Anal Cancer: Types of Treatment

Approved by the Cancer.Net Editorial Board, 06/2019

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with anal cancer. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for anal cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

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 include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians and others.

Making treatment decisions

For anal cancer, there are 3 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 common types of treatments used for anal cancer are listed below. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients' preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear.

These types of talks are called “shared decision making.” Shared decision making is when you and your doctors work together to choose treatments that fit the goals of  your care. Shared decision making is particularly important for anal cancer because there are different treatment options.

Talk with your doctor about the goals of each treatment 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 regularly receive 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, recent 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.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. 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, or 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 5 to 6 weeks of radiation therapy which is given daily, Monday through Friday. If there is irritation of the skin, sometimes a break from radiation is needed for several days.

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. Talk with the radiation oncologist about what side effects you can expect and how to reduce or relieve them.

Learn more about the basics of radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs given 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.

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 after treatment is finished.

Learn more about the basics of chemotherapy.

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. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer 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 and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Metastatic anal cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of surgery, radiation therapy, and chemotherapy. There may also be a clinical trial appropriate for you to consider.  Palliative care will also be important to help relieve symptoms and side effects.

For most people, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. You and your family are encouraged to talk about how you feel 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 is 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 returns 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 new cycle of testing will begin again to learn as much as possible about the recurrence. After this 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 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. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope.

Learn more about dealing with cancer recurrence.

If treatment does not work

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

People who have advanced cancer and who are expected to live less than 6 months may want to consider 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 talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations Nursing care and special equipment can make staying at home a workable option 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. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose another section to continue reading this guide.