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 on its own if your anal cancer has spread (advanced anal cancer). Common chemotherapy drugs for advanced anal cancer are carboplatin and paclitaxel.

You usually have chemotherapy combined with radiotherapy (chemoradiotherapy) as your main treatment for anal cancer that hasn't spread.

When you have it

You usually have chemotherapy on its own for advanced anal cancer. This is to shrink or slow down the cancer. It can also relieve your symptoms. The treatment you have depends on which treatment you've already had.

Types of chemotherapy

You may have one drug or a combination of drugs to treat advanced anal cancer. The most common types of chemotherapy drugs are:

  • carboplatin and paclitaxel
  • fluorouracil and cisplatin with folinic acid, or with docetaxel

Check the name of the chemotherapy treatment with your doctor or nurse, then find out about it on our A to Z list of cancer drugs.

How you have chemotherapy

You have the chemotherapy drugs for advanced anal cancer into your bloodstream (intravenously).

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.

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.

Before you start chemotherapy

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

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
  • a lower resistance to infections
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have signs of infection. These include a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

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. They 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.

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