Treatment options for anal cancer
A team of doctors and other health professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT). Your doctor will then talk with you about the treatment they recommend.
Most people with anal cancer have radiotherapy combined with chemotherapy (chemoradiotherapy). Other treatments include surgery. And chemotherapy or radiotherapy on their own and not combined together.
Deciding what treatment is best for you
The MDT usually includes:
- a surgeon who specialises in the bowel,
rectum 
and anus (colorectal surgeon) - specialist cancer doctors - these are called oncologists
- a specialist cancer nurse
- a doctor who looks at cells under a microscope (pathologist)
- a doctor who looks at your scans and x-rays (radiologist)
It may also include other specialist nurses such as a or nurse. Or other specialist doctors.
The MDT might be based at your local hospital. Or you might be referred to a specialist MDT at a different hospital.
Which treatment they recommend depends on:
- where the cancer is in your anus
- how far it has grown or spread (the stage)
- what type of cells the cancer is in
- how abnormal the cells look under a microscope (the grade)
- your general health and level of fitness
After the MDT meeting you have an appointment with your doctor. They will talk with you about the treatments the MDT recommend. And explain the benefits and possible side effects of them.
The main treatments for anal cancer
Treatment for anal cancer includes:
- chemoradiotherapy
- surgery
- chemotherapy
- radiotherapy
You have one or more of these treatments depending on the stage of the cancer.
Chemoradiotherapy
Chemotherapy combined with radiotherapy is called chemoradiotherapy or chemoradiation.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream.
Radiotherapy uses high energy waves similar to x-rays to kill cancer cells.
Chemoradiotherapy is the main treatment for anal cancer that hasn't spread elsewhere in the body.
Surgery
You might have a type of surgery called a local resection if you have a stage 1 cancer in the
Or you might have an operation called an abdominoperineal resection (APR) if the cancer:
- comes back after chemoradiotherapy or local resection
- hasn't gone completely after chemoradiotherapy
An APR is a large operation to remove:
- the lower part of your bowel
- rectum
- anus
- the lymph nodes near the anus
Your surgeon and will make sure you are well enough to have the surgery.
Sometimes your surgeon may recommend an operation before you have chemoradiotherapy treatment. This might be:
- to bring the end of your bowel out through your skin - doctors call this a stoma
- if you have an abnormal connection (fistula) between the anus and the skin
Treatment by stage
Your treatment depends on the stage of the cancer. It also depends on where it is in your anus.
Anal intraepithelial neoplasia (AIN)
AIN is where the cells in the anus are abnormal. It is not cancer, but it may develop into cancer in the future.
You might not need treatment for some AINs as the cells can go back to normal by themselves. These are called low grade squamous intraepithelial lesions (LSILs).
For high grade squamous intraepithelial lesions (HSILs) you will need treatment. This is because the abnormal cells are less likely to get better on their own. Treatments include creams and using heat or laser to destroy the abnormal cells.
Stage 1 anal cancer
This means the cancer is less than 2cm in size. And it hasn't spread to any nearby tissue, or other organs. Which treatment you have depends on whether the cancer is in the anal margin or anal canal.
Cancer in the anal margin
You might have an operation called a local resection. During the operation, your surgeon removes the cancer and an area of healthy tissue around it. This is called the margin. Some people may have chemoradiotherapy after a local resection.
If you are not able to have a local resection, you may have chemoradiotherapy instead of surgery.
Cancer in the anal canal
If the cancer is in your anal canal your doctor normally recommends chemoradiotherapy. You might have an APR operation if the cancer hasn't gone completely after this treatment.
Stage 2 and 3 anal cancer
Stage 2 anal cancer means the cancer is larger than 2cm. It hasn't spread to any nearby tissue, lymph nodes or other organs. Stage 3 anal cancer means the cancer hasn't spread to distant parts of the body. But it has grown into nearby organs, spread to nearby lymph nodes or both. A stage 3 anal cancer can be any size.
Your doctor normally recommends treatment with chemoradiotherapy. You might have an APR operation if the cancer hasn't gone completely after this treatment.
Stage 4 cancer
Stage 4 anal cancer means the cancer has spread to other parts of the body, such as the liver. The cancer can be any size and may or may not have spread to the nearby lymph nodes. Unfortunately, cancer that has spread elsewhere in the body is advanced cancer.
You might have chemotherapy, radiotherapy, surgery or a combination of these. Which treatments you have depends on a number of factors including:
- what treatments you have already had
- your general health
- where the cancer has spread to
The aim of treatment is usually to relieve any symptoms you have and improve your quality of life rather than cure the cancer.
If anal cancer comes back after treatment
Unfortunately, anal cancer can sometimes come back after treatment. Cancer that has come back after treatment is called recurrent cancer.
If it comes back near the original (primary) cancer after you've had a local resection or chemoradiotherapy, your surgeon normally recommends an APR operation. They call this salvage surgery.
If the cancer comes back in another part of the body, you might have chemotherapy. If you aren't able to, you may have other treatments including radiotherapy or surgery. Treatment aims to relieve the symptoms of the cancer and improve your quality of life.
Your doctor will talk with you about which treatment is best for your situation.
Clinical trials
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.
