Chemotherapy treatment

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

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

Or you might have chemotherapy on its own or with other treatments if your anal cancer has spread (advanced anal cancer). 

When you have it

Doctors usually give chemotherapy and radiotherapy together (chemoradiotherapy) to try to cure anal cancer. Chemotherapy makes the cancer cells more sensitive to radiotherapy, so that the radiotherapy works better. 

Some people have chemotherapy to control symptoms of advanced 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. You might have chemotherapy with radiotherapy or surgery.

Types of chemotherapy for anal cancer

There are many different chemotherapy drugs. The most common type of drugs for anal cancer are:

  • fluorouracil (5FU)
  • mitomycin C

You usually have these drugs together with radiotherapy (chemoradiotherapy).

Doctors might also use:

  • cisplatin
  • irinotecan
  • oxaliplatin
  • capecitabine
  • bleomycin
  • lomustine (CCNU)
  • carboplatin
  • taxol

How you have chemotherapy

You might have chemotherapy into your bloodstream or as tablets.

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.


You might have your chemotherapy as tablets, instead of having chemotherapy into a vein. The tablets you have are called capecitabine. Taking tablets means that you can have most of your treatment at home.

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

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

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

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.

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.

Your doctors and pharmacists work out your chemotherapy dose based on your blood cell levels, and your weight, height and general health.

Side effects

You might have side effects from chemoradiotherapy to the anus. These can be more severe than either radiotherapy or chemotherapy on their own.

Side effects can include: 

  • feeling tired
  • opening your bowels more often (diarrhoea)
  • sore skin around the anus and groin - which can make opening your bowels painful

Tell your nurse or doctor if this happens. They can give you painkillers and tell you about how to look after your skin. 

Use only creams or dressings on your skin that your nurse or doctor recommends.

Contact your doctor or nurse immediately if you have signs of infection, such as a temperature above 37.5C, or if you develop a severe skin reaction. Signs of a severe skin reaction include peeling or blistering of the skin.

The side effects can be different when you have chemotherapy and radiotherapy together. 

You have regular blood tests during your treatment to make sure your blood cells aren’t too low. A low white blood cell count means you are more at risk of picking up infections. A low red blood cell count causes anaemia, with tiredness and breathlessness.

Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.

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.

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.

Last reviewed: 
13 May 2019
  • Current management of anal canal cancer
    B. Czito and others
    Current Oncology Rep, 2009. Volume 11, Pages 186-92

  • Anal carcinoma therapy: can we improve on 5-fluorouracil/mitomycin/radiotherapy?
    Y.Jiang and others
    Journal of National Comprehensive Cancer Network. 2010. Volume 8, Pages 135-44

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

  • Anal cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    R. Glynne-Jones and others
    Annals of Oncology 2014. Volume 25, Pages iii10-iii20

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