be carried out before a complete diagnosis is made. This is usually done by computer tomography (CT) or alternatively by magnetic resonance imaging (MRT).