Types of treatment for anal cancer

The treatments described in this section are for squamous cell cancer of the anus, the most common type of anal cancer. Adenocarcinoma of the anus is treated in the same way as rectal cancers, so if you have adenocarcinoma you should go to the treating bowel cancer section of CancerHelp UK.

The National Institute for Health and Clinical Excellence (NICE) recommends that anyone with anal cancer is referred to a specialist team, even if you have already had your cancer removed. Specialists plan your treatment by taking several factors into account

• The type and size of the cancer
• Which part of the anus is affected
• Your general health
• Your age
• Whether the cancer has spread
• What the cancer cells look like under the microscope (the grade)

You may find that other people you meet are having different treatment to you. This may be because some of the factors above are different. Don't be afraid to ask your doctor or nurse any questions you have about your treatment.

It often helps to write down a list of questions you want to ask. You could also take a close friend or relative with you when you go to see the doctor - they can help you remember what was said.

Some people feel they would like to get an opinion from a second doctor before they decide about their treatment. If you would like a second opinion, you can ask your specialist or your GP. It can be better to arrange a second opinion through your specialist because then all your notes and test results can be sent with you.

Note: A second opinion does not mean that the second doctor will take over your care. Your treatment will still be managed by your original specialist.

Some bowel cancer organisations can give information about the choice of treatment available for anal cancer. Or they can put you in touch with cancer support groups where you can talk to other people who have been through similar experiences to your own.

The main treatment for anal cancer is a combination of chemotherapy and radiotherapy, sometimes called chemoradiation. You may have surgery as well. You are more likely to have surgery if you have a small cancer near the anal margin. There is more detailed information about all of these treatments for anal cancer in this section of CancerHelp UK.

The stage of the cancer helps doctors to decide which treatment to use. There is information below about treatments for

• Stage 0 (AIN)
• Stage 1 and 2 anal cancer
• Stage 3A
• Stage 3B
• Stage 4

Stage 0 or anal carcinoma in situ (AIN)

Treatment is usually with surgery to remove just the affected area.

Stage 1 and Stage 2

If your cancer is less than 1 cm in size, you are likely to have an operation called a local resection. Occasionally doctors might treat these small cancers with radiotherapy wires (internal radiotherapy).

If the cancer is larger than 1 cm, or involves the anal sphincter, you will probably have both chemotherapy and radiotherapy, which is known as chemoradiation.

Stage 3A

If you have this stage of anal cancer, you are most likely to have chemoradiation. But sometimes this doesn’t get rid of all the cancer. In this case you would need surgery to remove any remaining cancer cells. If your lymph nodes are affected by cancer, you may need to have these removed by surgery too.

Stage 3B

For this stage of anal cancer you are likely to have chemoradiation.

Stage 4

The aim of treatment at this more advanced stage is to control your disease and any symptoms you have. You might have chemotherapy, radiotherapy or surgery, or a combination of any of these treatments.