Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-22T08:56:15.298Z Has data issue: false hasContentIssue false

Chapter 12 - Anal and Colorectal Cancer

Published online by Cambridge University Press:  23 October 2024

By
Emma B. Holliday ,
Van K. Morris  and
Craig Messick
Edited by
Laurie J. Mckenzie  and
Denise R. Nebgen
Laurie J. Mckenzie
Affiliation:
University of Texas MD Anderson Cancer Center, Houston
Denise R. Nebgen
Affiliation:
University of Texas MD Anderson Cancer Center, Houston
Get access

Summary

Improvements in multimodality treatment of anal and colorectal cancer has led to increased numbers of women survivors who experience gynecologic problems in long-term survivorship. The etiology of gynecologic problems after anal and colorectal cancer treatment is complex and multifactorial. Pelvic radiation, surgery and chemotherapy can all cause anatomic, hormonal and psychological changes. Consideration of preventative measures can ideally reduce the risk of vaginal stenosis, dyspareunia, sexual dysfunction, infertility, premature menopause and pelvic pain after therapy. Proactive screening and appropriate treatment of cancer therapy late effects can improve patients’ quality of life during survivorship.

Keywords

Radiationlate effectssurvivorshipdyspareuniavaginal stenosissexual dysfunctioninfertilitypremature menopausepelvic pain
Type
Chapter
Information
Caring for the Female Cancer Patient
Gynecologic Considerations
 , pp. 200 - 214
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Siegel, R. L., Miller, K. D., Fuchs, H. E., Jemal, A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7–33.CrossRefGoogle Scholar
Bailey, C. E., Hu, C. Y., You, Y. N., et al. Increasing disparities in the age-related incidences of colon and rectal cancer in the United States, 1975–2010. JAMA Surg. 2015;150(1):17–22.CrossRefGoogle ScholarPubMed
Nelson, V. M., Benson, A. B. Epidemiology of anal canal cancer. Surg Oncol Clin N Am. 2017;26(1):9–15.CrossRefGoogle ScholarPubMed
Stoffel, E. M., Murphy, C. C. Epidemiology and mechanisms of the increasing incidence of colon and rectal cancer in young adults. Gastroenterology. 2020;158(2):341–53.CrossRefGoogle ScholarPubMed
Eng, C., Ciombor, K. K., Cho, M., et al. Anal cancer: Emerging standards in a rare disease. J Clin Oncol Off J Am Soc Clin Oncol. 2022;40(24):2774–88.CrossRefGoogle ScholarPubMed
Sauer, R., Liersch, T., Merkel, S., et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: Results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol Off J Am Soc Clin Oncol. 2012;30(16):1926–33.CrossRefGoogle ScholarPubMed
Gunderson, L. L., Winter, K. A., Ajani, J. A., et al. Long-term update of US GI intergroup RTOG 98-11 phase III trial for anal carcinoma: Survival, relapse, and colostomy failure with concurrent chemoradiation involving fluorouracil/mitomycin versus fluorouracil/cisplatin. J Clin Oncol Off J Am Soc Clin Oncol. 2012;30(35):4344–51.CrossRefGoogle ScholarPubMed
Bretthauer, M., Løberg, M., Wieszczy, P., et al. Effect of colonoscopy screening on risks of colorectal cancer and related death. N Engl J Med. 2022;387(17):1547–56.CrossRefGoogle ScholarPubMed
Rex, D. K., Boland, C. R., Dominitz, J. A., et al. Colorectal cancer screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017;112(7):1016–30.Google ScholarPubMed
NCCN Guidelines: Colon Cancer v2.2022 [Internet]. [cited November 21, 2022]. www.nccn.org/professionals/physician_gls/pdf/colon.pdfGoogle Scholar
NCCN Clinical Practice Guidelines in Oncology: Rectal Cancer v1.2022 [Internet]. National Comprehensive Cancer Network. 2022. www.nccn.org/professionals/physician_gls/pdf/rectal.pdfGoogle Scholar
National Comprehensive Cancer Network. NCCN Guidelines Version 2. 2020 Anal Carcinoma [Internet]. [cited February 5, 2021]. www.nccn.org/professionals/physician_gls/pdf/anal.pdfGoogle Scholar
Hall, E., Giaccia, A. Radiobiology for the Radiologist. 7th ed. Philadelphia, PA: Lippincott, Williams & Watkins; 2011.Google Scholar
Abitbol, M. M., Davenport, J. H. The irradiated vagina. Obstet Gynecol. 1974;44(2):249–56.Google ScholarPubMed
Delanian, S., Lefaix, J. L. Current management for late normal tissue injury: Radiation-induced fibrosis and necrosis. Semin Radiat Oncol. 2007;17(2):99–107.CrossRefGoogle ScholarPubMed
Kaidar-Person, O., Abdah-Bortnyak, R., Amit, A., et al. Tolerance of the vaginal vault to high-dose rate brachytherapy and concomitant chemo-pelvic irradiation: Long-term perspective. Rep Pract Oncol Radiother J Gt Cancer Cent Poznan Pol Soc Radiat Oncol. 2014;19(1):56–61.Google ScholarPubMed
Mirabeau-Beale, K., Hong, T. S., Niemierko, A., et al. Clinical and treatment factors associated with vaginal stenosis after definitive chemoradiation for anal canal cancer. Pract Radiat Oncol. 2015;5(3):e113-8.CrossRefGoogle ScholarPubMed
Bregendahl, S., Emmertsen, K. J., Lindegaard, J. C., Laurberg, S. Urinary and sexual dysfunction in women after resection with and without preoperative radiotherapy for rectal cancer: A population-based cross-sectional study. Colorectal Dis Off J Assoc Coloproctology G B Irel. 2015;17(1):26–37.Google ScholarPubMed
Bruheim, K., Tveit, K. M., Skovlund, E., et al. Sexual function in females after radiotherapy for rectal cancer. Acta Oncol Stockh Swed. 2010;49(6):826–32.Google ScholarPubMed
Thyø, A., Elfeki, H., Laurberg, S., Emmertsen, K. J. Female sexual problems after treatment for colorectal cancer: A population-based study. Colorectal Dis Off J Assoc Coloproctology G B Irel. 2019;21(10):1130–9.Google ScholarPubMed
Provencher, S., Oehler, C., Lavertu, S., et al. Quality of life and tumor control after short split-course chemoradiation for anal canal carcinoma. Radiat Oncol Lond Engl. 2010;5:41.CrossRefGoogle ScholarPubMed
Fakhrian, K., Sauer, T., Dinkel, A., et al. Chronic adverse events and quality of life after radiochemotherapy in anal cancer patients. A single institution experience and review of the literature. Strahlenther Onkol Organ Dtsch Rontgengesellschaft Al. 2013;189(6):486–94.Google ScholarPubMed
Sunesen, K. G., Nørgaard, M., Lundby, L., et al. Long-term anorectal, urinary and sexual dysfunction causing distress after radiotherapy for anal cancer: A Danish multicentre cross-sectional questionnaire study. Colorectal Dis Off J Assoc Coloproctology G B Irel. 2015;17(11):O230–239.Google ScholarPubMed
Koerber, S. A., Seither, B., Slynko, A., et al. Chemoradiation in female patients with anal cancer: Patient-reported outcome of acute and chronic side effects. Tumori J. 2019;105(2):174–80.CrossRefGoogle ScholarPubMed
Corrigan, K. L., Rooney, M. K., De, B., et al. Patient-reported sexual function in long-term survivors of anal cancer treated with definitive intensity modulated radiation therapy and concurrent chemotherapy. Pract Radiat Oncol. 2022;12(5):e397–405.CrossRefGoogle ScholarPubMed
Wallace, W. H. B., Thomson, A. B., Kelsey, T. W. The radiosensitivity of the human oocyte. Hum Reprod Oxf Engl. 2003;18(1):117–21.CrossRefGoogle ScholarPubMed
Schüring, A. N., Fehm, T., Behringer, K., et al. Practical recommendations for fertility preservation in women by the FertiPROTEKT network. Part I: Indications for fertility preservation. Arch Gynecol Obstet. 2018;297(1):241–55.CrossRefGoogle ScholarPubMed
Griffiths, M. J., Winship, A. L., Hutt, K. J. Do cancer therapies damage the uterus and compromise fertility? Hum Reprod Update. 2020;26(2):161–73.CrossRefGoogle ScholarPubMed
Van der Ven, H., Liebenthron, J., Beckmann, M., et al. Ninety-five orthotopic transplantations in 74 women of ovarian tissue after cytotoxic treatment in a fertility preservation network: Tissue activity, pregnancy and delivery rates. Hum Reprod Oxf Engl. 2016;31(9):2031–41.CrossRefGoogle Scholar
Muñoz, E., Fernandez, I., Martinez, M., et al. Oocyte donation outcome after oncological treatment in cancer survivors. Fertil Steril. 2015;103(1):205–13.CrossRefGoogle ScholarPubMed
Vogel, J. D., Felder, S. I., Bhama, A. R., et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer. Dis Colon Rectum. 2022;65(2):148–77.CrossRefGoogle ScholarPubMed
Kidane, B., Chadi, S. A., Kanters, S., Colquhoun, P. H., Ott, M. C. Local resection compared with radical resection in the treatment of T1N0M0 rectal adenocarcinoma: a systematic review and meta-analysis. Dis Colon Rectum. 2015;58(1):122–40.CrossRefGoogle ScholarPubMed
Rajput, A., Bullard Dunn, K. Surgical management of rectal cancer. Semin Oncol. 2007;34(3):241–9.CrossRefGoogle ScholarPubMed
Kim, S., Kim, S. W., Han, S. J. et al. Molecular mechanism and prevention strategy of chemotherapy- and radiotherapy-induced ovarian damage. Int J Mol Sci. 2021;22(14):7484.CrossRefGoogle ScholarPubMed
Bedoschi, G., Navarro, P. A., Oktay, K. Chemotherapy-induced damage to ovary: Mechanisms and clinical impact. Future Oncol Lond Engl. 2016;12(20):2333–44.Google ScholarPubMed
Cercek, A., Siegel, C. L., Capanu, M., Reidy-Lagunes, D., Saltz, L. B. Incidence of chemotherapy-induced amenorrhea in premenopausal women treated with adjuvant FOLFOX for colorectal cancer. Clin Colorectal Cancer. 2013;12(3):163–7.CrossRefGoogle ScholarPubMed
Sauer, M. V., Paulson, R. J., Ary, B. A., Lobo, R. A. Three hundred cycles of oocyte donation at the University of Southern California: Assessing the effect of age and infertility diagnosis on pregnancy and implantation rates. J Assist Reprod Genet. 1994;11(2):92–6.CrossRefGoogle ScholarPubMed
Gupta, S., Gupta, Y. N., Sanyal, B. Radiation changes in vaginal and cervical cytology in carcinoma of the cervix uteri. J Surg Oncol. 1982;19(2):71–3.CrossRefGoogle ScholarPubMed
Shandley, L. M., McKenzie, L. J. Recent advances in fertility preservation and counseling for reproductive-aged women with colorectal cancer: A systematic review. Dis Colon Rectum. 2019;62(6):762–71.CrossRefGoogle ScholarPubMed
Koerber, S. A., Seither, B., Slynko, A., et al. Chemoradiation in female patients with anal cancer: Patient-reported outcome of acute and chronic side effects. Tumori. 2019;105(2):174–80.CrossRefGoogle ScholarPubMed
Son, C. H., Law, E., Oh, J. H., et al. Dosimetric predictors of radiation-induced vaginal stenosis after pelvic radiation therapy for rectal and anal cancer. Int J Radiat Oncol Biol Phys. 2015;92(3):548–54.CrossRefGoogle ScholarPubMed
Briere, T. M., Crane, C. H., Beddar, S., et al. Reproducibility and genital sparing with a vaginal dilator used for female anal cancer patients. Radiother Oncol J Eur Soc Ther Radiol Oncol. 2012;104(2):161–6.CrossRefGoogle ScholarPubMed
Arians, N., Häfner, M., Krisam, J., et al. Intrafractional vaginal dilation in anal cancer patients undergoing pelvic radiotherapy (DILANA): A prospective, randomized, 2-armed phase-II-trial. BMC Cancer. 2020;20(1):52.CrossRefGoogle ScholarPubMed
Miles, T., Johnson, N. Vaginal dilator therapy for women receiving pelvic radiotherapy. Cochrane Database Syst Rev. 2010;9:CD007291.Google Scholar
Stahl, J. M., Qian, J. M., Tien, C. J., et al. Extended duration of dilator use beyond 1 year may reduce vaginal stenosis after intravaginal high-dose-rate brachytherapy. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2019;27(4):1425–33.Google ScholarPubMed
NCCN. NCCN Clinical Practice Guidelines: Survivorship Guidelines [Internet]. National Comprehensive Cancer Network. [cited July 17, 2020]. www.nccn.org/professionals/physician_gls/default.aspx#survivorshipGoogle Scholar
Candy, B., Jones, L., Vickerstaff, V., Tookman, A., King, M. Interventions for sexual dysfunction following treatments for cancer in women. Cochrane Database Syst Rev. 2016;2:CD005540.Google ScholarPubMed
Denton, A. S., Maher, E. J. Interventions for the physical aspects of sexual dysfunction in women following pelvic radiotherapy. Cochrane Database Syst Rev. 2003;2003(1):CD003750.Google ScholarPubMed
Wo, J. Y., Viswanathan, A. N. Impact of radiotherapy on fertility, pregnancy, and neonatal outcomes in female cancer patients. Int J Radiat Oncol Biol Phys. 2009;73(5):1304–12.CrossRefGoogle ScholarPubMed
Bisharah, M., Tulandi, T. Laparoscopic preservation of ovarian function: An underused procedure. Am J Obstet Gynecol. 2003;188(2):367–70.CrossRefGoogle ScholarPubMed
Ribeiro, R., Rebolho, J. C., Tsumanuma, F. K., et al. Uterine transposition: Technique and a case report. Fertil Steril. 2017;108(2):320–324.e1.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×