On this page: Chemoradiotherapy | Surgery | Follow-up appointments | More information
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.
Side effects of chemoradiotherapy
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:
- nausea, vomiting and diarrhoea
- appetite loss
- needing to pass urine more often or leaking
- loss of pubic hair
- low resistance to infection – if you have a
temperature over 38°C, contact your doctor
or go to the emergency department
- sensitivity to light (photosensitivity) and gritty eyes
- sore, reddened skin and ulcers around the anus,
genital areas and groin – this can cause intense
pain when sitting and during bowel movements
- narrowing and closing up of the vagina (managed
with regular use of dilators after treatment)
- effects on sexuality, including painful intercourse
and loss of erections (see sexuality and intimacy for more information)
- effects on fertility (see fertility and cancer for more information)
For more information on treatments and managing
these side effects, see our radiotherapy and chemotherapy sections.
Effects on sexuality and fertility
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.
Surgery for very small tumours
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.
For detailed information about radiotherapy and managing side effects, visit targetingcancer.com.au. You can also find out more about HPV and anal cancer at analcancerfoundation.org.
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.