How anal cancer is treated
If you're diagnosed with anal cancer, you'll be cared for by a team of different specialists who work together to provide the best treatment and care.
The main treatments used for anal cancer are:
- chemoradiation – a combination of chemotherapy and radiotherapy
- surgery – to remove a tumour or a larger section of bowel
If the cancer has spread and can't be cured, chemotherapy alone may be considered to help relieve symptoms. This is known as palliative care.
Chemoradiation
Chemoradiation is a treatment that combines chemotherapy (cancer-killing medication) and radiotherapy (where radiation is used to kill cancer cells).
It's currently the most effective treatment for anal cancer. You don't usually need to stay in hospital when you're having chemoradiation.
In many cases, part of the chemotherapy is delivered through a small tube called a peripherally inserted central catheter (PICC) in your arm, which can stay in place until your treatment has finished.
The tube means you don't need to stay in hospital during each of the cycles of chemotherapy. However, you'll be attached to a small plastic pump, which you take home with you.
A few hospitals now offer tablet chemotherapy for anal cancer, which avoids the need for the pump and PICC.
Read more about how chemotherapy is carried out.
Radiotherapy is usually given in short sessions, over several weeks. Read more about how radiotherapy is carried out.
Both chemotherapy and radiotherapy often cause significant side effects, including:
- tiredness
- sore skin around the anus
- sore skin around the penis and scrotum in men or vulva in women
- hair loss – limited hair loss from the head, but total loss from the pubic area
- feeling sick
- diarrhoea
These side effects are usually temporary, but there's also a risk of longer-term problems, such as infertility.
If you're concerned about the potential side effects of treatment, discuss this with your care team before treatment begins.
Other possible long-term side effects can include:
Tell your doctor if you develop any of these symptoms so they can be investigated and treated.
Surgery
Surgery is a less common treatment option for anal cancer. It's usually only considered if the tumour is small and can be easily removed, or if chemoradiation hasn't worked.
If the tumour is very small, it may be cut out during a procedure called a local excision. This is a relatively simple procedure, carried out under general anaesthetic, that usually only requires a stay in hospital of a few days.
If chemoradiation has been unsuccessful or the cancer has returned after treatment, a more complex operation called an abdominoperineal resection may be recommended. As with a local excision, this operation is carried out under general anaesthetic.
An abdominoperineal resection involves removing your anus, rectum, part of the colon, some surrounding muscle tissue, and sometimes some of the surrounding lymph nodes (small glands that form part of the immune system) to reduce the risk of the cancer returning. You'll usually need to stay in hospital for a bit longer after this type of surgery.
During the operation, a permanent colostomy will also be formed to allow you to pass poo.
This is where a section of the large intestine is diverted through an opening made in your tummy called a stoma. The stoma is attached to a pouch that will collect your poo after the operation.
Before and after the operation, you'll see a specialist nurse who can offer support and advice to help you adapt to life with a colostomy.
Adjusting to life with a colostomy can be challenging, but most people get used to it over time.
Read more about living with a colostomy.
Follow-up
After your course of treatment ends, you'll need to have regular follow-up appointments to monitor your recovery and check for any signs of the cancer returning.
To start with, these appointments will be every few weeks or months, but they'll gradually become less frequent over time.
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