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Anal cancer and chemo/radiation - side effects of both? How do you treat HIV+ patients?
Sep 7, 2002

Hi. My partner's brother had surgery four weeks ago to remove a tumour. They couldn't get it all out and have now confirmed that he has anal squamous cell cancer and said it was Stage C. Do you know what Stage C could mean? But what I mostly wanted to ask was, for HIV patients, (he has been + for over 13 years - CD4 count 200) is the chemo somewhat watered down and if so, does this increase the chance of the cancer spreading? As well, the surgeon has said that the lymph nodes are affected and that chemo and radiation are what they are recommending but I just wondered if lymph nodes are mentioned, is it automatically a higher-stage cancer? I am just scared that his immune system is so shot that the cancer protocols will wipe him out completely. And as soon as they said lymph nodes, it freaked me out. Could they just be affected because of his HIV status or is it likely the cancer?

Response from Dr. Dezube

The standard treatment for anal cancer is a combination of radiation and chemotherapy, also known as combined modality treatment. It is quite effective and for many patients, this combined modality treatment permits them to survive without a colostomy (a pouch to collect waste). Although one may be tempted to give lower doses of chemotherapy to HIV-infected patients, I personally recommend full dose chemotherapy and radiation. These tumors can be quite aggressive, particularly in HIV-infected individuals. By giving full dose, one enhances the chance of preventing the tumor from coming back. That said, some patients with advanced AIDS simply can not tolerate full dose. One additional point is that chemotherapy does not mix well with AZT (sold as retrovir, combivir, trizivir). If he's on AZT, he should consult his HIV physician about switching to an alternative medicine if possible. I have many patients who have had anal cancer in the past, and who have gone through this treatment, and who are alive today with an intact butt.

As for his Stage C, that simply means that the cancer has spread to his lymph nodes. The only way to know if a lymph node harbors the cancer or is just related to his HIV is to biopsy it. Usually such biopsies are done at the time of surgery.

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