Because anal cancer is rare, it is recommended that you are treated in a specialised centre with a multidisciplinary team (MDT) who regularly manages this cancer. The team will work out the best treatment for you, depending on the type and location of the cancer, whether the cancer has spread, your age and fitness, and your preferences. 

Understanding the disease, the available treatments, possible side effects and any extra costs can help you weigh up the treatment options and make a well-informed decision. 

Chemoradiation

This treatment combines a course of radiation therapy with some chemotherapy sessions. The chemotherapy makes the cancer cells more sensitive to the radiation therapy.

For anal cancer, a typical treatment plan might involve a session of radiation therapy every weekday for several weeks, as well as chemotherapy on some days during the first and fifth weeks. This approach allows for lower doses of radiation therapy. For anal cancer, the chemotherapy drugs will usually be given into a vein through an intravenous (IV) drip.

Side effects of chemoradiation

Both chemotherapy and radiation therapy can have side effects. These can occur during or soon after the treatment (early side effects), or many months or years later (late side effects). 

Early side effects

These usually settle down in the weeks after treatment and can include:

• tiredness
• appetite loss, nausea and vomiting
• bowel changes, such as diarrhoea, needing to poo more often or more urgently, and pain when pooing
• passing urine (weeing) more often, leaking urine (incontinence) or pain when weeing
• skin changes, with redness, itching, peeling or blistering around the anus, genital areas and groin
• pain in the anal region
• increased risk of infection
• loss of pubic hair.

Late side effects

These can occur more than six months, or even years, after treatment ends. They vary a lot from person to person and can include:

• bowel changes, with scar tissue in the anal canal or rectum leading to ongoing frequent, urgent or painful bowel movements
• dryness, shortening or narrowing of the vagina (vaginal stenosis)
• impacts on sexuality, including painful intercourse, difficulty getting erections or loss of pleasure
• effects on the ability to have children.

Surgery

Surgery may be used for very early anal cancer or in a small number of other situations.

Surgery for very small tumours

An operation called local excision can remove very small tumours located near the entrance of the anus (anal margin), if they are not too close to the muscles of the anus. The surgeon will give you a local or general anaesthetic and insert an instrument into the anus to remove the tumours. Once the wound heals, the anal canal will still work in the normal way.

Abdominoperineal resection

A major operation called an abdominoperineal resection may be recommended if you cannot have chemoradiation because you have previously had radiation therapy to the pelvic region. This operation may also be used if anal cancer comes back after chemoradiation.

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, an opening in the abdomen that allows poo to leave the body. A stoma bag is worn on the outside of the body to collect the poo. 

Follow-up appointments

After treatment, you will need check-ups every 3–12 months for several years to confirm that the cancer hasn’t come back. Between visits, let your doctor know immediately if you have new symptoms in the anal region or any other health problems.