Treatment Options 

After the biopsy results return from the anoscopy, there are multiple treatment options
for any warts or dysplasia.  How extensive the problem, and the location of the lesions,
will effect which treatment to use. The choices are:

Infrared Coagulator (IRC):  This is a bright light, similar to a laser, that causes
superficial destruction of the tissue.  It can be done repeatedly down to the healthy
tissue.  It can cause pain from heat, and a topical or injected anesthetic is used to
minimize this.

Hyfrecator:  Low powered electro surgery.  Painful, but useful for more external lesions
after injection of anesthetic.  Can also be used inside the rectum, but usually in the
operating room more commonly that the office.

Cryosurgery:  Freezing with liquid nitrogen.  Less painful, but usually requires repeated
treatments.

Topical Trichloracetic Acid (TCA):  Easy to apply and pretty painless, but usually
requires repeated weekly application.  It can be used after cryosurgery.

Topical 5FU (5-Fluorouracil):  A cancer chemotherapy that can be self-applied by
the patient over a period of weeks.  It can cause a fair amount of rectal irritation.  It can be
used if there is extensive dysplasia or warts to try to bring down the amount of dysplasia
and make IRC treatment easier.

Imiquimod Cream (Aldara, Zyclara):  Another topical agent applied by the patient over
a period of weeks.  It is felt to cause the body's immune system to turn on to treat the
lesions.  It can cause rectal irritation, but most people tolerate it well.  It has a fair
success rate.  Mostly used on external lesions.

Sinecatechins (Veregan):  Another topical agent, derived from green tea leaves.  This
can be applied by the patient over a period of months, and has shown fairly good results.