Anal canal cancer: current treatment and results

Combined radiation and chemotherapy is established as the preferred treatment for primary epidermoid cancer of the anal canal. This approach allows preservation of anorectal function without any apparent decrease in the survival rates obtained in the past with radical surgery. Most experience has been gained with radiation, 5-Fluorouracil (5-FU) and mitomycin C, but radiation, 5-FU and cisplatin are also effective. Regional lymph node metastases can be eradicated by radiation and chemotherapy, but cancers which have metastasized to regional nodes or to extrapelvic organs carry a poor prognosis. Extrapelvic metastases and recurrent pelvic cancer respond poorly to systemic chemotherapy, and to combinations of radiation and chemotherapy. Cisplatin combined with 5-FU is the most effective treatment presently available in such situations. No effective systemic adjuvant therapy has yet been devised.