Certain factors affect your prognosis (chance of recovery) and treatment options. Your doctor will consider if this is an initial or recurrent diagnosis and if you have human immunodeficiency virus (HIV), in addition to the size and location of the tumor, stage and grade of cancer, possible side effects, your overall health and your preferences.
Chemotherapy, radiation therapy and surgery may be used in various combinations to treat anal cancer and to provide relief as palliative care. How they are used depends on the type and stage of the cancer. Ask your doctor about the potential side effects of each therapy before beginning treatment, if possible, and how to manage them if they occur.
Chemoradiation (a combination of chemotherapy and external-beam radiation therapy) is typically the standard treatment approach. Two or more chemotherapy drugs are often used together, because one drug may boost the effects of another. Tumors may continue to shrink over time, so after chemoradiation is complete, monitoring is necessary for up to six months to determine if the therapy was effective. If additional treatment is needed, your doctor may choose chemotherapy, radiation therapy or surgery.
Surgery may be used to remove small tumors that haven’t spread. This is done with a procedure called a local resection and is often followed by chemotherapy or radiation therapy. Whenever possible, doctors avoid surgery that affects the ability of the sphincter muscles to work as they should.
In certain cases of advanced disease, an abdominoperineal resection may be necessary. In this surgical procedure, the anus, the rectum, part of the sigmoid colon and affected lymph nodes are removed through an incision made in the abdomen. The doctor connects the end of the intestine to an opening, called a stoma, made in the surface of the abdomen so body waste can be collected in a disposable bag outside of the body. This is called a colostomy.
Clinical trials that combine these standard and other therapies are a valuable treatment option to consider. Talk with your doctor about available trials.