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Treatment decisions

Your doctor considers a number of factors when deciding which treatment you need. Find out how they make the decision, the types of treatment you might have and treatment by stage.

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

  • where your cancer is
  • how far it has grown or spread (the stage)
  • the type of cancer
  • how abnormal the cells look under a microscope (the grade)
  • your general health and level of fitness

Your doctor will discuss your treatment, its benefits and the possible side effects with you.

Treatment overview

The main treatments are:

  • chemoradiotherapy (chemotherapy and radiotherapy together)
  • surgery
  • chemotherapy
  • radiotherapy

You have one or more of these treatments depending on the stage of your cancer.

Treatment by stage

Stage 0 (anal intraepithelial neoplasia)

For low grade AIN (AIN 1 or AIN 2) you might not need treatment. The abnormal cells might go back to normal without treatment. Your doctor will arrange regular checks to monitor your AIN. 

For high grade AIN (AIN 3) you will need treatment because the abnormal cells are less likely to get better on their own. Doctors usually use surgery to remove some of the skin around the anus. Research has looked at other treatments, such as lasers to destroy the cells (laser ablation) and skin ointment (imiquimod). 

Stage 1 cancer

You might have surgery if your cancer is less than 1 cm in size and is near the anal margin. The operation is called a local resection.

You might have a combination of chemotherapy and radiotherapy (chemoradiotherapy) if your cancer

  • is larger than 1 cm
  • involves the anal canal
  • involves the anal sphincter

You might have surgery if the cancer comes back or hasn't gone completely after chemoradiotherapy. 

Stage 2 and 3 cancer

You are likely to have chemoradiotherapy – a combination of chemotherapy and radiotherapy.

You might have surgery if the cancer hasn't gone completely or comes back after chemoradiotherapy. 

Stage 4 cancer

You might have chemotherapy, radiotherapy or surgery, or a combination of any of these. The aim of treatment is to slow down the growth of the cancer or to shrink it. Treatment will also try to relieve any symptoms you have.

Clinical trials to improve treatment

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to improve treatment by:

  • making existing treatments better
  • developing new treatments
Last reviewed: 
07 Jun 2016
  • Anal cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    R Glynne-Jones and others
    Annals of Oncology 2014. 25 (Supplement 3)

  • Diagnosis and management of anal intraepithelial neoplasia and anal cancer
    J Simpson and others
    British Medical Journal. (2011) Nov 4;343

  • Cancer: Principles and Practice of Oncology (10th edition)
    VT De Vita, TS Lawrence and SA Rosenberg
    Lippincott, Williams and Wilkins, 2015

Information and help

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