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Radiation burns after anal cancer treatment
Dec 21, 2002

Hello:

I'm a 40 year old, HIV+ gay male (CD4 count 50), smoker (1 pack / day) who was diagnosed a little more than a year ago with Stage II anal squamous cell carcinoma. I underwent chemotherapy (5FU, cisplatin, mitomycin) and concurrent external radiation treatments (25 daily treatments, unknown radiation dosage) for the cancer, ending mid-October of last year (i.e. approximately one year ago). The radiation treatments caused the skin of my groin and perianal region to melt away and left me raw, oozing lymph fluids and in a lot of pain. These radiation burns have slowly and progressively healed -- my front side and perineal area healed by mid-December, the size of the irritated / inflamed area in my perianal region has shrunk significantly in size, but has not yet completely disappeared. I am presently treating this continuing radiation burn with 2 - 3x daily soaks / sitz baths in a lukewarm salt and baking soda solution, alternating with sitz baths using a dilute solution of "Hemor-Aid3", which is a mild astringent soaking solution, silver sulfadiazine ointment applied liberally to the remaining irritated area, occasional use of "proctofoam", and various over-the-counter ointments and creams, including Aquaphor, A+D original ointment and A+D zinc oxide and aloe vera ointment. I am also taking 5mg methadone per day for the continuing pain from these radiation burns. None of these treatments has seemed to have much effect on facilitating or speeding the healing of the remaining radiation burns.

My colorectal surgeon did a follow-up examination under anasthesia with biopsies earlier this year and determined that the cancer had been completely eradicated.

I returned to work on a part-time basis approximately three months ago. Since I've returned to work, I have found that the additional friction and physical stress that the partially-healed tissues in my perianal area have undergone have caused my healing progress to stop and reverse itself -- in particular, I've developed some extremely painful, inflamed ulcerations in my perianal region and on the mound of tissue that separates my anus from my perineum. I am also seeing a greenish-yellowish discharge from my anus, some slight fever of 99.5 - 101F and occasional diarrhea.

After external examination, my radiation oncologist and colorectal surgeon have both expressed concern about recurrence and have recommended that I undergo another examination under anasthesia. My colorectal surgeon has recommended that if things look "really bad" that he perform a temporary ileostomy to give the area a chance to heal.

This course of action seems a little drastic and does not seem that it will be effective in providing me relief from my pain, given that the irritation and ulcerations seem to exhibit all symptoms of an infection, which should be treated by an antibiotic, not a "roto-rooter job".

My questions: 1. should my colorectal surgeon concentrate first on getting the external ulcerations healed before attempting an internal examination ? How can I suggest this alternate course of action to him ?

2. Can you suggest any products, either over-the-counter or prescription, either systemic or topical which I should ask my doctors about, which might help facilitate the healing of my continuing radiation burns ?

Thanks

Response from Dr. Dezube

I'm sorry to hear about what sounds like an awful situation. It sounds like you may have a fistula. A diversion makes sense as it may allow you to heal better. Your situation does make me worry about a recurrence. A biopsy, however, may cause more problems, so the decision to re-biopsy should not be taken lightly but should be based on what your repeat examination shows. Chronic radiation damage can sometimes be treated with pentoxifylline (400 mg twice a day) and Vitamin E (400 units twice a day). Good luck and let me know how things progress.


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