cancer of the anusAnal cancer (cancer of the anus) is a malignant tumor that develops in the cells of the anus or the anus.

Among the risk factors for the disease say the human papilloma virus, sexual activity, reduced immunity, the presence of other cancers in the history of smoking. Possible factors include fistula; infections, sexually transmitted diseases.

Symptoms of anal cancer may include itching of the anus, bleeding, abnormal mucus; pain and pressure that do not go away after a bowel movement; changes in bowel habits (dimensions stool, constipation, diarrhea or alternating) swelling in the anus, enlarged lymph nodes in the groin and anal zone.

Complete organization of diagnosis and treatment of anal cancer in Israel - selection of the best specialists, clinics, taking into account the patient's wishes:

  1. Dr. Hagit Tulchinskaya is head of colorectal surgery at Ichilov (Sourasky).

  2. Professor Ron Greenberg, head of the department of surgery proctologic Ichilov Hospital.

  3. Dr. Yehuda Kariwa - a leading surgeon at Ichilov and Assuta.

At the end of the article you can read a summary of doctors, of course, this is not a complete list, as well as the cost of diagnostic services and treatment of cancer of the intestine.

Medical service «Tlv.Hospital» will assist in the organization of the treatment of anal cancer in Israel, and in the selection of the most appropriate medical facility, the best specialists in matters of domestic support. Learn more about the full range of services and benefits of selecting «Tlv.Hospital» focal point, you can call us or email via the inquiry form, you will be contacted within the hour.

In the process of diagnosis of anal cancer the following types of surveys conducted in Israel:

  • Blood tests (clinical and biochemical).
  • Tests for HIV antibodies.
  • Anoscopy.
  • Proctoscopy.
  • Ultrasound (transrectal ultrasound, abdominal ultrasound).
  • A biopsy (surgical or fine needle).
  • CT, MRI.
  • A chest radiograph.

Treatment of cancer of the anus in Israel

The therapy is carried out a group of specialists (oncologists). They are developing a treatment program based on the size of the tumor, its location, stage of the disease, the age and general health of the patient.

Anal cancer surgery

Surgical interventions in cancer of the anus is used in the following cases:

  1. To completely remove the tumor and cure cancer.
  2. When there are contraindications to radiation and chemotherapy.
  3. In the later stages of the disease, to alleviate pain, to remove the blockage, bleeding.

The choice of the operation affect the magnitude and location of malignancy.

  1. Local resection is recommended for small tumors anus when no secondary lesions in lymph nodes. During the operation, remove the tumor and a small margin of healthy tissue around it. Mostly resection allows preservation of the anal sphincter.
  2. Abdominoperineal extirpation of the rectum - is a major surgery that is performed when the tumors do not respond to chemoradiation therapy or relapse occurs. The surgeon removes the anus, rectum, and sigmoid part of the lymph nodes. The abdominal physician creates a colostomy for removing waste from the body.

Side effects of surgery anal cancer:

  1. The pain occurs because of tissue injury. For anal cancer can perform operations as a small and large. The intensity of pain will be determined by the procedure, the ability to tolerate pain and speed healing process. Doctors prescribe analgesics to relieve the condition.
  2. Bleeding can be caused by a non-insulated vessel during surgery and bleeding disorders. When serious problems possibly surgery. The risk of bleeding with less local resection.
  3. Deep vein thrombosis is possible after BPE anal cancer, because the person is unable to move enough, along with other factors. Contributes to the prevention of DVT receiving blood thinners (anticoagulants), wearing compression stockings during and after surgery.
  4. To prevent the risk of infection is used in some cases, drainage is to drain excess fluid from the wound, antibiotics.
  5. Changes in bowel habits after BPE anal cancer is to create a permanent colostomy, when the end of a healthy colon bring to the surface of the abdomen. Fecal incontinence bag going in, which is fixed on the outside of the body.
  6. Bowel problems, such as constipation and diarrhea can occur after BPE anal cancer. For the most part, they are 3-6 months later. Sometimes there are more serious complications such as paralytic ileus and adhesions.
  7. After BPE anal cancer often notice symptoms such as fatigue, lack of energy, weakness and exhaustion. This condition is characterized by fatigue, which a person usually experiences at the end of the day. It can persist long after recovery.
  8. BPE anal cancer may cause malfunctions of the reproductive organs in males. During this operation, the nerves that control erection and ejaculation may be damaged. This will lead to erectile dysfunction (impotence) or problems with ejaculation.
  9. There may be difficulty with urination after BPE anus cancer due to nerve injury. To prevent this side effect are used surgical techniques to preserve the nerves. If made removal of the bladder during surgery, creates a permanent urostomy.

Anal cancer chemotherapy in Israel

For the most part, this method is used in the treatment of anal cancer. It is administered concurrently with radiation therapy (chemoradiotherapy) as the standard treatment. Cytotoxic drugs used predominantly systemically.

The indications for chemotherapy for anal cancer:

  1. As a primary treatment in combination with radiotherapy.
  2. To eliminate the remaining cancer segments after initial chemoradiotherapy.
  3. To loosen the pain and control the disease in the late stages.

Among cytostatic drugs in anal cancer is most often administered 5-fluorouracil (5-FU), cisplatin (Platinol AQ) and mitomycin (Mutamycin). In most cases, combinations listed below are used:

  • 5-fluorouracil and mitomycin;
  • 5-fluorouracil and cisplatin.

Adverse effects of anal cancer chemotherapy:

  1. A number of drugs causes vomiting and nausea, mainly combinations thereof.
  2. Loss of appetite may be due to various factors: gastrointestinal disorders, weakness and fatigue, accumulation of toxins in the body due to the death of cancer cells.
  3. Hair loss provoke some cytotoxic agents in cancer of the anus. Manifest to varying degrees, the side effect is unpredictable.
  4. Diarrhea occurs due to the effects of chemotherapy on the gastrointestinal tract cells. Largely depends on the dose and type of medication. Enhances the effect of the combination of drugs.
  5. Inflammation in the oral cavity is frequently caused by the treatment with cytotoxic drugs anus cancer. Doctors prescribe medicines, special oral solutions.
  6. Bone marrow suppression is the reduction in the amount of one or more types of blood cells - red blood cells, leukocytes or platelets. The reason is the impact of drugs on the bone marrow.
  7. In the decay of cytostatics in the organism to form products that can damage the cells of kidneys, ureters and bladder.

Radiation therapy for anal cancer in Israel

Radiotherapy uses ionizing radiation in the treatment of malignant tumors. The standard treatment for anal cancer is chemoradiation.

Irradiation in this disease is recommended:

  1. The main treatment of cancer of the anus along with cytostatics to eliminate cancer cells.
  2. As the main anal cancer therapy without the involvement of chemotherapy patients with small tumors in the early stages and when there are contraindications to chemotherapy.
  3. After the surgical intervention for the destruction of malignant remaining segments and reduce the likelihood of disease return.
  4. To mitigate the pain and to control anal cancer in the later stages.

Anal cancer is primarily treated by external beam radiotherapy. Accelerators direct flux of radiation to malignant tumor and its surrounding tissues.

Radiotherapy is also used for the treatment of the lymph nodes. Lymph nodes are treated with high-dose chemotherapy with radiation.

Radiation therapy intensity modulated (IMRT) is involved in the treatment of anal cancer more often than in the past. This technique uses specialized CT images to provide a high-dose irradiation of the tumor, reducing to healthy surrounding tissue load. This approach helps to reduce the unwanted effects of therapy.

Brachytherapy is an internal radiation therapy in which radioactive material is placed inside the neoplasm or in close proximity thereto. The isotopes can also be placed in the area where the tumor was removed. Over time, the radiation kills the cancer cells. For the most part do not apply brachytherapy for cancer of the anus. If prescribed, it is usually in combination with external radiotherapy.

Potential adverse effects of radiation therapy for anal cancer:

  1. the-art skin may become red, dry, irritated, itchy possible.
  2. Fatigue associated with toxic substances, which are generated when the destruction of tumor cells occurs. Contributes to fatigue anemia.
  3. Nausea and vomiting occur if a large area is treated upper abdomen. A side effect is caused by radiation dose and the frequency of sessions.
  4. Irradiation for anal cancer can cause a variety of problems, including diarrhea or radiation enteritis, constipation, pain and itching in the process of bowel movements, bowel obstruction in the small or large intestine, rectal spasms, partial incontinence; irritation and inflammation of the sigmoid colon, direct or anus; rectal bleeding, hemorrhoids. The use of certain chemotherapy drugs for cancer of the anus in this situation may worsen the condition. Among the options for the treatment of serious intestinal problems noted anti-inflammatory drugs, corticosteroids, medications to treat spasms; expansion of rectal stricture; operations.
  5. Radiation therapy is a cancer of the anus can affect the reproductive organs, depending on the number of treated tissue and the radiation dose. Measures are being taken to protect the organs, but some effects of radiation on the testes or ovaries are inevitable. For some people, there is a decrease in sexual desire due to the inhibition of the function of the testes and ovaries. Women may cause menopausal symptoms in men - the development of erectile dysfunction and for both sexes - the development of fertility problems.

Treatment of cancer of the anus in stages in Israel

anal cancer treatment at stage 0 involves the use of surgery. In the process of the local resection of the tumor is removed and a small margin of healthy tissue around it. For the most part only the operation is sufficient.

Cancer Treatment anus in step I and II

Chemotherapy combined with radiation therapy is the main treatment in these stages. Combined therapy has a high efficiency. Fewer patients then require surgery to remove the tumor and the need for a colostomy.

In stage I and II anal cancer chemotherapy following suggestions:

  • 5-fluorouracil (5-FU) and mitomycin (Mutamycin);
  • 5-fluorouracil (5-FU) and Cisplatin (Platinol AQ).

Some people may refuse treatment with cytostatics or not be able to move it. In this case, they are invited to a radiation therapy, probably at higher doses. This approach also provides a good chance for successful treatment of anal cancer with preservation of anal sphincter function. For the most part it used external beam radiation therapy.

Surgery may be needed to remove any tumor that is left in the anus or anal canal after chemoradiotherapy. Local resection may be performed if a small tumor or BPE when neoplasm more than 1 cm and invades nearby structures.

anal cancer treatment at stage IIIA and IIIB in Israel

Chemoradiotherapy regarded as a primary treatment of disease at these stages. Apply the same drugs as in the previous stages.

By resorting to surgery after chemoradiotherapy to remove the remaining tumor in the anus or anal canal. For the most part performed BPE. If you save the tumor is very small, the possibility of local resection.

In the propagation of cancer of the anus to the local lymph nodes are used radiotherapy or surgery (BPE).

anal cancer treatment step IV in Israel

There is not a standard treatment at this stage of the disease. The main goal - to control the disease and relieve symptoms.

Chemoradiation therapy may improve local control of the tumor. Radiotherapy is also recommended to relieve pain, eliminate bleeding caused by tumors. Mainly used external radiation.

Surgery may be needed to remove the tumor and control pain, bleeding or infection caused by neoplasm.

Laser therapy is sometimes recommended to reduce tumor which blocks the anal canal, or bleeding control.

Treatment of recurrent anal cancer in Israel

The choice of treatment options depend on the re-localization of the tumor.

When local recurrence if the previously carried out operation is performed chemoradiotherapy. If preceded chemoradiotherapy may be recommended treatment with cytostatics and surgery (BPE).

When distant relapse is proposed, as a rule, chemotherapy. Most often, a combination of 5-fluorouracil and cisplatin. Rarely preference is given to surgery.

anal cancer recurrence treatment can not eliminate the disease, but helps to reduce or alleviate the symptoms.

Observation after treatment anus cancer

The disease can behave in different ways, so there is no standard prescriptions. If symptoms persist or there are new, it is not necessary to wait for the next appointment. These manifestations include anal bleeding, itching, discharge of mucus, pain and pressure in the anal area, changes in bowel habits. The risk of recurrence of cancer of the anus is the highest in five years.

Subsequent visits usually are outlined as follows:

  • Every 2-3 months for 3 years after primary treatment of anal cancer.
  • Every 3-6 months over the next 5 years.

diagnostic procedures

Doctor queries about the manifestation of the side effects of therapy. May conduct a physical exam:

  • digital rectal examination for suspected recurrence;
  • examination of the lymph nodes in the groin, as Anal cancer is mainly returned to the zone.

Possible to carry out the following tests:

  1. Anoscopy or proctoscopy can visually inspect the anal canal for signs of cancer.
  2. CT pelvis, abdomen and chest may appoint annually within 3-5 years after treatment of anal cancer.
  3. Blood tests, such as tests designed to test liver function, may be performed periodically throughout the observation period. However, CT scans and physical examination are more effective in detecting recurrence of anal cancer.

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