Your doctor will recommend the best treatment for you, depending on the type and location of the anal cancer; whether the cancer has spread (its stage); your age and fitness; and your preferences.
Most anal cancers are treated with a combination of radiotherapy and chemotherapy, which is known as chemoradiotherapy. Surgery may also be used in some cases.
Understanding the available treatments and possible side effects can help you weigh up the pros and cons of different treatments. You may want to get a second opinion from another specialist to confirm or clarify the doctor’s recommendations
Also known as chemoradiation, this treatment combines a course of radiotherapy with some chemotherapy sessions. The chemotherapy makes the cancer cells more sensitive to the radiotherapy. For anal cancer, a typical treatment plan might involve a session of radiotherapy every weekday for several weeks, as well as some days with chemotherapy during the first and fifth weeks. This approach avoids surgical removal of the anus in most people and allows for lower doses of radiotherapy.
This is the treatment of cancer with anti-cancer (cytotoxic) drugs. It aims to kill cancer cells while doing the least possible damage to healthy cells. For anal cancer, the chemotherapy drugs will usually be given into a vein through an intravenous (IV) drip.
This uses radiation, such as high-energy x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells so they cannot grow or multiply. The radiation is targeted to the location of the cancer, and treatment is carefully planned to do as little harm as possible to the normal body tissue around the cancer.
During a treatment session, you lie under a machine that delivers radiation to the treatment area. It can take 10–20 minutes to set up the machine, but the treatment itself takes only a few minutes and is painless. You will be able to go home afterwards.
If you smoke, it is worth making every effort to quit before treatment begins. Smoking can make side effects worse and treatment less effective. Call 13 QUIT (13 7848) for support.
Both chemotherapy and radiotherapy can have side effects, but many side effects are temporary and there are ways to prevent or reduce them.
Side effects of chemoradiotherapy can include:
Chemoradiotherapy for anal cancer can have a range of effects on sexuality, including loss of interest in sex (low libido); changes to the vagina or to the anus and rectum that can cause pain or loss of pleasure during intercourse; and difficulty getting and maintaining an erection (erectile dysfunction). Ask your doctor about ways to manage these changes. You can also ask for a referral to a sexual therapist.
You may be advised to use contraception during chemoradiotherapy as the treatment could harm a developing fetus. The treatment may also affect fertility, so talk to your doctors before treatment begins if you may want to have children in the future. It is sometimes possible to store sperm or eggs for future use, or to move ovaries away from the treatment area.
For women who have not yet been through menopause, radiotherapy to the pelvic region may cause periods to stop permanently. This is known as early menopause and can lead to symptoms such as hot flushes, dry skin and vaginal dryness. Talk to your doctor about hormone replacement therapy (HRT) and other treatments for these symptoms.
For more information about the impact of cancer treatment on fertility and sexuality, call Cancer Council 13 11 20 or read Cancer Council’s Sexuality, Intimacy and Cancer and Fertility and Cancer booklets.
Surgery may be used for very early anal cancer and in a small number of other situations.
A form of surgery called local excision can remove very small tumours that have clear edges and are located near the entrance of the anus (anal margin). The surgeon inserts an instrument into the anus to remove the tumours. You will usually have a general anaesthetic.
For most people with anal cancer, chemoradiotherapy is the main treatment and is usually very effective. However, a major operation called an abdominoperineal resection may be recommended if you cannot have chemoradiotherapy because you have had radiotherapy to the pelvic region for another cancer. This operation may also be used for anal cancer that remains or comes back after chemoradiotherapy.
In an abdominoperineal resection, the anus, rectum and part of the colon (large bowel) are removed. The surgeon uses the remaining colon to create a permanent stoma. Also called a colostomy, this stoma is an opening in the abdomen that allows faeces to leave the body. A stoma bag is worn on the outside of the body to collect the faeces. For more information, see our having a stoma and surgery sections.
After treatment, you will need check-ups every 3–12 months for several years to confirm that the cancer hasn’t come back. As part of your follow-up, your specialist may arrange a test called a high-resolution anoscopy. In this test, a short instrument is inserted into the anus to create magnified images of the anal canal.
Between visits, let your doctor know immediately of any health problems.
Reviewed by: A/Prof Richard Hillman, Sexual Health Physician, Western Sydney Sexual Health Centre and University of Sydney, NSW; A/Prof Martin Borg, Radiation Oncologist, Adelaide Radiotherapy Centre, SA; Mr Chip Farmer, Colorectal Surgeon, The Alfred Hospital, Cabrini Hospital and The Avenue Hospital, VIC; Judy Koch, Consumer; Stephen Leppard, Consumer; Caitriona Nienaber, 13 11 20 Nurse, Cancer Council Western Australia, WA.