Q1. How will chemoradiation be given to me?
Chemoradiation is when chemotherapy and radiotherapy are given alongside each other. Chemotherapy can be given by a drip, injection or sometimes in tablet form. Radiotherapy uses high-energy rays from a machine directed at the cancer and is usually given to you in the X-ray department.
Your treatment plan will be tailored to your specific needs. Chemotherapy is usually given over four to five days. There are generally two cycles of chemotherapy; the second is usually around four weeks after the first. You may have to stay in hospital for chemotherapy treatment, although increasingly it can be given to you in your own home. Your radiation treatment may start on the same day as chemotherapy, or may be sandwiched between the two chemotherapy cycles. Radiation is a short treatment that you may have once every weekday for a number of weeks. You can usually have radiotherapy as an out-patient which means you have the treatment in hospital but won’t need to stay overnight.
Q2. What happens after treatment for anal cancer?
After you have finished your treatment, you will need to attend regular check-ups with your doctor to see if the cancer has come back (this is called a recurrence) or if the cancer has spread.
Your doctor will give you regular check-ups. Your doctor will ask questions about how you are feeling, whether you have had any symptoms and will examine your anus. In addition to this, you may need to have:
• a blood test
• a CT (computerised tomography) scan – this uses X-rays to build up a three-dimensional picture of the anus
• an MRI (magnetic resonance imaging) scan – this uses magnets and radio waves to produce two- and three-dimensional pictures of the inside of your body
• an ultrasound – this uses sound waves to produce an image of your abdomen, or you may have an ultrasound where a small probe will be passed into your anus for the scan.
If you get any symptoms between your scheduled check-ups, you should see your doctor as soon as possible.
Q3.What if my anal cancer comes back?
Your cancer may come back again after treatment; this is known as a recurrence. It’s often possible to try a treatment again.
Remission occurs when, after the initial treatment, there is no sign of the cancer. It’s possible, however, that your cancer will return at some point. It may come back in the same place as your original cancer (this is known as local recurrence) or in a different part of your body (known as metastasis or secondary cancer).
It’s often possible to try a treatment again. This may be the same treatment you had before or your doctor may suggest a different treatment plan. Unfortunately in some people, the cancer may not respond to treatment when it comes back again. If this happens, you may receive palliative treatment which helps relieve any symptoms the cancer may be causing.
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Q4. If I have had anal cancer do I need to change my diet?
Not necessarily, but some people find they do need to make changes to their diet if they are having symptoms related to digestion such as diarrhoea, constipation or wind. Changes to your diet often depend on the type of anal cancer treatment you received.
Chemoradiation, a common treatment for anal cancer, may cause you to have frequent bowel movements. The radiotherapy part of the treatment can make your back-passage (rectum) irritated and may make you need to pass your bowel movements urgently. The chemotherapy may give you diarrhoea.
You may be advised to have a diet low in fibre during and following your treatment. Your digestion may take a while to settle down after treatment but will usually get back to normal and you will gradually be able to reintroduce more fibre into your diet. If you have surgery, you may need to have a colostomy. Some people will not have to make any changes while others will find that they feel better when they avoid certain foods. For example, if you have excess wind, which can be difficult to control if you have a colostomy, you may want to try and cut down on high fibre foods, fizzy drinks and rich and fatty foods.
If you are having problems with your digestion following treatment you may want to keep a record of what you eat, when you eat and any symptoms you have. You could ask to see a dietitian who would be able to give you advice about your diet.
Q5. I have some of the symptoms of anal cancer. What else could it be?
There are a number of much less serious conditions that can cause symptoms similar to anal cancer.
It can be common to see a little blood on the toilet paper. This may be due to a small injury to the anus caused by passing hard faeces or could be due to piles (haemorrhoids). Piles can feel like small lumps around the anus and can also cause itchiness. If you have these symptoms for more than a day, or if you have any other symptoms in the anal area, you should visit your GP for a check-up. Treatment for anal cancer is much more likely to be successful if it’s started early.
Q6. Will I still be able to do sports and exercise, such as swimming, if I have a colostomy?
Yes. You can still participate in sports and other activities, including swimming and watersports, if you have had a colostomy. However, before doing any contact sports, such as rugby or boxing, it’s advisable to discuss this with your doctor or stoma nurse. This is because of the potential risk of injuring the stoma.
There is no reason why you shouldn’t lead a lifestyle as active as before you had your colostomy. There are a number of different stoma appliances such as special waterproof bags and seals for swimming and watersports. Caps are also available that can block your stoma during activities where you don’t want to wear a colostomy bag.
You may worry that other people will be able to see or smell your colostomy bag, but modern stoma appliances are well designed and are not easily visible through your clothes, and your bag shouldn’t smell if it’s properly fitted. If you do notice that it smells, see your stoma nurse who may be able to recommend a different type or fit of bag.
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