Anal cancer treatment options?

In My Humble Opinion (IMHO)
#1

My mom who is 70 has been diagnosed via biopsy with anal cancer, it doesn’t seem to have metastasized anywhere else in her body.

Her doctor wants to treat it with chemotherapy and radiation rather than surgery, however they did not explain to her just how serious chemotherapy is and the side effects(she was clueless about chemo). Her doctor does not think the cancer has spread, but wants to avoid surgery because it would mean losing her anal sphincter.

Here is what worries me is that she is in an incredible amount of pain daily from the cancerous growth, she was looking forward to surgery when initially it was though to be hemorrhoids. Apparently it is very large and is so intrusive and painful she has difficulty sitting or sleeping, every bowel movement in an ordeal.

She says that her doctor has blown her off about the pain, and gave her a sleeping pill RX along with stool softeners. She is taking some low dose acetaminophen and codeine pills which isn’t making bowel movements easier, but she says it is preferable to the pain.

I’m worried she will go through chemo and radiation only to require surgery anyway because she says she doesn’t know how much longer she can live with it.

:(I really don’t know what to advise her to do.

#2

Chemo and radiation aren’t necessarily the horrors you’re imagining. My grandmother, at 80, went through treatment for pancreatic cancer. She kept the idea that if she was healthy enough for chemo she wasn’t really sick. In fact, she fell on the ice outside the doctor’s office, broke her hip and recovered from that amidst the treatment. Her doctors initially wanted to send her home to die (palliative care) and she had to fight to get treatment at her age. She still died from it, but had 21 months, instead of the three they initially gave her, and was pain-free for all but the last couple weeks. And that was 15 years ago.

Just a few years ago, my sister was treated with surgery, chemo and radiation for breast cancer. With the new anti-emetics, she managed chemo just fine. Her radiation was pinpoint - inserting radioactive pellets in her breast and removing them.

If she doesn’t trust her doctors, get a second opinion. But this is her choice to make, not yours.

StG

#3

sorry i can’t recommend anything regarding chemo (i don’t know enough about it but i’d look at alternative options). a suggestion for less pain during evacuation: laxatives, maybe?

#4

Obviously, she has asked me what I would do in her place. Talking to her I realized:

1.She has no clue that chemo has any adverse effects, she assumed it was basically taking a antibiotic. I’ve told her to request her doctor explain to exactly what to expect so she is more informed.

2.She asked me if she thinks they would finally do the surgery on her after she goes through the chemo and rad therapy, I’ve told her the point is to avoid surgery. I’ve tried to explain surgery would mean losing sphincter control, which isn’t something anyone would want to deal with.

#5

Grude - You and she need to talk together with her doctor 9or team of doctors). You need to get specifics about the treatment - the chemo may not be as bad as you’re dreading, but your mother needs to have all the particulars to make her decisions about treatment options. It’s hard to believe your mother made it to 70 without knowing someone who has been through cancer treatment.

StG

#6

“Chemotherapy” is one of those scary bugaboo terms that makes me want to scream. Have you seen Wit, with Emma Thompson? That’s what most people envision when they hear the words “chemotherapy” or “chemo”…but that’s NOT how it generally is these days. (In that particular movie, she was on massive, massive doses of chemo as part of a study, and side effects for the chemo she was on were dose dependent, meaning more severe with higher doses of the drugs.)

“Chemotherapy” means “treatment of a medical ailment with chemicals”. Technically, using rubbing alcohol on a pimple is “chemotherapy”.

Now, I’m not suggesting that the chemotherapy for your mom’s cancer will be as side effect free as wiping a pimple with alcohol, but I’m just saying…you don’t know. Some chemotherapy agents (drugs) these days *are *nearly side effect free. Some aren’t. The only way to know is to ask the doctor exactly what drug/s he wants to use, what the side effects are, and what the frequency and intensity of those side effects at the dosage he wants to use are.

If the surgical option is a colostomy (as it sounds like it is, if the anal sphincter needs to be removed) then I would strongly recommend you do a LOT of research on that before you push that option with your mom. It’s not an easy surgery - it should be only 3 or 4, but can sometimes go 12 hours in the OR, which can produce pressure ulcers, pneumonia and other Bad Stuff. It requires lots of maintenance after, including emptying a bag of shit on her belly several times a day. The adhesive which holds the bag on can cause skin breakdown, infections, yeast infections (basically diaper rash of the belly) and sores. Fistulas can develop, necessitating further bowel surgeries and removal of more intestine further up. Depending on how much intestine they have to remove, you can run into chronic dehydration and electrolyte imbalances, which can be deadly in the elderly or someone with a heart condition. Not to mention the body image issues and depression which often arise from having a bag of shit on your belly.

Did I ever tell you about the time my SO’s bag came off in the middle of a TGIFridays and got shit all over the booth and table and his clothes and my purse? Fun times.

Colostomies are life saving and a godsend to people who need them, but after spending 2 years at monthly colostomy group meetings, and 2 years helping my SO deal with his and the resulting medical/psychological/social issues, I would never, ever recommend them if there was another good option available.

Ditto for pouches, reservoirs or other bowel surgery options which cannot preserve the anal sphincter. They all suck, to some degree or another, and have a pretty high failure rate and high complication rate. If your quality of life is already sucky (say, severe Crohn’s disease, IBS or constant bowel incontinence) then it may be worth it to improve your quality of life, but again, it’s still worth considering other options first.

#7

The NIH’s pages are usually a good place to start. The doctors may not be doing a good job in explaining the issues and the side effects to your mother or making sure she retains the information, but keep in mind they may know some things that you don’t, and maybe surgery is not a good option given her age, health issues, the particulars of her tumor, or the general aftereffects. Some chemotherapy really sucks and some doesn’t; the side effects can vary from person to person and there are a lot of different regimens. This cancer.net page says studies have shown that radiation and chemotherapy are about as effective as surgery in at least some types of anal cancer.

#8

My grandfather was diagnosed with colon cancer at age 87; he had already lost several chunks of thin intestine previously, due to things such as ignoring apendicitis until it ruptured :smack:. He had ambulatory surgery, chemo (very few ill effects; his hair finally went from coal-black to steel grey but he didn’t lose it, we aren’t even sure whether this was due to the chemo or to age catching up), more surgery, more chemo, eventually a colostomy at age 89 which spent a lot of time infected because he wouldn’t care for it properly (usually women are a lot better at that), and still had to go to the hospital every three months to get the always-reproducing anal polyps burned, until his death of a stroke at 95.

Surgery is not necessarily the best option, nor an option that’s 100% guaranteed to work; there are a few types of cancer (with more being identified) that are considered “stationary” enough to be treated with surgery only and monitorized for reappearance, but in most cases, either chemo or radio will still be used after cancer surgery. The doctors are trying to skip the step they see as skippable.