Although Karolinska currently is not a domestic provider of oncological treatment for anal cancer, competence, and facilities for such treatment are available. Our surgical unit has unique expertise in performing anal cancer surgery.
Karolinska University Hospital is a national and regional referral center for patients with advanced colorectal cancer requiring extensive, complex oncological and surgical treatment. Our CRC unit performs cytoreductive surgery with HIPEC (intra abdominal treatment with chemotherapy) as well as advanced multi organ resection surgery as indicated.
When possible, are performed with minimally invasive techniques, including robotic and laparoscopic surgery, although complex situations may require open surgery. All patients are treated within an enhanced recovery after surgery (ERAS) protocol, which has been shown to significantly reduce complications and length of hospital stay after surgery. Our unit is also involved in world-leading research in cancer, inflammatory bowel disease, and ERAS.
Anal cancer is a rare disease, but the least uncommon form is squamous cell anal cancer. A biopsy is used to make a diagnosis, and it is essential to stain for HPV association (preferably by p16 staining).
Apart from a thorough clinical examination, an MRI of the pelvis and a PET/CT should be performed to select the optimal treatment.
For most patients with anal cancer, combined chemoradiation (CRT) is the primary treatment, and surgery is reserved for poor responders to this therapy or after locally recurrent disease. For Swedish patients, CRT for anal cancer is not provided at Karolinska because of national centralization to four other units. However, in Sweden, there is an ongoing randomized trial examining the role of proton radiotherapy in this diagnosis. Patients needing surgery most often require complete excision of the rectum with a permanent colostomy, but for some patients, a full pelvic exenteration may be required. Patients with distant metastasis should be managed after individualized assessment.
In the case of localized anal cancer, the chance of a complete response after CRT exceeds 80% and chances for long-term survival are significant.