Anal Cancer Surgery
- Introduction
- Risk Factors & Screening
- Staging of Anal Cancer
- Chemotherapy and Radiation
Anal Cancer Surgery
As alluded to earlier surgery is reserved for the unfortunate patients whose tumors do not disappear with chemoradiation. This is usually the more advanced tumors. On occasion the treatment may result in curing the cancer, but lead to fecal incontinence that the patient finds unacceptable. When these conditions exist, then surgery is done and a colostomy is created. When there is still tumor in the anal canal, the operation is called an Abdominal Perineal Resection (APR). This requires removal of the anus, all the skin and soft tissue around the anus and all of the rectum and surrounding lymphatics. This is a complicated operation and may require a plastic surgeon to place a flap of skin and muscle to close the large defect thus created in the perineum. Even with this operation there is no guarantee that the tumor may not come back in a distant place later such as the liver or lungs, but long term survival is seen over half the patients.
There are instances where the tumor is small (1 cm or less) and does not involve the internal anal canal or the anal sphincter muscles. On those occasions, local excision may be appropriate and curative. An important distinction should be made for cancers of the anal margin. These tumors occur near the anus but are entirely on the hair bearing skin of the buttock. These can be treated like any other skin cancer that occurs elsewhere on the body and be excised without the need for chemoradiation.
