Treatment options for anal cancer

A team of health professionals decides what treatment you need. This depends on several factors. 

Most people with anal cancer have radiotherapy and chemotherapy combined (chemoradiotherapy). Other treatments include surgery, chemotherapy or radiotherapy. 

Deciding what 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 team usually includes:

• a specialist surgeon
• an oncologist (a cancer specialist)
• a specialist cancer nurse (also called clinical nurse specialist)
• a pathologist (an expert who examines any cancer or tissue the surgeon removes)
• a pharmacist
• a radiologist (who looks at your scans and x-rays)
• a dietician  (who offers support and advice about eating and drinking)

Your MDT might be based at your local hospital. Or you might be referred to a specialist MDT at a different hospital.

Your treatment depends on:

• where your cancer is in your anus
• 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 MDT will discuss your treatment, its benefits and the possible side effects with you.

Treatment overview

Treatment for anal cancer includes: 

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

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

Most people with anal cancer have chemoradiotherapy as their main treatment. 

Surgery

You might have a type of surgery called a local resection if you have one of the following:

• high grade AIN (AIN 3) in the anal margin
• a stage 1 cancer that is in the anal margin

Or you might have a type of surgery called an abdominoperineal resection (APR) if the cancer:

• is in the anal canal
• comes back after chemoradiotherapy
• hasn't gone completely after chemoradiotherapy

Treatment by stage

Your treatment depends on how far your cancer has grown (the stage). It also depends on where it is in your anus.

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 creams such as imiquimod or 5FU.

Stage 1 cancer

You might have surgery for stage 1 anal cancer if your cancer:

• is less than 1 or 2cm's in size 
• is near the anal margin
• doesn't involve the muscles around the anus that help control the release of poo (anal sphincter)

This operation is called a local resection.

If you are not suitable for a local resection, you have a combination of chemotherapy and radiotherapy (chemoradiotherapy).

You might have an operation called abdominoperineal resection if the cancer:

• is in the anal canal
• comes back
• hasn't gone completely after chemoradiotherapy

Stage 2 and 3 cancer

You're likely to have a combination of chemotherapy and radiotherapy (chemoradiotherapy).

You might have surgery if the cancer hasn't gone completely or comes back after chemoradiotherapy. The operation is called abdominoperineal resection (APR).

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, rather than to try to cure your cancer. Treatment also tries to relieve any symptoms you have.

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.