Radiation or Surgery?

Li Liu, MD
Last Modified: November 1, 2001

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I would like to ask you a question.

My father was recently diagnosed with anal cancer. The doctor said his tumor is about 3cm in size. He had a CT scan done which did not show any lymph node spread. The doctor is planning to do radical surgery and permanent colostomy. I read that this tumor can be treated with radiation without sacrificing the anus. What is the standard care for this cancer? Is radiation as effective as surgery?

Li Liu, MD, OncoLink Editorial Assistant, responds:

Dear K,  
Surgery was the definitive treatment for carcinoma of the anal region before the advent of modern radiotherapy and chemotherapy. Dr. Nigro and associates (Disease of Colon and Rectum, 27:763, 1984) first demonstrated the role of combination radiation therapy, 5-FU, and mitomycin-C as a definitive treatment rather than as an adjuvant to surgery. Two randomized trials conducted by the United Kingdom Coordinating Committee for Cancer Research (UKCCCR) (Lancet, 348:1049, 1996) and the European Organization for Research on Treatment of Cancer (EORTC) (Journal of Clinical Oncology 15:2040, 1997) demonstrated a significant improvement in local cancer control and in colostomy-free survival rate in patients who received irradiation combined with chemotherapy. The Radiation Therapy Oncology Group (RTOG) reported in a randomized trial that the combination of mitomycin-C with 5-FU and irradiation is more effective than 5-FU alone with irradiation (Journal of Clinical Oncology, 14:2527, 1996). Now the combination of radiation therapy, 5-FU, and mitomycin-C is considered a standard treatment for anal cancer to which other treatments should be compared.

Without knowing the detailed history of your father's disease, it is impossible to make any clinical recommendations. He should discuss the case with his oncologists, perhaps obtaining consultations from radiation oncologists and medical oncologists.

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