When treating anal squamous cell carcinoma, how does your radiotherapy regimen change when there is a bleeding anal fissure?

I wouldn't delay tx. The simple non-surgical things used to try to manage an anal fissure (Metamucil, warm water soaks, and a topical cream like Anusol) also help to get a patient through the acute effects of RT. I would be very uncomfortable with any surgical attempts to manage the fissure. Cutting through the cancer and waiting for it to heal before starting RT won't happen. The only question is, whether the patient would benefit from a diverting ileostomy pre tx. We've sometimes done that for...