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Anal cancer

Anal cancer treatment options

Once you have been diagnosed with anal cancer, your multidisciplinary care team will work with you to customize a comprehensive treatment plan for your needs. Your individualized plan will include evidence-based medical treatments and technologies, as well as supportive care services designed to help you manage side effects.

In the past, surgery was the only treatment for anal cancer, but today, the disease is often treated with a combination of radiation therapy and chemotherapy. Surgery remains an option for early-stage anal cancer, particularly stage 0, and some stage I and II anal cancers.

Typically, two surgical procedures are used to treat anal cancer, depending on the type and location of the tumor:

  • A local resection treats cancers in the lower part of the anal canal, known as the anal margin. This may be an option for early-stage anal cancer that has not spread. This approach is primarily used to remove small tumors not involving the sphincter, which is the muscle used to control bowel movements. The tumor is removed along with a small amount of surrounding tissue. The sphincter is left intact to allow for normal bowel movements after surgery. Chemotherapy and radiation therapy may follow surgery.
  • An abdominoperineal resection is an option for recurrent cancer or cancer that has not responded to other treatments. It involves removing the anus and anal sphincter. Incisions are made in the abdomen and around the anus to remove the anus and rectum. A new opening is created to allow stool to pass from the body. A lymph node dissection to remove lymph nodes in the groins may also be performed, though this procedure may be done later.

A combination of radiation and chemotherapy, mainly performed for anal preservation, may be recommended as an alternative to surgery that results in a permanent colostomy, which requires a bag attached to the abdomen to collect stool.

Chemotherapy drugs, given intravenously or orally, target cancer cells to destroy them or impede their ability to grow and reproduce, while radiation therapy allows radiation oncologists to target difficult-to-reach tumors. Higher doses of radiation may be directed at anal cancer cells while reducing exposure to healthy tissue.