Chemotherapy for anal cancer

Chemotherapy uses anti cancer drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

This page is about having chemotherapy for anal cancer that has spread or come back after treatment. Unfortunately this means the cancer is advanced .

If the cancer hasn't spread, you usually have chemotherapy combined with radiotherapy. This is called chemoradiotherapy.

When you have chemotherapy for anal cancer

You may have chemotherapy for anal cancer that has:

• come back in a different part of your body after treatment
• already spread to a different part of your body when you were diagnosed
• has come back near the original (primary) cancer and you cannot have surgery to remove it

Common places for anal cancer to spread to are lymph nodes further away from the cancer and the liver. Less commonly it can spread to the:

• lungs
• bones
• peritoneum
• skin

The area the cancer has spread to is called a secondary cancer or a metastasis.

Types of chemotherapy for anal cancer

You normally have a combination of chemotherapy drugs to treat advanced anal cancer. Common combinations include:

• carboplatin and paclitaxel
• cisplatin and fluorouracil (5FU)
• cisplatin and capecitabine
• mitomycin and 5FU
• capecitabine and carboplatin

Your doctor will talk with you about which combination they recommend and why.

How you have chemotherapy

You have most cancer medicines in treatment cycles. This means you have the drug for a set period, followed by a break. The break allows your body to recover. For example, you might have a drug every day for a week and then not have it for 2 weeks. This 3 week period in total is one cycle of treatment.

Most chemotherapy drugs for advanced anal cancer are given into your bloodstream (intravenously). Capecitabine you take as a tablet.

Into your bloodstream

You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment. This means your doctor or nurse won't have to put in a cannula every time you have treatment.

Taking your tablets

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.

Watch the video below about what happens when you have chemotherapy. It is almost 3 minutes long.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test. 

DPD deficiency

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called dihydropyrimidine dehydrogenase (DPD) in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.

Before starting treatment with capecitabine or fluorouracil you have a blood test to check levels of DPD. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor or nurse will talk to you about this.

Side effects

Common chemotherapy side effects include:

• feeling sick

• loss of appetite

• losing weight

• feeling very tired

• increased risk of getting an infection

• bleeding and bruising easily

• diarrhoea or constipation

• hair loss

Side effects depend on:

• which drugs you have

• how much of each drug you have

• how you react

Tell your treatment team about any side effects that you have.

Dietary or herbal supplements and chemotherapy

Let your doctors know if you:

• take any supplements
• have been prescribed anything by alternative or complementary therapy practitioners

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.

When you go home

Chemotherapy for anal cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.