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Cancers may arise in either the anus or rectum and it is important to make a distinction about the site of origin, because treatments are different. Anal cancer is very sensitive to radiation and chemotherapy. In fact, 85 percent to 90 percent of these tumors can be successfully treated this way and will not require surgery.
Using proper anatomic definitions, the anus is the opening of the lower intestinal tract. It is surrounded by the sphincter muscle, which helps control the passage of gas and stool. The anal canal is about 2 inches long and connects with the rectum internally. The rectum is the lowest portion of the colon or large intestine and its sole function is to store stool until it is passed.
If you are diagnosed with anal cancer and wish to be evaluated at Loyola, we ask that you come to our multidisciplinary Gastrointestinal Oncology Center in the Cardinal Bernardin Cancer Center. With one visit, you will sit down with all physicians involved with your care. Your team may include medical oncologists, radiation oncologists, colon and rectal surgeons, gastroenterologists, radiologists, pathologists and geneticists. Your team will review your medical history, pathology results and previous X-rays. As a team, we will draw up a treatment plan tailored just for you.
After radiation and chemotherapy has been completed (approximately 6 weeks later), you will be examined again to determine if there has been any response. Sometimes another biopsy is needed to determine whether any cancer remains. Persistent cancer is usually treated with surgery and a colostomy is probably necessary at this point. Follow-up visits will be in the GI cancer clinic every 3 months for the first 2 years after radiation and chemotherapy.
Rectal tumors may be discovered during a colonoscopy performed for screening or for symptoms such as bleeding or a change in bowel habits. Small, accessible tumors that appear benign can be removed during the examination. But if the tumor appears malignant, the doctor may choose to perform only a biopsy and then refer the patient to a surgeon. Surgical options vary according to size and location of the polyp and whether or not it is benign or malignant.
Large benign polyps may be removed by either an operation performed through the anus or the abdomen. The second approach is more invasive, painful and generally requires a longer hospital stay. Only small and early-stage cancers are suitable for a conservative operation through the anus. If a cancer is large and deep, open surgery through the abdomen is the appropriate choice. Deciding when to use transanal excision requires the sound judgment of an experienced surgeon.
Transanal Endoscopic Microsurgery (TEM)
Transanal surgery at Loyola is performed with a technique known as TEM, or Trananal Endoscopic Microsurgery. Only a few surgeons in the United States are trained and qualified in this procedure, which uses a special scope and long-shafted instruments. The transanal approach allows surgeons to remove many polyps that conventional instruments could not.