Mucinous Adenocarcinoma, Stage 3 Cancer in the Anal region treated with surgery and IGRT

A 76 year old male presented to MIOT on 8^th May 2017, with growth in the anal region of 3 months duration associated with discharge and occasional bleeding. The growth was protruding outside the anal canal such that the patient could not sit.

Diagnosis:

On examination, it was an ulcerated growth involving the whole anal region that bleeds on touch. PET scan and Biopsy confirmed it as Mucinous Adenocarcinoma, involving anus and protruding into rectum region.

“Adeno“means “gland”. Glands commonly secrete things in the body (endocrine glands) or outside of the body (exocrine glands). For example, mucous and sweat. A MUCINOUS ADENOCARCINOMA is a type of cancer that produces what is called “mucin”, which is the main component of mucus. They begin to form on the lining of certain internal and external organs.

Treatment Plan:

1^st step was to give rest to the anal canals by bypassing its functions. Overall Oncology management was to give Neoadjuvant chemo radiotherapy followed by surgery. Radiotherapy planning was done with IGRT technique and was delivered with hospital image guidance protocol.

NEOADJUVANT CHEMORADIOTHERAPY is the administration of therapeutic agents before a main treatment. Neoadjuvant therapy aims to reduce the size or extent of the cancer before using radical treatment intervention, thus making procedures easier and more likely to succeed. IMAGE-GUIDED RADIATION THERAPY (IGRT) is the use of imaging during radiation therapy to improve the precision and accuracy of treatment delivery.

Treatment Done:

Diversion colostomy was done by inserting a tube in the region which will take care of the anal function followed by Neoadjuvant Therapy. He had very good response to the therapy that the tumour shrank to a very small size. Then the patient was taken up for surgery- Laparoscopic Abdominoperineal resection by October.

An ABDOMINOPERINEAL RESECTION is a surgery in which the anus, rectum, and sigmoid colon are removed. This procedure is most often used to treat cancers located very low in the rectum or in the anus.

Post surgery, PET scan was taken which showed no remnants of the tumour.  He is currently very fit and able to sit. Now, he is a very satisfied and happy man. His daughter, a police office says “I am very proud of my father. I may have fought many enemies, but my father fought and won over an unseen enemy- Cancer”. He is currently on Chemotherapy.