Gastrointestinal cancer club delhi india, Dr.Ajay K.Sachdev delhi based Dept. of Gastrointestinal Surgeon serior gastro intestinal surgeonconsultant Surgery G.I. Surgeon G I Surgery Radiotherapy,Chemotherapy, G.I Cancers Advanced Hepatobiliary, Pancreatic, Esophageal,Intestinal,Colorectal surgeries and G.I. Oncoogy cancers of abdominal organs Gastroenterology IASG CANCERS OF ABDOMINAL ORGANSEXPERIENCED G.I. SURGEON

Localized disease Vs Advanced disease
Localized disease :-

-	Primary chemo radiation- 5year survival 22%. Cisplatin and 5 FU based regimens
-	Preop Chemo radiation- still investigational- Mostly adenoca and modest survival benefit with increased post op mortality.
-	Drugs used are 5 FU and Cisplatin Week 1,5,8 and 11.

Paclitaxel and DDP are being evaluated.
Preoperative chemotherapy - tried in resectable localized
cancer with variable results. Can be considered investigational.

Symptom control and prolongation of survival
Inoperable ,locally advanced- Chemo/Rad.
Metastatic- Chemotherapy

	-	Mainstay remains Cisplatin, addition of 5 FU increases responses
	-	Addition of Taxanes/irinotecan/gemcitabine- response rate of 50% with MS-14-16 months.

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With anal cancer, chemotherapy is most commonly given at the same time as radiation

A number of different chemotherapeutic agents exist, each with their own side effects. The most commonly used agents in anal cancer are 5-flourouracil (5-FU) with either Mitomycin C or Cisplatin. Exactly which chemotherapeutic agents are given for anal cancer varies according the physician given them. It is important to discuss the risk of each of these medications with your medical oncologist. Based on your own health status and the risks of side effects that you are willing to accept, the choice of chemotherapy can vary.

Chemotherapy can also be given if the cancer has spread to distant sites. In this setting, unless there are specific local symptoms from anal cancer, the mainstay of treatment becomes chemotherapy, because as discussed above, chemotherapy can travel throughout the entire body.

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This cancer is unfortunately common in northern India . It usually presents in fairly advanced stage with either extensive liver involvement or with spread beyond.

It is common to offer chemotherapy to relieve the symptoms and prolong the life. The chemotherapy drugs commonly used are Gemcitabine and Oxaliplatin.