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Anal Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Anal Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

About the anus and anal cancer

The anus is part of the gastrointestinal tract. It is the opening at the end of the large intestine, below the rectum, where bowel movements leave the body. Anal cancer begins when healthy cells in or on the anus change and grow uncontrollably, forming a mass called a tumor.

A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

At first, the changes in a cell are abnormal, not cancerous. Researchers believe, however, that some of these abnormal changes are the first step in a series of slow changes that can lead to cancer.

Some of the abnormal cells go away without treatment, but others can become cancerous. This phase of the disease is called dysplasia, which is an abnormal growth of cells. Dysplasia in the anus is called anal intraepithelial neoplasia (AIN) or anal squamous intraepithelial lesions (SILs).

Growths—such as polyps or warts—that are not cancerous can also occur in or around the anus; some may become cancerous over time. In some cases, the precancerous tissue needs to be removed to keep cancer from developing.

The anus is made up of different types of cells, and each type can become cancerous. There are several different types of anal cancer based on the type of cell where the cancer began:

  • Squamous cell carcinoma is the most common type of anal cancer. This cancer begins in the outer lining of the anal canal.
  • Cloacogenic carcinoma accounts for about one-quarter of all anal cancer. This type of cancer arises between the outer part of the anus and the lower part of the rectum. Cloacogenic cell cancer likely starts from cells that are similar to squamous cell cancer, and it is treated similarly.
  • Adenocarcinoma arises from the glands that make mucous located under the anal lining.
  • Basal cell carcinoma is a type of skin cancer that can appear in the perianal (around the anus) skin.
  • Melanoma begins in cells that produce color found in the skin or anal lining.

The next section in this guide is Statistics and it helps explain how many people are diagnosed with this disease and general survival rates. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Anal Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find information about how many people are diagnosed with this type of cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

This year, an estimated 7,270 adults (2,640 men and 4,630) women in the United States will be diagnosed with anal cancer. It is estimated that 1,010 deaths (400 men and 610 women) from this disease will occur this year.

The five-year survival rate is the percentage of people who survive at least five years after the cancer is found. The five-year survival rate is 71% for people diagnosed with the early stages of squamous cell anal cancer, which is the most common type of anal cancer. Later-stage squamous cell anal cancer (stage IV) has a five-year survival rate of 21%. Survival rate may be lower for people who have human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS).

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States each year, so the actual risk for a particular individual may be different. It is not possible to tell a person how long he or she will live with anal cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2015, and the ACS website.

The next section in this guide is Risk Factors and Prevention and it explains what factors may increase the chance of developing this disease. Or, use the menu on the side of your screen to choose another section to continue reading this guide 

Anal Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. In addition, this page includes information on how to reduce your risk of getting anal cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a person’s risk of developing anal cancer:

  • Human papillomavirus (HPV) infection. Research indicates that infection with this virus is a risk factor for anal cancer. HPV is most commonly passed from person to person during sexual activity. There are different types, or strains, of HPV. Some strains are more strongly linked with certain types of cancer. HPV vaccines protect against certain specific strains of the virus.
  • Age. Most people diagnosed with anal cancer are between age 50 and 80.
  • Frequent anal irritation. Frequent anal redness, swelling, and soreness may increase the risk of developing anal cancer.
  • Anal fistula. An anal fistula is an abnormal tunnel between the anal canal and the outer skin of the anus. The tunnel often drains pus or liquid, which can soil or stain clothing. An anal fistula may irritate the outer tissues or cause discomfort. An anal fistula may increase the risk of developing anal cancer.
  • Cigarette smoking. Smoking tobacco can cause harm throughout the body. Chemicals from the smoke can enter the bloodstream and affect nearly every organ and tissue in the body. Smokers are about eight times more likely to develop anal cancer than nonsmokers.
  • Lowered immunity. People with diseases or conditions affecting the immune system—such as HIV or organ transplantation—are more likely to develop anal cancer. People who take immunosuppressive drugs that make the immune system less able to fight disease are also more likely to develop anal cancer.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

  • Talk with your doctor about HPV vaccination. In 2010, the U.S. Food and Drug Administration (FDA) approved the HPV vaccine Gardasil for prevention of anal cancer in females and males ages nine to 26. Learn more about cancer vaccines.
  • Avoid anal sexual intercourse, which carries an increased risk of HPV and HIV infection.
  • Limit the number of sex partners. Having many partners increases the risk of HPV and HIV infection.
  • Use a condom. However, even though condoms can protect against HIV, they cannot fully protect against HPV.
  • Stop smoking. Learn more about how to quit smoking.

The next section in this guide is Screening and it explains how tests may find cancer before signs or symptoms appear. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Anal Cancer - Screening

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find out more about how people may be screened for this type of cancer, including risks and benefits of screening. To see other pages, use the menu on the side of your screen.

Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer before signs or symptoms appear. The overall goals of cancer screening are to:

  • Lower the number of people who die from the disease, or eliminate deaths from cancer altogether
  • Lower the number of people who develop the disease

Learn more about the basics of cancer screening.

Screening information for anal cancer

Cancer screening is done to find cancer as early as possible in people who don’t yet have any signs of the disease. Anal cytology is a test being developed that doctors can use for people who don’t have symptoms of anal cancer but do have a high risk of contracting a sexually transmitted disease (STD), such as HPV and HIV.

The test is similar to a Pap test, which looks for cervical cancer. The doctor can swab the anal lining and look at the cells on the swab under a microscope to find early cellular changes that might lead to cancer or may diagnose cancer from this swab.

Some doctors are advocating the routine use of this test for men who have HIV and who have sex with men and for other people who are at high risk for developing anal cancer.

The next section in this guide is Symptoms and Signs and it explains what body changes or medical problems this disease can cause. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Anal Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.  

People with anal cancer may experience the following symptoms or signs. Sometimes, people with anal cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer.

  • Bleeding from the anal area
  • Pain or pressure in the anal area
  • Itching or discharge from the anus
  • A lump or swelling near the anus
  • A change in bowel habits or change in the diameter of the stool

If you are concerned about one or more of the symptoms or signs on this list, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis and it explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu on the side of your screen to choose another section to continue reading this guide. 

Anal Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer.

If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread.

This list describes options for diagnosing this type of cancer. Not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of cancer suspected
  • Signs and symptoms
  • Previous test results

In addition to a physical examination, the following tests may be used to diagnose anal cancer:

  • Digital rectal examination (DRE). During this test, the doctor inserts a gloved finger into the anus to feel for lumps or other abnormalities. General cancer guidelines suggest men have a DRE annually after the age of 50 and women have one during routine pelvic examinations. If you are at higher risk for developing anal cancer, your doctor may perform a DRE more often.
  • Anoscopy. If the doctor feels a suspicious area during a DRE, this endoscopic test may be performed to take a closer look at the area. An anoscopy allows the doctor to see inside the body with a thin, lighted, flexible tube called an anoscope. Similarly, a proctoscope can be used to view the rectum in a procedure called a proctoscopy. The person may be sedated as the tube is inserted into the anus and/or rectum.
  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The type of biopsy performed will depend on the location of the tumor. For instance, an excisional biopsy can remove the entire lump if the lump is small and has not grown into other tissues. Lymph nodes may also be removed and examined in a biopsy.
  • Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. In an anal ultrasound, an ultrasound wand is inserted into the anus to obtain the pictures.
  • X-ray. An x-ray is way to create a picture of the structures inside of the body using a small amount of radiation.
  • Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.
  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.
  • Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

The next section in this guide is Stages and Grades, and it explains the system doctors use to describe the extent of the disease. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Anal Cancer - Stages and Grades

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. In addition, you can read about how doctors evaluate and compare cancer cells to healthy cells, called grading. To see other pages in this guide, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished.

Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery.

There are different stage descriptions for different types of cancer.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?
  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?
  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are five stages of anal cancer: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for anal cancer:

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below:

TX: The primary tumor cannot be evaluated.

T0: There is no tumor.

Tis: Carcinoma in situ (early cancer that has not spread to other tissue) is present.

T1: The tumor is no larger than 2 centimeters (cm).

T2: The tumor is larger than 2 cm but not larger than 5 cm.

T3: The tumor is larger than 5 cm.

T4: The tumor has invaded other organs, such as the urethra, bladder, or a woman’s vagina.

Node (N)

The “N” in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the anus are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: Regional lymph nodes cannot be evaluated.

N0 (N plus zero): There is no regional lymph node metastasis.

N1: Cancer had spread to the perirectal (around the rectum) lymph nodes.

N2: Cancer has spread to the internal iliac (pelvic) and/or the inguinal (groin) lymph nodes on the same side of the body.

N3: Cancer had spread to the perirectal and inguinal lymph nodes and/or the internal iliac and/or inguinal lymph nodes on both sides of the body.

Metastasis (M)

The “M” in the TNM system indicates whether the cancer has spread to other parts of the body, called distant metastasis.

MX: Distant metastasis cannot be evaluated.

M0 (M plus zero): There is no distant metastasis.

M1: There is metastasis to other parts of the body.

Grade (G)

Doctors also describe this type of cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together.

If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor.

The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

GX: The tumor grade cannot be identified.

G1: The cells look more like normal tissue cells (well differentiated).

G2: The cells are somewhat different from normal cells (moderately differentiated).

G3: The cells do not look like normal cells (poorly differentiated).

G4: The cells barely resemble normal cells (undifferentiated).

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, M, and G classifications.

Stage 0: Abnormal cells are in the first layer of the lining of the anus only. The abnormal cells may become cancer. This stage is also called carcinoma in situ (Tis, N0, M0).

Stage I: The tumor is no larger than 2 cm and has not spread to the lymph nodes or other parts of the body (T1, N0, M0).

Stage II: The tumor is larger than 2 cm and has not spread to the lymph nodes or other parts of the body (T2 or T3, N0, M0).

Stage IIIA: The tumor may be any size and has spread to either the nearby lymph nodes or to organs, such as the urethra, bladder, or a woman’s vagina (T1 or T2 or T3, N1, M0; or T4, N0, M0).

Stage IIIB: The tumor has invaded other nearby organs, but lymph node spread is limited to the area around the rectum; there is no distant spread. Or, the tumor may be of any size; lymph node spread can be local or distant, but there is no disease spread to distant organs (T4, N1, M0; or any T, N2 or N3, M0).

Stage IV: The tumor may be any size and has spread to the lymph nodes and to distant parts of the body (any T, any N, M1).

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Anal Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu on the side of your screen.  

This section outlines treatments that are the standard of care (the best known treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option.

A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians and others.  

Making treatment decisions

For anal cancer, there are three main types of treatment: surgery, radiation therapy, and chemotherapy. Treatment options and recommendations depend on several factors, including:

  • The type, stage and grade of cancer
  • Possible side effects
  • The patient’s preferences
  • The patient’s overall health

Descriptions of each treatment option are listed below.

Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment, including possible bowel function, urinary function, and sexual side effects of the specific treatment plan.

Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. The type of surgery for anal cancer depends on the stage of the cancer. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Surgery for anal cancer may also be performed by a colorectal surgeon, who specializes in surgery on the colon or rectum.

Anal carcinoma in situ or early-stage cancer can often be treated by removing the abnormal cells and a small area of the surrounding healthy tissue, which is called a margin. Afterward, patients should receive regular follow-up screening to watch for and remove any new abnormal cells.

Previously, most patients with later stages of anal cancer were treated surgically before effective chemotherapy and radiation therapy were developed for anal cancer. However, studies have shown similar cure rates between surgical treatment and the combination of radiation therapy and chemotherapy. Now, most patients have a biopsy (which may require some level of surgery; see Diagnosis) followed by chemotherapy and radiation therapy without further surgery. Many patients can avoid major surgery with this type of combined treatment.

If a patient cannot have chemotherapy or radiation therapy, surgery may be recommended. Surgery may also be recommended if the cancer remains after initial treatment or returns after treatment has been completed.

A persistent or recurring tumor may be treated with an abdominoperineal resection, which is the surgical removal of the anus, rectum, and part of the colon. This procedure results in the patient needing a colostomy, which is an opening on the abdominal wall to allow feces to be collected in a bag. During this procedure, lymph nodes may also be removed, which is called a lymph node dissection.

Talk to your doctor about the possible side effects of the specific surgery recommended, before the operation. This discussion should include the ways side effects can be reduced or managed.

Learn more about the basics of cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.

A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. Radiation therapy for anal cancer is often combined with chemotherapy. Typically, patients receive five to six weeks of radiation which is given daily, Monday through Friday. Due to irritation of the skin, sometimes a break from radiation is needed for several days.

Patients with both anal cancer and HIV may need to be treated with lower doses of radiation therapy. This depends on the degree to which the patient’s immune system is compromised by the HIV.

Side effects of radiation therapy may include fatigue, mild to modest skin reactions, upset stomach, temporary anal irritation, loose bowel movements, and discomfort when having a bowel movement.

Scar tissue may form from the damage to anal tissue, which may interfere with bowel function. Most side effects go away soon after treatment is finished.

Learn more about the basics of radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.  

Chemotherapy for anal cancer usually consists of a combination of drugs. Common drugs for anal cancer include fluorouracil (5-FU, Adrucil) combined with either mitomycin C (Mitozytrex, Mutamycin) or cisplatin (Platinol). Chemotherapy is particularly effective for treating anal cancer when given in combination with radiation therapy, as discussed above. The combined treatment allows the use of lower radiation doses and improves the likelihood of completely destroying the tumor.

Patients with both anal cancer and HIV may need to receive lower doses of chemotherapy. This depends on the degree to which the patient’s immune system is compromised by the HIV.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, lowering of blood counts, (including cells that fight infection and help stop bleeding as well as anemia) risk of infection, nausea and vomiting, hair loss, loss of appetite, diarrhea. These side effects usually go away once treatment is finished.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible.

Learn more about palliative care.   

Metastatic anal cancer

If cancer has spread to another location in the body, it is called metastatic cancer.

Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about getting a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

Your health care team may recommend a treatment plan that includes a combination of surgery, radiation therapy, and chemotherapy. Palliative care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED. 

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above, such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace.

Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope.

Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help. Many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families.

Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials and it offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Anal Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for patients with anal cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was previously tested in clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the standard treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and managing the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result.

Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating anal cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with anal cancer.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects.

Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will provide their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for anal cancer, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research and it explains areas of scientific research currently going on for this type of cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.    

Anal Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages in this guide, use the menu on the side of your screen.

Doctors are working to learn more about anal cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

  • Radiosensitizers. Drugs that make tumor cells more susceptible to radiation therapy are being explored as a way to enhance the effectiveness of radiation therapy.
  • HPV vaccines. Because anal cancer is likely caused by HPV, an HPV vaccine (see Risk Factors and Prevention) could potentially prevent many cases of anal cancer from occurring. Learn more about HPV and cancer.
  • Anal cytology. Similar to a Pap test, anal cytology looks for abnormal cells in the anal lining. This test may help find anal cancer at the earliest, most treatable stages.
  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current anal cancer treatments, in order to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding anal cancer, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Side Effects and it offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu on the side of your screen to choose another section to continue reading this guide. 

Anal Cancer - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

There are possible side effects for every cancer treatment, but patients don’t experience the same side effects when given the same treatments for many reasons. That can make it hard to predict exactly how you will feel during treatment. Common side effects from each treatment option for anal cancer are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them.

Side effects depend on a variety of factors, including:

  • The cancer’s stage
  • The length and dosage of treatment(s)
  • Your overall health

Damage to the anus, bowel, or bladder can occur from the use of radiation therapy, resulting in diarrhea, problems with urination, or problems having bowel movements. Surgery or combined use of radiation therapy and chemotherapy can result in sexual side effects for both men and women, beyond the anus. For men, this many include impotence. For women, the vagina can be affected.  

Talking with your health care team about side effects

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them.

And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with anal cancer. Learn more about caregiving.

In addition to physical side effects, there may be psychosocial emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

The next section in this guide is Follow-up Care and it explains the importance of check-ups after cancer treatment is finished. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Anal Cancer - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

Care for people diagnosed with cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. Regular examinations are important following treatment of anal cancer to find any recurrence of the cancer or spread to other parts of the body. The examinations usually are scheduled in the anus for every few months for the first two or three years following treatment, and then at less frequent intervals.

In addition to physical examination, other procedures (such as proctoscopy), imaging scans (such as CT scanning), and blood tests may be done, depending on the treatment given.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors including the type and stage of cancer originally diagnosed and the types of treatment given.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship and it describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Anal Cancer - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will read about how to with challenges in everyday life after a cancer diagnosis. To see other pages, use the menu on the side of your screen.

What is survivorship?

The word survivorship means different things to different people. Two common definitions include:

  • Having no signs of cancer after finishing treatment.
  • The process of living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

In some ways, survivorship is one of the most complex aspects of the cancer experience because it is different for every person.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,
  • Thinking through solutions,
  • Asking for and allowing the support of others, and
  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from anal cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. For anal cancer survivors who smoke, quitting smoking is strongly encouraged. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical check-ups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: This 44-page booklet (available as a PDF) helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms.
  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.
  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Anal Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you.

You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What type of anal cancer do I have?
  • Can you explain my pathology report (laboratory test results) to me?
  • What is the stage and grade of my cancer? What does this mean?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?
  • What clinical trials are open to me? Where are they located, and how do I find out more about them?
  • What treatment plan do you recommend? Why?
  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?
  • What are the possible side effects of each treatment, both in the short term and the long term?
  • Who will be part of my health care team, and what does each member do?
  • Who will be coordinating my overall treatment?
  • How will this treatment affect my daily life? Will I be able to work, exercise, or perform my usual activities?
  • Will I need a colostomy bag?
  • Could this affect my bowel function? If so, for how long?
  • Could this treatment affect my sex life? If so, how and for how long?
  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?
  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?
  • What support services are available to me? To my family?
  • Whom should I call for questions or problems?
  • Is there anything else I should be asking?

Questions to ask about having surgery

  • What type of surgery will I have? Will lymph nodes be removed?
  • How long will the operation take?
  • How long will I be in the hospital?
  • Can you describe what my recovery from surgery will be like?
  • What are the possible long-term effects of having this surgery?

Questions to ask about having radiation therapy or chemotherapy?

  • What type of treatment is recommended?
  • What is the goal of this treatment?
  • How long will it take to give this treatment?
  • What side effects can I expect during treatment?
  • What are the possible long-term effects of having this treatment?
  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What is the risk of the cancer returning? Are there signs and symptoms I should watch for?
  • What long-term side effects or late effects are possible based on the cancer treatment I received?
  • What follow-up tests will I need, and how often will I need them? 
  • How do I get a treatment summary and survivorship care plan to keep in my personal records?
  • Who will be coordinating my follow-up care?
  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources, and it offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Anal Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Anal Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

Search for a cancer specialist in your local area using this free database of doctors from the American Society of Clinical Oncology.

Review dictionary articles to help understand medical phrases and terms used in cancer care and treatment.

Read more about the first steps to take when newly diagnosed with cancer.

Find out more about clinical trials as a treatment option.

Get information about managing the financial cost of cancer care.

Learn more about coping with the emotions that cancer can bring, including those within a family or a relationship.

Find a national, not-for-profit advocacy organization that may offer additional information, services, and support for people with this type of cancer.

Explore next steps a person can take after active treatment is complete.

To find a range of information and insights from different voices on timely cancer topics, visit the Cancer.Net Blog.

This is the end of Cancer.Net’s Guide to Anal Cancer. Use the menu on the side of your screen to select another section to continue reading this guide.