Anal cancer


Treatment for anal cancer

Thursday 13 August, 2020

Because anal cancer is rare, experts recommend that you have your treatment in a specialised centre and provided by 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 (its stage), your age and fitness, and your preferences. You may want to get a second opinion from another specialist team to confirm or explain the treatment options.

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. Most anal cancers are treated with a combination of radiation therapy and chemotherapy, which is known as chemoradiation or chemoradiotherapy. Surgery may also be used in some cases.

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.

Radiation therapy

Also known as radiotherapy, this treatment uses targeted radiation, such as x-ray beams, to kill or damage cancer cells so they cannot grow, multiply or spread. 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.

Chemotherapy

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.

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. Early side effects include the following

  • tiredness
  • appetite loss, nausea and vomiting – nausea and vomiting are usually prevented with medicines
  • 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: your team will recommend creams for this
  • pain in the anal region: talk to your treatment team about a pain management plan
  • increased risk of infection: if you have a temperature over 38° C, contact your doctor or go to a hospital emergency department
  • 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. Late side effects include the following:

  • bowel changes, with scar tissue in the anal canal or rectum leading to problems with poo
  • dryness, shortening or narrowing of the vagina (vaginal stenosis): this can be prevented or minimised by using vaginal dilators regularly
  • impacts on sexuality, including painful intercourse, difficulty getting erections or loss of pleasure
  • effects on the ability to have children (fertility).

See Cancer Council's Understanding Radiation Therapy and Understanding Chemotherapy booklets for more details about treatment and side effects.

Effects on sexuality and fertility

Chemoradiation for anal cancer can have a range of effects on sexuality and may also affect fertility. Ask your doctor about ways to manage these changes, as early treatment and support can help. You can also read Cancer Council's booklets on sexuality and fertility.

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

For most people with anal cancer, chemoradiation is the main treatment. It is usually very effective and allows you to keep your anal canal. 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. For more information, see Cancer Council’s Understanding Bowel Cancer booklet.

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.

Questions for your doctor

You may find this checklist helpful when thinking about the questions you want to ask your doctor.

  • What type of anal cancer do I have? What part of the anus is affected? Has the cancer spread?
  • What treatment do you recommend? What are the risks and possible side effects?
  • Are there any other treatment options for me?
  • Will the treatment affect my sexual function or pleasure? Will the treatment affect my fertility?
  • Do I have HPV? Can I pass on HPV to my partner? Should I or my partner get vaccinated against HPV?
  • Are there any clinical trials or studies I could join?
  • How often will I need check-ups? Can I examine myself between check-ups?
  • If the cancer comes back, how will I know? What treatments could I have then?

Expert content reviewers:

Dr Chip Farmer, Colorectal Surgeon, The Alfred, The Avenue and Cabrini hospitals, Vic; Tara Faure, Lower GI Nurse Consultant, Peter MacCallum Cancer Centre, Vic; Dr Debra Furniss, Radiation Oncologist,
GenesisCare, Qld; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Max Niggl, consumer; Julie O’Rourke, CNC Radiation Oncology, Cancer Rapid Assessment Unit, Cancer and Ambulatory Support, Canberra Health Services, ACT; Dr Satish Warrier, Colorectal Surgeon, Peter MacCallum Cancer Centre, Vic

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