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Treatment of anal cancer

Treatment for anal cancer is dependant on the stage of the disease and on the aim of the treatment. When the disease is localised it is potentially curable.


Treatment options include surgery to remove the anus, or a combination of radiotherapy and chemotherapy given simultaneously. Specialised locally delivered radiotherapy (brachytherapy) has been used for very small anal tumours as well.


The usual treatment that is chosen is combination of chemotherapy and radiotherapy, called chemoradiotherapy. This treatment has a major advantage over surgery in that most patients do not require a colostomy bag permanently. When surgery is performed with the aim of curing anal cancer, the anus itself is removed as well. With chemoradiotherapy, the organ is preserved. Another advantage of using chemoradiotherapy as the first treatment is that, surgery is still available as a curative treatment if the disease returns in the anus.


The radiotherapy is usually given on a daily basis, monday to friday, in a specialist department. It will involve lying still on a couch in a treatment room, whilst a treatment machine, gives the radiotherapy. The treatment does not hurt and is invisible. It does not make patient s radioactive. Each treatment lasts about fifteen minutes. Often, the bladder is kept full during the treatment to minimise the amount of radiotherapy given to the small bowel.


Before radiotherapy starts, there are a number of sessions that are undertaken to work out how to aim the radiotherapy to the areas that need to be treated. Often the firs visit is to make sure the position is correct (sometimes lying on the front), and a specialised CT scan done with the patient in that position (this usually only takes 45 minutes to do). The scans are then worked on by the radiotherapy department, using sophisticated computer software, so as to get the best 'plan' for the treatment and the best treatment beam orientation. This can take 2 to 3 weeks to do. After a series of checks, the patient is given another appointment for a 'dummy run' of the treatment to make sure everything lines up accurately. The actual treatment then starts shortly afterwards.


The chemotherapy is usually given in the first and last week of the 5 and a half weeks of daily radiotherapy treatment. The chemotherapy may be given as an in-patient.


Chemoradiotherapy is a complex treatment and has many side effects. Most side effects disappear a few weeks after the treatment is completed, but some may last many months or be permanent.


The side effects of radiotherapy include:

  • Tiredness
  • Sore skin, and peeling of the skin near the anal area and in the groins
  • Diarrhoea
  • Pain around and in the anus


The combination of the diarrhoea and the sore skin around the anus means that a temporary colostomy is sometimes recommended to make these side effects easier to manage.


These effects usually improve in the weeks after the treatment is completed, although the way the bowel works may not return to normal completely.


Side effects that may be long term or permanent include:

  • Vaginal narrowing and dryness: this can affect sexual function after treatment. It is important to see a specialist nurse before and during treatment who may advise using a vaginal dilator to minimise the risk of this side effect as much as possible.
  • Infertility: this should be discussed with the oncologist if it is an issue.
  • All the potential risks and side effects should be discussed by the oncologist.


Side effects of chemotherapy include:

  • Tiredness
  • nausea and vomiting: this can be reduced by anti-sickness medication given with the chemotherapy
  • sore mouth: mouthwashes can be given to help this
  • loss of appetite
  • a low blood count: if this happens, the body's defences against infection can be reduced, which in turn means any infection may become more serious. 


Last updated 02/12/2008

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