Anal cancer

Treatment

Fred Hutchinson Cancer Center experts offer comprehensive care for anal cancer, including advanced treatments and new options available only through clinical studies. Although anal cancer is uncommon, we treat it regularly here.

Most patients with anal or colorectal cancer are seen at our Colorectal Cancer Specialty Clinic. At this clinic, all of the specialists who will be involved in your care will meet to design treatment that's tailored to you. You will receive a multidisciplinary treatment plan in a single day — truly one-stop shopping.

Some patients see a single specialist, based on their individual needs. Either way, we see you quickly so you can start your treatment quickly.

A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Anal cancer expertise at Fred Hutch

Everything you need is here

We have medical oncologists, radiation oncologists, colorectal surgeons and pathologists who specialize in anal and other gastrointestinal cancers; the most advanced diagnostic, treatment and recovery programs; and extensive support.

Gastrointestinal Refers to the stomach and intestines. Also called GI. Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Radiation oncologist A physician who has special training in using radiation to treat cancer.

Anal cancer treatment tailored to you

We view treatment as a collaborative effort. Your Fred Hutch doctors will explain all your options and recommend a treatment plan to get you the best results based on the type, stage and location of your cancer and your health, lifestyle and preferences.

Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Team-based approach

Your personal team includes more than your anal cancer doctors. Additional experts who specialize in treating people with cancer will be involved if you need them — experts like a dietitian, pharmacist, social worker or palliative care professional.

Learn More About Supportive Care Services

Innovative anal cancer therapies

Fred Hutch patients have access to advanced therapies being explored in clinical studies for anal cancer conducted here and at UW Medicine.

Ongoing care and support

During and after treatment, your team continues to provide follow-up care on a schedule tailored to you and helps you return to your normal quality of life. The Fred Hutch Survivorship Clinic is also here to help you live your healthiest life as an anal cancer survivor.

Learn More About Our Survivorship Clinic

Treatment types

If you have this type of cancer:

Squamous cell carcinoma that started in the outer lining of your anal canal — it’s treated according to the guidelines in this anal cancer section.
Adenocarcinoma that started in the anus — it’s treated like rectal cancer.
Skin cancer that started in the skin around your anus (whether it’s squamous cell carcinoma, basal cell carcinoma or melanoma) — it’s treated like skin cancer in other parts of the body.

Radiation therapy

Most people with anal cancer have a combination of radiation therapy and chemotherapy, called chemoradiation. This combination may cure anal cancer without the need for surgery.

For anal cancer, doctors most often use intensity-modulated radiation therapy (IMRT).

IMRT uses a computer-controlled linear accelerator that moves around you to deliver X-ray radiation.
It shapes the beams and aims them at the tumor from several angles.
The intensity of the beams can be adjusted to lessen the dose that reaches sensitive normal tissue.
Proton therapy for anal cancer is also an option and might be used in certain situations, such as if your anal cancer recurs after previous radiation therapy or has spread to your liver.

If your treatment involves radiation therapy, your radiation oncologist will explain the type that we recommend for you, determine the dosage and schedule for your treatments and help you prevent or manage any side effects.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

Radiation therapy

Most people with anal cancer have a combination of radiation therapy and chemotherapy, called chemoradiation. This combination may cure anal cancer without the need for surgery.

Chemotherapy

Your doctor will recommend chemotherapy:

In combination with radiation therapy if you have localized anal cancer (cancer that hasn’t spread)
By itself if you have metastatic anal cancer (cancer that has spread)

Usually chemotherapy medicines are given by infusion into a vein. Then they enter your bloodstream and travel throughout your body.

Your Fred Hutch team will talk with you about the specific medicines we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and we’ll connect you with medical and support resources throughout Fred Hutch.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Infusion An injection of medications or fluids into a vein over a period of time. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body.

Chemotherapy

Your doctor may recommend chemotherapy.

Surgery

For most people, chemoradiation cures anal cancer, meaning there's no evidence of disease. If your cancer is not completely gone after these treatments, surgery remains an option. Your team may recommend surgery if your cancer either doesn’t respond to chemoradiation or comes back after treatment.

Anal cancer surgery for Fred Hutch patients is performed by colorectal surgeons at University of Washington Medical Center who are specially trained to do this operation.

Abdominoperineal resection

The exact procedure you need will depend on many factors. You and your team will discuss your options and decide together what is best for you.

Abdominoperineal resection is a typical procedure for anal cancer in the anal canal (from teh anal skin to the rectum) that doesn’t respond to chemoradiation or that recurs. This means removing the anus, rectum, part of the colon and lymph nodes.

After this surgery, stool cannot move out of your body along the normal pathway. Instead, you will need a colostomy. The surgeon creates an opening (stoma) in your abdomen. They bring the open end of your colon through the opening and sew it to the skin. They attach a bag to the skin on the outside to collect waste.

We help you learn how to care for your colostomy and adjust so you can go on with normal activities comfortably. We have a specially certified wound ostomy nurse who understands the physical and emotional impact of ostomies and can work closely with you, your family and your doctors. Our survivorship clinic also plays an integral part in your ongoing care.

Wide local excision

If you have perianal cancer (in the skin around the anus), your surgeon will operate to remove the tumor itself and a margin of healthy tissue around it.

Colostomy An opening into the colon from the outside of the body. A colostomy provides a new path for waste material, such as urine and feces, to leave the body after part of the colon has been removed.

Surgery

For most people, chemoradiation cures anal cancer, meaning there's no evidence of disease. If your cancer is not completely gone after these treatments, surgery remains an option.

Treating liver metastases

Over the past decade, amazing advances have been made in treating anal cancers that have spread to the liver. If you have liver metastases, surgeons and interventional radiologists work together at UW Medicine’s Secondary Liver Tumor Clinic to determine which treatment approaches will work best for you. Treatments may include concurrent liver and anal surgeries or catheter-based therapies, such as transarterial chemoembolization.

Radiologist A physician who has special training in creating and interpreting pictures of areas inside the body. The pictures are made with X-rays, sound waves or other types of energy. Chemoembolization A procedure in which the blood supply to a tumor is blocked after anticancer drugs are given in blood vessels near the tumor.

A procedure in which the blood supply to a tumor is blocked after anticancer drugs are given in blood vessels near the tumor. Sometimes, the anticancer drugs are attached to small beads that are injected into an artery that feeds the tumor. The beads block blood flow to the tumor as they release the drug. This allows a higher amount of drug to reach the tumor for a longer period of time, which may kill more cancer cells. It also causes fewer side effects because very little of the drug reaches other parts of the body. Chemoembolization is used to treat liver cancer. Also called TACE and transarterial chemoembolization.

Treating liver metastases

Over the past decade, amazing advances have been made in treating anal cancers that have spread to the liver.

Proton therapy

Protons can be controlled with greater precision than X-rays. This means that more energy goes into destroying the tumor and less radiation is delivered to surrounding healthy tissue. For this reason, proton therapy is particularly good for treating tumors near healthy organs, including gastrointestinal tumors.

Gastrointestinal Refers to the stomach and intestines. Also called GI.

Proton therapy

Proton therapy can be an effective treatment option because protons deposit more energy directly to the tumor and significantly reduce the radiation dose to healthy tissues. Patients treated with proton therapy for GI tract tumors often experience fewer side effects.

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