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Follow-up care after treatment of anal cancer

Four to six weeks after chemotherapy and radiation are finished, the patient should be examined for assessment of local response. This is because the degree of actual tumor regression may be difficult to determine, and it may be necessary to take new biopsies. Immediatley after treatment, the patient should be followed up every month until the tumor has completely disappeard. If the tumor does not show complete response after a maximum of 3 months, the tumor should be considered therapy-resistant and a rectal amputation should be considered.

An oncologist has the primary responsibility for the follow-up, however anorectoscopy can be carried out by a surgeon.

Most recurrences appear within 2-3 år.

Further recommended follow-up

  • Every 3 months for the first 2 years.
  • Every 6 months for 5 follow-up years. 
  • Later follow-up annually by a general practitioner.

Examinations at follow-up check

  • General health status, especially anorectal symptoms, from pelvis and abdomen
  • Clinical examination of the anal area and perineum, palpation of the abdomen/groin, rectal exploration
  • Blood tests (hematology, liver and kidney function). 
  • CT of the thorax/liver (thoracic X-ray, ultrasound liver after 3, 6, 12, 18 and 24 months. Then annually the next three years.
  • PET/CT, at three months follow-up, if taken before treatment start
  • MRI pelvis at 3, 6 and 12 months follow-up. Then, only if clinically indicated.
  • Anorectoscopy at follow-ups the first year, possibly longer.
  • Evaluation of local anal function, supplementary examinations for documentation of reduced function.

Complications after chemotherapy/radiation treatment

  • Stool urgency occurs in some patients. Frequent bowel movements and continued loose stool may occur, especially after high doses of radiation.
  • Chemotherapy and radiation can in some cases, cause varying degrees of anal incontinence, partly due treatment and partly due to necrosis of large tumor involving the sphincter. This may require sigmoideostomy. 
  • Anal stenosis may occur, which is a condition requiring a sigmoideostomy.
  • Sterility in women. Germinal cells in the ovaries are very senstive to radiation. The ovaries are often located in the radiation field causing the patient to enter menopause and become sterile. 
  • Sterility in men. Germinal cells in the testicles are also very sensitive to radiation. If the testicles are included or close to the radiation field, the risk for sterility is great. In some cases, it is possible to shield the testicles, sparing the germinal cells from radiation.  
  • Dry and atrophic vaginal mucosa.
  • Cystitis may occur and possibly reduction in size of the bladder (rare) causing frequent urination.

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