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.
