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Above: enlarged medial iliac lymph nodes in a springer spaniel with anal sac adenocarcinoma.
Treatment and Prognosis
There are a number of treatment options available for the management of anal sac gland carcinoma (anal sac adenocarcinoma). Decisions are made on the basis of a number of factors, primarily the amount and location of tumour tissue as noted above.
For patients with small (less than 3cm diameter) primary tumours and no evidence of spread of the tumour, local surgical excision can be the most appropriate therapy. For patients where this proves difficult or where the surgeon is concerned about the completeness of tumour removal, radiotherapy is used post-operatively to improve the tumour control. The average life expectancy for these patients in our clinic is three years and three months.
For patients with larger primary tumours but still no evidence of spread, chemotherapy can be used to attempt to shrink the tumour, permitting definitive excision to be performed with reduced risks of post-operative complications. Again, radiotherapy may be appropriate following surgery to improve the duration of the resulting complete remission. The average life expectancy for these patients in our clinic is two years.
Some patients have spread to their regional lymph nodes but no further and in these cases the treatment plan is determined by whether those enlarged lymph nodes can be removed surgically or not. As always, our aim is always to achieve optimal quality of life first and foremost and a good long and enjoyable life second. Therefore, if it is apparent that the enlarged lymph nodes can be excised without causing undue risk, they are removed. Subsequent surgery can be performed in these dogs to remove other lymph nodes that become enlarged months or years in the future.
For these patients there is an average life expectancy of sixteen months. If the lymph nodes look like they cannot be removed in their entirety or without presenting the patient with undue risk, they can be left or managed by either chemotherapy or radiotherapy or sometimes by a combination of these. Sadly less than 50% of these patients live more than 12 months from the time of diagnosis but as before, their quality of life is paramount during this time and measures are always being taken to ensure their well-being.
The final group of patients is the group with cancer that has spread throughout their body. Of course this is the worst case scenario but even in this situation patients can enjoy a normal quality of life for long periods of time with appropriate management.
Despite the gravity of a diagnosis of malignant cancer, some patients can enjoy an extremely prolonged period of complete normality and an excellent quality of life with appropriate therapy.