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Treatment Options by Stage

Revised 26 Sept 2012

Stage 0: cancer is limited to mucosa without invasion of the lamina propria

  • If no sphincter involvement, wide local excision with negative margins
  • If sphincter is involved, primary radiation therapy with or without chemotherapy​

Stage I: T1, N0, M0

  • If no sphincter involvement, wide local excision with negative margins
  • If sphincter is involved, primary radiation therapy with or without chemotherapy

Stage II – Stage IIIA: T2-4, N0, M0 or T1-3, N1, M0

Stage IIIB: T4, N1, M0 or any T, N2-3, M0

  • Primary chemoradiotherapy (GICART, GICPART, GIFUART, GIFUPART) followed by resection of residual disease (local resection or APR of primary site with or without inguinal lymph node dissection)
  • Consider treatment on a clinical trial, if available.

Stage IV: any T, any N, M1 (Metastatic disease)

  • Palliative surgical resection or bypass of obstructing or bleeding primary lesions in selected patients
  • Palliative radiation therapy with or without chemotherapy
  • Palliative chemotherapy may be given to help improve symptoms and quality of life, and extend survival in appropriately selected patients.
  • Currently approved chemotherapeutic agents for advanced anal cancer include: 5-fluorouracil (5-FU) and cisplatin (GIFUC)
  • Please refer to current treatment protocols for indications, dosing and eligibility criteria
  • Consider treatment on a clinical trial, if available.
  • Symptom management, best supportive care, and involvement of palliative care services as indicated by patient’s clinical status.

Recurrent disease:

  • Local recurrences or persistent disease after primary chemoradiotherapy may be controlled with APR with permanent colostomy.
  • If no previous chemoradiotherapy, consider radical chemoradiotherapy with or without surgery.

SOURCE: Treatment Options by Stage ( )
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