Anal cancers are rare, representing only 0.4% of all new cancers in the U.S. However, certain conditions (HIV infection, immunosuppression, HPV infection) are associated with an increased risk of developing anal canal cancer. The early symptoms of anal cancer include perianal pain and blood associated with bowel movements. These symptoms are very similar to symptoms associated with hemorrhoids; therefore, this cancer is often diagnosed in patients with long history of treatment for benign anal disease (hemorrhoids, fistula). If you have perianal symptoms that do not subside after a course of local therapy, ask your primary care physician to refer you to a specialist.

Treatment for cancer of the anal canal varies based on the type of cells in which the cancer develops.

Types of anal and rectal cancers include:

• Squamous cell carcinoma: the most common kind of anal cancer, which starts to form in the anal canal's outer lining. Like cervical cancer, 95% of anal squamous cell carcinoma is linked to human papillomavirus (HPV) infection. HPV-related inflammation could lead to changes in the lining of the anal canal, called dysplasia, and high-grade intraepithelial lesions. These changes are not malignant but could evolve into invasive cancer if left untreated. When appropriately treated, cancer can be prevented.
• Adenocarcinoma: represents 10-15% of all anal canal cancers. It occurs in the mucus-producing glands situated under the anal lining.
• Cloacogenic carcinoma: makes up about 25% of all cases of anal cancers, which develops between the outer part of the anus and the lower part of the rectum
• Basal cell carcinoma: a kind of skin cancer that can appear on the skin around the anus.
• Melanoma: anal melanoma is rare; it represents only 0.5-2% of all anorectal cancers. Melanoma starts in the pigment-producing cells found in the skin or anal lining.

Squamous cells and cloacogenic anal cancer usually do not require surgery. Instead, treatment involves chemotherapy and radiation, leading to excellent outcomes with a 5-year overall survival rate of 76%. Adenocarcinoma of the anal canal might require surgery after completing a course of chemotherapy and radiation to be eradicated.

Immunotherapy, with or without surgery, is the primary treatment for managing anal canal melanoma.

Tests

Early detection and an accurate diagnosis are essential to a successful colon or rectal cancer treatment. Along with reviewing your medical history and blood work, the following tests may be recommended to help us diagnose your cancer.

Colonoscopy

Colonoscopy uses a small, flexible tube with a camera at the end to check the full length of your inner colon. If polyps or other precancerous lesions are found, they can be removed during the test, preventing cancer from forming.

A colonoscopy should be performed every 10 years in those who are over the age of 50 and who have a normal level of risk. People with a strong family history of colorectal cancer or a genetic predisposition, they should be screened more often and screening should start at an earlier age.

Flexible Sigmoidoscopy

This exam is similar to a colonoscopy. It utilizes a small and flexible tube to check just the lower part of the colon. The procedure is performed without sedation and should be done every five years. If polyps or cancer are found, you will need a colonoscopy.

Virtual Colonoscopy (Colonography)

Although the same bowel preparation is required for clear viewing of the colon, for some people, virtual colonoscopy provides an alternative to traditional colonoscopy. Colonography is a type of CT scan that creates a 3D image of the inside of the colon. While you are awake, a small tube is inserted into your rectum, which slowly inflates the colon with air so it can be properly scanned. The procedure doesn’t involve the use of any instruments, so any polyps or suspicious areas found can’t be removed or biopsied — this would require a colonoscopy.

Biopsies

If your imaging exam or colonoscopy reveals a polyp or suspicious lesion, your doctor will remove the polyp or take a tissue sample to examine. This is the only definitive way to know if a growth is cancerous.

Multigene Tests

Multigene tests are performed after a biopsy. Because no tumor has a single mutation, genomic profiling allows us to identify groups of mutations in your tumor tissue sample and create a tumor profile for you. This enables us to develop and deliver treatments that target those mutations. The profile can help us predict if your cancer is likely to spread to other parts of your body.

Treatments

Surgery

Due to advances in radiation and chemotherapy, surgery is rarely used anymore in anal cancer. In many cases, Sylvester specialists can use radiation or chemotherapy or a combination to cure or control the cancer without disrupting bowel function.

Sylvester surgeons can now safely remove many cancers not directly involving the sphincter muscle or pelvic floor, while preserving normal bowel function. Only a limited number of patients will still require colostomies; those who do will be supported by experienced and knowledgeable enterostomal therapists to teach them how to manage them.

Radiation Therapy

Sylvester’s radiation oncologists use the most advanced technology to deliver radiation externally or internally to colorectal tumors.

• External beam radiation: This radiation therapy approach is delivered from outside the body using specialized equipment. Most colorectal cancer treatment at Sylvester uses this technique. We use RapidArc® to provide intensity modulated external radiation therapy (IMRT), which shortens treatment times to one-half to one-eighth that of conventional radiation therapy. This results in more precise tumor targeting and reduces damage to nearby healthy tissue.
• Internal radiation: Called brachytherapy, this type of radiation is used for smaller primary tumors, with clean, healthy skin around them and no evidence of cancer in the lymph nodes. Brachytherapy involves temporarily implanting a radiation applicator into the tumor site and delivering doses of radiation locally, at certain intervals. It allows the radiation oncologist to keep the radiation dose away from sensitive organs.

Chemotherapy (Systemic Medical Therapy)

Chemotherapy is usually a combination of cancer-fighting medicines and can be administered intravenously or by a pill. If you require intravenous (infusion) chemotherapy, you can receive it at the Comprehensive Treatment Unit (CTU) at Sylvester's main location in Miami. It's a 12,000-square-foot unit that includes 33 recliners and 11 private rooms. If you prefer, you can also have your infusion treatments at the Kendall, Hollywood, Coral Springs, Coral Gables, or Deerfield Beach locations.

• Before surgery (Neoadjuvant): Sometimes, a rectal tumor is too large or marginal to avoid damaging the sphincter muscle with surgery. In cases like these, neoadjuvant chemotherapy with or without radiation are given before surgery to shrink the tumor so it's easier to remove.
• After surgery (Adjuvant): Most chemotherapy is provided after surgery. Sometimes, chemotherapy includes combinations of medicines that have been shown to work well together for your type of cancer. Your specialist may also recommend using a standard therapy coupled with a clinical trial drug.

Targeted Therapy

Targeted therapies are designed to attack the molecular alterations that make the cancer cell grow and spread. They have the potential to be more effective and with fewer side effects than chemotherapy. Some of these medicines are given along with chemotherapy medicines, while others are used by themselves.

Clinical Trials

As a colorectal cancer patient at Sylvester, you have access to more novel or advanced treatments than anywhere else in South Florida. Your doctor will recommend any clinical trials that are right for you.

Why Choose Sylvester Comprehensive Cancer Center?

Sylvester is an NCI-designated cancer center. The National Cancer Institute has reaffirmed us as South Florida’s only NCI-designated cancer center. We have been recognized for our scientific leadership, our commitment to training the next generation of cancer researchers and providers, as well as our engagement with the communities that we serve. For patients, this designation translates into greater access to leading-edge treatment options, including clinical trials that prioritize your specific cancer.

The Dysplasia Clinic at the Sylvester Comprehensive Cancer Center offers diagnosis and treatment for pre-invasive diseases of the lower genital tract and screening and treatment of anal dysplasia in men and women. Our medical experts in the Dysplasia Clinic use high-resolution anoscopy (HRA), which is a colposcopy of the anal canal. This procedure allows for a magnified examination and evaluation of the anal canal. Abnormal areas can be identified, and biopsies can be obtained if needed. HRA is very different from colonoscopy or flexible sigmoidoscopy, neither of which can adequately examine the anal canal for the problems being detected by HRA.

More cancer clinical trials than any other South Florida hospital. We offer you ease of access and the newest ways to treat and potentially cure your cancer.

Advanced radiation oncology tools. Sylvester was the first medical center in Florida to offer Magnetic Resonance guided (MR-g) radiation therapy. This precision therapy guides daily treatment and adapts the radiation plan daily to respond to changes in the tumor and surrounding normal organs’ motion. In addition, our RapidArc® radiotherapy system delivers intensity-modulated external radiation therapy (IMRT) in a more efficient way, leading to shorter treatment times, better precision while targeting the tumor, and less damage to surrounding healthy tissue. Patients treated in our cancer center could also be offered proton therapy in our state-of-the-art Dwoskin Proton Therapy Center.