Treatment

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. 

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 SCCA 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 SCCA.

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 SCCA 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.

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.