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Follow-Up to question
Jan 8, 2002

Hi -- Thanks for your answer to my first question ("Treatment Options for perianal squamous cell carcinoma", circa 12/23). You said to "keep you posted", so I am. Right after I wrote, I consulted an oncologist, who had me get staging blood work, a pelvis CT scan, and a chest X-ray. All of those were OK with "no abnormalities". The next day, I had surgery again to remove more perirectal tissue for testing and to have a groin lymph node biopsied, and both came back "clear" of any cancer. I see my oncologist next week for follow-up for the first time since my second surgery and the holidays, and I'm not sure what she'll recommend. My colorectal surgeon says he wants to see me every 6-8 weeks for LIFE. I'm healing OK from the surgery, but I worry about anal cancer now that I've had HPV-related perirectal cancer removed outside and tons of condyloma removed from inside. Even if (like you said) I might not need chemo or radiation, how do I prevent anal cancer? Should I do some chemo or radiation now just to make super-sure? I'm afraid of going through that if I don't really need it, but I want to be safe, too. Should I get more than one oncologist's opinion? My colorectal surgeon is leaving the chemo/rad question to my oncologist; he's just going to follow me to watch for any more condyloma. When is safe "safe" and when do you do radiation or chemo for "good measure"? My viral load is about 900 and my CD4's steady around 250 for several years now and otherwise good health (I'm 37). Thanks!

Response from Dr. Dezube

You raise many good questions. For the general reading audience, we are talking about peri-anal cancer, and not anal cancer. Peri-anal cancer is cancer that occurs on the outside of the butt in the area surrounding the opening. Anal cancer on the other hand really involves both the opening and inside the opening.

Peri-anal cancer is much less worrisome than anal cancer. You should NOT do chemotherapy or radiation to prevent anal cancer, assuming you have just peri-anal cancer and that it has been completely removed. Although I understand your wish to do a "pre-emptive strike", it won't work in this case. You should have your bottom checked frequently, a few times a year; Every 6-8 weeks for life, as has been recommended to you, strikes me as excessive.

So what can you do?? For any external warts, I would highly recommend Aldara which is a medicine that you can apply to the warts. It's very effective. It stimulates the cells in the butt area to mount an immune response against the warts. Some feel that Aldara can also help early (low stage) cancer. In terms of internal warts and disease, these are harder to treat. Basically in the year 2002 the best treatment we have is frequent anoscopies (whereby health provider looks up your butt) and removal (either surgically, by infra-red coagulator, or by laser). At least two very promising vaccines for HPV disease are in trials; Only time will tell if they are safe and effective, and available for the general HIV-infected public. Some of the major cities have HPV/anal centers, which may have clinical trials.

You ask me if you need another opinion. I have given you my opinion. You'll have the opinion of your oncologist, who you have yet to see. If we are in agreement, then another opinion may not be necessary. Good luck and thanks for keeping me posted.


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