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Persons who have cancers of the anus that have spread to the nearby lymph nodes or are large in size may require more aggressive therapy than individuals with smaller cancers. Now, researchers say that chemotherapy with fluorouracil and cisplatin, followed by a combination of radiation therapy and chemotherapy with fluorouracil and mitomycin, may help preserve bowel function and improve survival for persons with this type of disease.

Cancer of the anus, the opening at the end of the rectum, is an uncommon cancer. Depending on the stage of disease (extent of disease at diagnosis) and other factors, cancer of the anus may be treated with surgery, chemotherapy, and/or radiation therapy. Persons who have surgery for anal cancer sometimes need a colostomy, an opening created from the skin to the bowel to help dispose of waste; however, a colostomy is usually temporary. Persons who have anal cancer that can be operated upon are often treated with surgery followed by a combination of radiation therapy and chemotherapy with fluorouracil and mitomycin. Seventy percent of these individuals are cured and maintain bowel functioning. However, persons with anal cancers that are large in size or have spread to the lymph nodes, do not respond as well to the standard therapies and need more aggressive treatment.

Researchers from the Cancer and Acute Leukemia Group B conducted a study with the hope of improving survival rates and preserving bowel function for persons with cancer of the anal canal that were large in size or had spread to the lymph nodes. Forty-five patients first received chemotherapy with fluorouracil and cisplatin. They then received a combination of radiation therapy and chemotherapy with fluorouracil and mitomycin. Thirty-six patients had a complete response to the therapy. After an average of 21 months, 78% of the patients were alive and 67% were free from any signs and symptoms of cancer. Fifty-six percent of those who were alive were without a colostomy.

The researchers concluded that this more aggressive combination of chemotherapy and radiation therapy appears to result in better survival and better preservation of bowel functioning than the standard regimens for persons with more advanced anal cancer. Persons with this type of disease may wish to talk with their doctor about the risks and benefits of receiving intensive chemotherapy with radiation therapy or of participating in a clinical trial in which other promising new therapies are being studied.

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