Which operation for anal cancer?

Until recently, surgery was the main treatment for anal cancer. Research has now shown that you are just as likely to be cured by having a combination of chemotherapy and radiotherapy as you would if you had surgery. If the chemotherapy and radiotherapy treatment is successful it also means that you avoid having a permanent colostomy.

The National Institute for Health and Clinical Excellence (NICE) guidelines for colorectal cancer recommend that most people with anal cancer have a combination of chemotherapy and radiotherapy, and if this treatment doesn’t cure their disease, they should then have an operation. This surgery is sometimes called salvage treatment.

Which operation you will have depends on

• Where your cancer is
• The type and size of your cancer
• Whether your cancer has spread

Before your operation, your doctor will talk to you about the best type of surgery for your cancer.

Your surgeon may call this operation a 'local resection'. If you have a very early stage cancer that doesn’t affect the anal sphincter, you may have surgery to remove the cancer and a small amount of tissue around the cancer. You will need to have a general anaesthetic for this operation and to stay in hospital for a few days.

When your surgeon removes your cancer they will send it to the lab so a pathologist can examine the cancer cells under a microscope. They will also check to make sure that there is an area of tissue around the cancer that doesn’t contain any cancer cells. This is what’s known as a clear margin of tissue.

Your surgeon may call this operation an abdomino perineal resection. You may have this surgery if the cancer has come back. Or if it hasn’t gone completely after chemoradiation. The surgeon will remove

• Your anus
• Your rectum
• Part of your colon

They may also remove

• Some of the lymph nodes near your anus
• Possibly the lymph nodes in your groin

With this type of operation you will need to have a colostomy. This is when part of your bowel opens out on to the surface of your abdomen. The opening is called a stoma, and you wear a bag over the stoma to collect your faeces (stools).

A specialist stoma nurse will teach you how to care for your stoma, and how to change the bags. They will also arrange the equipment you’ll need at home. Your stoma nurse is a good source of support for you while you recover from surgery and begin to adjust to living with a colostomy. The stoma nurse is experienced in looking after colostomies and teaching patients. They will probably visit you on the ward before and after your operation and will help you to learn to look after your stoma. At the first visit, your nurse will answer your questions and show you the type of colostomy bag you will be using at first. You will learn how the bag works and how to fit and empty it. The stoma nurse or ward nurse will look after your colostomy and change your bag for the first few days. Gradually, you will be encouraged to take over.

If you have any questions about colostomy, contact the Colostomy Association. They will be happy to try to help you.