Anal Cancer

What is anal cancer?

The anus is the body’s opening at the lower end of the intestines. The anus is about an inch and a half long and connects the lower part of the large intestine to the outside of the body. It opens to allow the passage of stool (feces) during a bowel movement. It is lined with cells that are like the cells lining the bladder, vagina, urethra, and other places in the body. These cells are called squamous cells.

Many kinds of tumors can grow in the anus. Not all of these tumors are cancers — some are benign, which means they are not cancer. There are also some growths that start off as benign but over time can change into cancer. These are called pre-cancerous conditions. A common term for these potentially pre-cancerous conditions is dysplasia. Some warts, for example, contain areas of dysplasia that can develop into cancer. Benign tumors include some kinds of warts and skin tags (small pieces of skin that hang loose from the body). To find out more about benign anal tumors, please see our document Anal Cancer.

 

Anal tumors that are cancer

Carcinoma in situ

Sometimes cells on the surface layer of the anus look like cancer cells but have not grown into any of the deeper layers. This is known as carcinoma in situ, (pronounced “in SY-too”), or CIS. It may also be called Bowen disease. Some doctors think this is the early form of anal cancer and others think it is a pre-cancer but not a true cancer.

 

Invasive anal cancers

Squamous cell carcinomas

These are the most common type of anal cancer and are the focus of this document. The tumors begin in the squamous cells that line the lower part of the anus and most of the anal canal. In its earliest stages it is known as carcinoma in situ or CIS. If it has spread beyond the surface cells to the deeper layers it is called invasive.

If the tumors are found in the skin around the anus (perianal skin) they are treated like the squamous cell carcinomas of the skin found elsewhere in the body. To learn more, see our document, Skin Cancer: Basal and Squamous Cell.

Cloacogenic carcinoma is a type of squamous cell cancer that starts in an area of the anus called the cloaca. It is sometimes seen as a sub-type of squamous cell cancer, but is treated the same.

Adenocarcinomas

A small number of anal cancers start in cells that line the upper part of the anus near the rectum or the glands found in the anal area. These cancers are called adenocarcinomas. Paget disease is a type of adenocarcinoma that spreads through the surface layer of skin and can affect the anal area. (This should not be confused with Paget disease of the bone which is a very different disease.)

Most adenocarcinomas start in the rectum and are treated as rectal carcinomas. For more information on this, see our document, Colorectal Cancer.

Skin cancers

A small percentage of anal cancers are basal cell carcinomas, a type of skin cancer. Another 1%-2% are malignant melanomas, another type of skin cancer. Melanomas are far more common on parts of the body that are exposed to the sun. Most anal melanomas are hard to see and are found at a late stage. To learn more, please see our documents, Skin Cancer: Basal and Squamous Cell and Melanoma Skin Cancer.

Gastrointestinal stromal tumors

These are rare anal cancers that are more often found in the stomach or small intestine. When these are found at an early stage, they are removed with surgery. If they have spread beyond the anus, they can be treated with drugs. To learn more, see our document, Gastrointestinal Stromal Tumor (GIST).

 

How many people get anal cancer?

The American Cancer Society’s estimates for anal cancer in the United States for 2013 are:

  • About 7,060 new cases of anal cancer
  • About 880 deaths from anal cancer

Women get anal cancer slightly more often than men. Anal cancer is found mainly in adults. The average age of patients when the cancer is found is in the early 60s. While anal cancer is a serious disease, treatment often works very well. Most people with this cancer can be cured.

 

What are the risk factors for anal cancer?

A risk factor is anything that affects a person’s chance of getting a disease. Although the exact cause of anal cancer is not known, most anal cancers seem to be linked to infection with HPV (human papilloma virus). Still, most people with HPV infections do not get anal cancer. The risk factors for anal cancer are listed below. But risk factors don’t tell us everything. Having a risk factor, or even several risk factors, does not mean that you will get cancer. Also, people without risk factors can still get cancer.

HPV (human papilloma virus)

Most squamous cell anal cancers seem to be linked to infection by the human papilloma virus (HPV), the same virus that causes cervical cancer. In fact, women who have had cervical cancer (or pre-cancer) have an increased risk of anal cancer.

HPV is a group of more than 100 related viruses. There are several subtypes of the virus, but the one most likely to cause anal cancer is called HPV-16. HPV-16, as well as HPV-18, HPV-31, HPV-33, and HPV-45 are called high-risk types of HPV because they are strongly linked to cancer. They can also cause cancers of the cervix, vagina, and vulva in women, cancer of the penis in men, and throat cancer in both women and men..

It can be very hard to avoid being exposed to HPV. The virus is spread from one person to another during skin-to-skin contact with an infected area of the body. HPV can be spread during sex — including vaginal intercourse, anal intercourse, and oral sex. It is even possible for a genital infection to spread through hand-to-genital contact.

An HPV infection also seems to be able to be spread from one part of the body to another. This means than an HPV infection may start in the genitals and then spread to the anus.

Infection with HPV is common, and in most cases the body is able to clear up on its own. But in some cases the infection does not go away and becomes long lasting (chronic). Chronic infection can eventually cause certain cancers, including anal cancer.

For men, the 2 main factors that impact the risk of genital HPV infection are circumcision and the number of sex partners. Men who are circumcised (have had the foreskin of the penis removed) have a lower chance of getting and staying infected with HPV. The risk of being infected with HPV is also strongly linked to having many sex partners (over a man’s lifetime).

In women, HPV infections occur mainly at younger ages and are less common in women over 30. The reason for this is not clear. A woman’s risk is increased if she has sex at an early age and has many sexual partners.

Although women who have had many sexual partners are more likely to get infected with HPV, a woman who has had only one partner can still get infected. This is more likely if she has a partner who has had many sex partners or if her partner is an uncircumcised male.

In a study that looked at risk factors for anal HPV infection in women, risk was increased in younger women and in those who had more than 5 sexual partners in their lifetime. Ever having anal sex also increased risk.

Condoms can provide some protection against HPV, but they do not always prevent infection. For more information about HPV and HPV vaccines, see Human Papilloma Virus and HPV Vaccines FAQ.

Other cancers

Ever having cancer of the cervix, vagina, or vulva is linked to an increased risk of anal cancer. This is likely because these cancers are also caused by infection with HPV.

HIV infection

People who have the human immunodeficiency virus (HIV), the virus that causes AIDS, are much more likely to get anal cancer than those who don’t.

Sex

Having many sex partners increases the risk of HIV and HPV infection. Having anal sex is a risk factor for anal cancer in both men and women, especially for those under the age of 30.

Smoking

Current smokers are several times more likely to have cancer of the anus compared with people who never smoked. Quitting smoking reduces this risk. People who used to smoke but have quit are only slightly more likely to get anal cancer compared with people who never smoked.

Weakened immune system

People with weak immune systems are at higher risk for anal cancer. This includes people who have had transplants and who must take drugs to suppress their immune systems.

Race and gender

Anal cancer is more common in African-Americans than in whites. Overall, it is more common in women than men, but in African Americans it is more common in men than in women.

 

Can anal cancer be prevented?

Since some people with anal cancer have no known risk factors, there is no way to completely prevent this disease. But the best way to reduce the risk of anal cancer is to avoid HIV or HPV infection. The risk of these is higher for those who have sex with many partners and those who have unprotected anal sex.

In people infected with HIV, the use of highly active antiretroviral treatment (also called HAART) can lower the risk of a kind of anal pre-cancer and the risk of HPV infection.

While condoms (rubbers) can protect against HPV, recent research has shown that they do not offer complete protection. That is because this virus can be spread by skin contact from areas that are not covered by the condom. Still, it is important to use condoms to protect against AIDS and other diseases that are passed on through some body fluids. People can have HPV for years without having any symptoms. So it can be nearly impossible to know whether a sex partner is infected with HPV.

A vaccine called Gardasil® can help protect against infection with HPV subtypes 16 and 18 (as well as subtypes 6 and 11). At first it was only approved for use in women to prevent cervical cancer, but it has also been shown to prevent other cancers and pre-cancers caused by HPV. It is now also approved for use in both men and women to prevent anal cancers and pre-cancers. To work best, the vaccine should be given before a person starts having sex.

Cervarix® is an HPV vaccine that can also be used to prevent infection with HPV types 16 and 18. Although it is only approved by the FDA to help prevent cervical cancers and pre-cancers, it was shown in a study to be helpful in preventing anal cancers and pre-cancers.

Stopping smoking also lowers the risk of many types of cancer, including anal cancer.

 

How is anal cancer found?

Many cases of anal cancer can be found early. Anal cancers form in a part of the body that the doctor can see and reach easily. Sometimes anal cancer does not cause any symptoms at all. But a rectal exam will still find some cases early. For this exam (called a DRE), the doctor puts a gloved finger into the anus to feel for lumps or growths. A rectal exam may be used to check for prostate cancer in men. For women, the rectal exam is done as part of the pelvic exam. If you are at higher risk for anal cancer, ask your doctor if you should have this exam (or any other tests) more often.

Doctors can also test people at high risk for sexually transmitted diseases with a test called an anal Pap. It is much like the Pap smear done for cervical cancer. The anal lining is swabbed and the cells are looked at under a microscope. Some doctors think that this test should be done routinely for people at high risk for anal cancer. That would include men who have sex with men, women who have had cervical cancer or vulvar cancer, all HIV-positive men and women, and all transplant patients. People with positive results should be referred for a biopsy and, depending on the results, treated. Still, not all doctors believe this test is helpful, because no study has shown that it lowers the chance of getting invasive anal cancer.

 

Signs and symptoms of anal cancer

Some cases of anal cancer have no symptoms at all. But people who do have symptoms of anal cancer may notice one or more of the following:

  • Bleeding or itching around the anus
  • Pain in the anal area
  • Change in the width of the stool (stool may be narrower than usual)
  • Swollen lymph nodes in the anal or groin area
  • Abnormal discharge from the anus

Itching can also be a symptom. This is more often a sign of anal pre-cancer, which may also need to be treated.

These symptoms can also be caused by something other than cancer, but only your doctor can tell for sure. Talk to your doctor right away if you notice any of these problems.

Tests for anal cancer

The doctor may feel a growth during a rectal exam. But since doctors cannot see what they feel, other steps may be needed if you have symptoms or if your doctor thinks you may have anal cancer.

Endoscopy

Endoscopy is the use of a tube with a lens or video camera on the end (called a scope) to look inside the body. Endoscopy may be used to look for the cause of anal symptoms.

Anoscopy: For this test you either lie on your side on top of an exam table, with your knees bent up to your chest, or you bend forward over the table. The doctor coats the anoscope (which is about 4 inches long) with a lubricant and then gently pushes it into the anus and rectum. By shining a light into this tube, the doctor has a clear view of the lining of the lower rectum and anus and sometimes the lower part of the colon. This is usually not painful.

Rigid proctosigmoidoscopy: The rigid proctosigmoidoscope is similar to an anoscope, except that the proctoscope is 10 inches long, so it allows the doctor to see the rectum as well as the lower part of the colon. You will most likely need to take laxatives or have an enema before the test to make sure the bowels are empty.

Biopsy

In order to find out if a growth is cancer, a biopsy must be done. For a biopsy, the doctor will remove a sample of tissue and send it to a lab to be looked at under a microscope. For anal cancer, this tissue sample is most often removed during endoscopy. If the tumor is very small and has not grown below the surface of the anus, your doctor may be able to take out the whole tumor during the biopsy.

Other types of biopsies that may be done to look for cancer spread to the lymph nodes include:

Fine-needle aspiration biopsy

Since anal cancer can spread through the lymph system, your doctor may want to do a biopsy of your lymph nodes, too. Lymph nodes are bean-sized groups of immune system cells. Swollen lymph nodes are sometimes a sign of spreading cancer. Most often, though, they are a sign of infection. A small (fine) needle is placed into the swollen node. It is used to remove some cells and fluid that is then sent to the lab. In some cases, an operation to remove the lymph nodes near the anus may be done.

Sentinel node biopsy

In this test, a needle is used to put a radioactive substance, often with a blue dye, into the tumor. The dye moves into the nodes that carry fluid away from the tumor. This helps tell how far the cancer may have spread, because these nodes would be the ones that any cancer cells leaving the tumor would have spread to first. The surgeon then takes out any blue-stained nodes and looks at them to see if they contain cancer cells. While this test has been shown to be useful for some other cancers, it’s not yet clear how helpful it is for anal cancer.

Imaging tests

If cancer is found, you may have tests to see how far it has spread. These tests produce different kinds of pictures of the inside of the body. Some of these tests are used more often than others.

Ultrasound

Ultrasound uses sound waves to make a picture of the inside of the body. Most people know about ultrasound because it is often used to look at a baby during pregnancy. For anal cancer, a probe must be placed in the rectum, which can be slightly uncomfortable but should not be painful. This test can show how far the cancer might have grown into nearby tissues.

CT scan (computed tomography)

A CT scan can help tell whether anal cancer has spread to the liver or other organs. The CT scan machine moves around you and uses x-rays to take many pictures of the body. A computer then combines them to make pictures of cross-sections of the body.

A CT scanner has been described as a large donut, with a narrow table in the middle “hole”. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.

You may be asked to drink 1 to 2 pints of a liquid called oral contrast which helps to outline the intestine on the pictures. You may also have a contrast “dye” put into a vein. When it is injected, you may feel warm and your skin may become red. Some people are allergic and get hives or, rarely, more serious problems such as trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays.

CT scans can also be used to guide a biopsy needle into a tumor.

MRI (magnetic resonance imaging)

Like CT scans, MRI scans show a cross-section of the body but in more detail. MRI uses radio waves and strong magnets instead of x-rays to take pictures. They take longer and you have to lie inside a tube-like machine, which can be upsetting for some people. If you have trouble with closed spaces, let your doctor know before the MRI scan. Sometimes drugs can be given just before the scan to help you relax. Another option is to use special “open” MRI machines where you will feel less closed in.

MRI machines also make loud thumping noises that can be distracting. Some places offer earplugs with music to help reduce the noise of the machine.

Chest x-rays

These may be done to see whether the anal cancer has spread to the lungs.

PET scan (positron emission tomography)

This test uses sugar combined with a radioactive atom that is put into a vein. Cancer cells absorb high amounts of the sugar and a special camera is used to see to show these areas. PET scans look for cancer in the whole body. They are useful when the doctor thinks the cancer has spread but doesn’t know where. There are machines that do a PET and CT scan at the same time.

 

How is anal cancer staged?

Staging is the process of finding out how far the cancer has spread. This is very important because your treatment and the outlook for your recovery depend on the stage of your cancer. If you have anal cancer, ask your doctor to explain staging in a way that you understand. Knowing all you can about staging lets you take a more active role in making informed decisions about your treatment.

The tests described in the section, “How is anal cancer found?” are the ones used to decide the stage of the cancer.

Stages are often labeled using 0 and the Roman numerals 1 through IV (1-4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV (4), means a more advanced cancer.

 

Survival rates for anal cancer by stage

Some people with cancer may want to know the survival rates for their type of cancer. Others may not find the numbers helpful, or may even not want to know them. Whether or not you want to read about survival rates is up to you. If you decide that you don’t want to know them, stop reading here and skip to the next section.

The 5-year survival rate refers to the percent of patients who live at least 5 years after their cancer is found. Of course, many people live much longer than 5 years (and many are cured). Also, people with anal cancer may die of something else. These rates, known as observed survival rates, don’t take that into account.

In order to get 5-year survival rates, doctors have to look at people who were treated at least 5 years ago. Better treatment since then may result in a better outlook for people now being treated for anal cancer.

The following numbers come from the National Cancer Data Base and are based on cancers found between 1998 and 1999. The National Cancer Database divides anal cancers based on how the cells look under the microscope (squamous cell cancers and non-squamous cell cancers) as well as by stage.

  • 5-year observed survival for anal cancer
  • Stage
  • Squamous cancers
  • Nonsquamous cancers
  • I
  • 71%
  • 59%
  • II
  • 64%
  • 53%
  • IIIA
  • 48%
  • 38%
  • IIIB
  • 43%
  • 24%
  • IV
  • 21%
  • 7%

While these numbers give an overall picture, keep in mind that every person is different. Statistics can’t predict what will happen in your case. Talk with your cancer care team if you have questions about your own chances of a cure, or how long you might survive your cancer. They know your situation best.

 

How is anal cancer treated?

This information represents the views of the doctors and nurses serving on the American Cancer Society’s Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don’t hesitate to ask him or her questions about your treatment options.

About treatment

There is treatment for every type and stage of anal cancer. The treatment you get depends on many things. The place, type, and stage of the tumor are very important. Your age, health, and personal wishes are also taken into account.

There are 3 main types of treatment for anal cancer are:

Often the best approach uses 2 or more of these. In the past, surgery was the only treatment that could cure anal cancer, but now most anal cancers are treated instead with both radiation and chemo, This treatment approach, called chemoradiotherapy (or chemoradiation), often does away with the need for surgery.

The goal of treatment may be to cure the cancer. If that is not possible, the goal may be to keep the tumor from spreading or to keep it from coming back for as long as possible. Another goal may be to relieve symptoms such as pain or bleeding. Often, an important part of the plan is to try to treat the cancer without affecting your being able to control your bowel movements.

It is important to discuss all of your treatment options, their goals and likely side effects, with your doctors to help choose the plan that best fits your needs. It’s also very important to ask questions if there is anything you’re not sure about. You can find some good questions to ask in the section, “What are some questions I can ask my doctor about anal cancer?

Surgery for anal cancer

Surgery is no longer the standard option for most people with anal cancer. In people who do need surgery, the kind of operation depends on the type and place of the tumor.

Local resection

A local resection may be done if the cancer has not spread to nearby tissues or lymph nodes. In this operation, only the tumor and a small area of tissue around the tumor are removed. In most cases the muscle that opens and closes the anus (called the sphincter muscle) is saved. If so, you will be able to have bowel movements as usual afterwards.

Abdominoperineal resection (APR)

This more involved approach is used for cancer that has spread. For this surgery, the doctor makes a cut through the belly (abdomen) and in the area between the anus and the sex organs. Then the anus and part of the rectum are removed. This surgery is not often needed when radiation and chemotherapy are used to treat the cancer. An APR is usually done only if other treatments do not work.

After an APR you will need to have a new opening made in your lower belly (abdomen) to pass stool. This opening is called a colostomy. Stool passes through this opening into a bag attached outside the body. If you would like to know more about colostomies, call the American Cancer Society and ask for Colostomy: A Guide.

Radiation therapy for anal cancer

Radiation therapy is treatment with high energy rays (like x-rays) to kill cancer cells or shrink tumors. The radiation may be given from outside the body (external radiation) or from a radioactive substance placed directly in the tumor (internal or implant radiation). Sometimes doctors give radiation to shrink a tumor so it is easier to remove during surgery.

External radiation

This is the most common way to give radiation for anal cancer. It uses a focused beam of radiation from a machine outside the body. Treatment is often given 5 days a week for about 5 weeks. It is much like getting a normal x-ray. The radiation field may include some of the pelvis in order to treat lymph nodes in the groin, because the cancer will often spread to these lymph nodes.

Sometimes, doctors use some newer techniques that let them give higher doses of radiation to the cancer while reducing the radiation to nearby healthy tissues.

Side effects

There can be side effects from radiation treatment. These side effects vary based on the part of the body treated and the dose of radiation given.

Some common short-term side effects include:

  • Skin changes (like a sunburn)
  • Temporary anal irritation and pain
  • Discomfort during bowel movements
  • Fatigue
  • Nausea
  • Diarrhea
  • In women, radiation may irritate the vagina. This can lead to discomfort and drainage (a discharge).
  • Swelling in the legs (lymphedema) if radiation is given to the lymph nodes in the groin

These side effects often improve after radiation stops.

Long-term side effects can also occur. Radiation to the pelvis can also weaken the bones, increasing the risk of fractures of the pelvis or hip later on. It can also damage blood vessels that nourish the lining of the rectum which can lead to the lining of the rectum becoming inflamed (chronic radiation proctitis). This can cause long-term rectal bleeding and pain.

Radiation can also cause infertility (not being able to have children) in both women and men. In women, it can also lead to vaginal dryness and even cause scar tissue to form in the vagina The scar tissue can make the vagina shorter or more narrow, which can make sex painful. A woman can help prevent this problem by stretching the walls of her vagina several times a week. This can be done by using a plastic or rubber tube to stretch out the vagina (a vaginal dilator).

Internal radiation (brachytherapy)

This kind of radiation treatment involves minor surgery to put radioactive seeds or pellets inside the body, in or near the tumor. The radioactive pellets slowly release their dose over a period of time. Though the pellets stop being radioactive after a while, they stay in place for the rest of your life. Fewer trips to the doctor are needed with this treatment. This approach is used less often than external radiation. When it is used, it is usually given along with external radiation. The possible side effects are often like those seen with external radiation.

To find out more about radiation treatment, please see our document Understanding Radiation Therapy: A Guide for Patients and Families.

Chemotherapy for anal cancer

Chemotherapy (chemo) is the use of drugs to treat cancer. Some drugs can be swallowed in pill form, while others need to be put into a vein or muscle. Once the drugs enter the bloodstream, they spread throughout the body to reach and destroy the cancer cells.

Often 2 or more drugs are used together because one drug can boost the power of the other. In anal cancer, chemo combined with radiation treatment often cures the cancer without the need for surgery. Doctors sometimes also give chemo after the cancer has been removed by surgery. The chemo is meant to kill any cancer cells that were left behind because they were too small to be seen. Chemo may also be used to treat anal cancer that has spread to distant sites such as the lungs or liver.

While chemo drugs kill cancer cells, they also damage some normal cells, causing side effects. These side effects will depend on the type of drug, how much you get, and how long you take it. Common side effects may include:

  • Nausea and vomiting
  • Loss of appetite
  • Hair loss
  • Diarrhea
  • Mouth sores
  • Easy bruising (from a shortage of blood platelets)
  • Feeling very tired (fatigue) or short of breath (from a shortage of red blood cells)
  • Increased chance of infection (from a shortage of white blood cells).

Most of the side effects go away when treatment is over. Talk with your doctor or nurse about side effects, as there are often ways to help. To learn more, see our document Understanding Chemotherapy: A Guide for Patients and Families.

Chemoradiation

The main treatment for anal cancer that has not spread is chemo combined with radiation treatment (called chemoradiation or chemoradiotherapy). When given together, these 2 treatments often cure the cancer without the need for surgery. Often, chemo is used by itself either before or after chemoradiation to help shrink the cancer further.

Patients with HIV

Most of the time people with HIV infection can be given the same treatment as others with anal cancer, and they can have a good outcome. Patients who have advanced HIV disease and weakened immune systems may need to have less strong chemo.

 

Treating recurrent anal cancer

Cancer is called recurrent when it come backs after treatment. It can come back in or near the same place it started (local) or spread to organs such as the lungs or bone (distant). If your cancer returns in the anus or nearby lymph nodes after treatment, your treatment depends on what treatment you had the first time. For instance, if you had surgery alone, you may now get radiation and chemotherapy (chemo). If you first had chemoradiation, then you can be treated with surgery and/or chemo. Treating cancer that comes back in or near the anus often involves an abdominoperineal resection (APR). Again, clinical trials may be an option for people with recurrent anal cancer.

In some people, the cancer will come back in distant sites or organs in the body. The most common places are the liver and the lungs. The main treatment for this is chemo, but in rare cases surgery to remove the cancer might be an option. Chemo may not cure the cancer, but it may help to reduce any symptoms from the disease.

 

Clinical trials for anal cancer

You may have had to make a lot of decisions since you’ve been told you have cancer. One of the most important decisions you will make is deciding which treatment is best for you. You may have heard about clinical trials being done for your type of cancer. Or maybe someone on your health care team has mentioned a clinical trial to you.

Clinical trials are carefully controlled research studies that are done with patients who volunteer for them. They are done to get a closer look at promising new treatments or procedures.

If you would like to take part in a clinical trial, you should start by asking your doctor if your clinic or hospital conducts clinical trials. You can also call our clinical trials matching service for a list of clinical trials that meet your medical needs. You can reach this service at 1-800-303-5691 or on our Web site at www.cancer.org/clinicaltrials. You can also get a list of current clinical trials by calling the National Cancer Institute’s Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) or by visiting the NCI clinical trials Web site at www.cancer.gov/clinicaltrials.

There are requirements you must meet to take part in any clinical trial. If you do qualify for a clinical trial, it is up to you whether or not to enter (enroll in) it.

Clinical trials are one way to get state-of-the art cancer treatment. They are the only way for doctors to learn better methods to treat cancer. Still, they are not right for everyone.

You can get a lot more information on clinical trials, in our document called Clinical Trials: What You Need to Know. You can read it on our Web site or call our toll-free number and have it sent to you.

Complementary and alternative therapies for anal cancer

When you have cancer you are likely to hear about ways to treat your cancer or relieve symptoms that your doctor hasn’t mentioned. Everyone from friends and family to Internet groups and Web sites may offer ideas for what might help you. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.

 

What are complementary and alternative therapies?

It can be confusing because not everyone uses these terms the same way, and they are used to refer to many different methods. We use complementary to refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctor’s medical treatment.

Complementary methods: Most complementary treatment methods are not offered as cures for cancer. Mainly, they are used to help you feel better. Some examples of methods that are used along with regular treatment are meditation to reduce stress, acupuncture to help relieve pain, or peppermint tea to relieve nausea. Some complementary methods are known to help, while others have not been tested. Some have been proven not to be helpful, and a few are even harmful.

Alternative treatments: Alternative treatments may be offered as cancer cures. These treatments have not been proven safe and effective in clinical trials. Some of these methods may be harmful, or have life-threatening side effects. But the biggest danger in most cases is that you may lose the chance to be helped by standard medical treatment. Delays or interruptions in your medical treatments may give the cancer more time to grow and make it less likely that treatment will help.

Finding out more

It is easy to see why people with cancer think about alternative methods. You want to do all you can to fight the cancer, and the idea of a treatment with few or no side effects sounds great. Sometimes medical treatments like chemotherapy can be hard to take, or they may no longer be working. But the truth is that most of these alternative methods have not been tested and proven to work in treating cancer.

As you think about your options, here are 3 important steps you can take:

  • Look for “red flags” that suggest fraud. Does the method promise to cure all or most cancers? Are you told not to have regular medical treatments? Is the treatment a “secret” that requires you to visit certain providers or travel to another country?
  • Talk to your doctor or nurse about any method you are thinking of using.
  • Contact us at 1-800-227-2345 to learn more about complementary and alternative methods in general and to find out about the specific methods you are looking at.

The choice is yours

Decisions about how to treat or manage your cancer are always yours to make. If you want to use a non-standard treatment, learn all you can about the method and talk to your doctor about it. With good information and the support of your health care team, you may be able to safely use the methods that can help you while avoiding those that could be harmful.

 

What are some questions I can ask my doctor about anal cancer?

As you cope with cancer and cancer treatment, you need to have honest, open talks with your doctor. You should feel free to ask any question that’s on your mind, no matter how small it might seem. Here are some questions you might want to ask. Be sure to add your own questions as you think of them. Nurses, social workers, and other members of the treatment team may also be able to answer many of your questions.

  • Will you please write down the type of anal cancer I have?
  • Has my cancer spread beyond the anus?
  • What is the stage of my cancer and what does that mean in my case?
  • What treatment choices do I have?
  • What treatment do you recommend and why?
  • What are the risks or side effects of the treatment?
  • How long will it take me to recover from treatment?
  • Will I need a colostomy?
  • Will treatment interfere with normal bowel movements?
  • How long will treatment last?
  • How soon after treatment starts will we know if it’s working?
  • When can I go back to work after treatment?
  • When can I have sex and do other normal activities?
  • What should I do to be ready for treatment?
  • What are the chances that my cancer will come back after treatment?
  • Based on my cancer as you see it, what is my outlook?
  • Should I get a second opinion?

 

Moving on after treatment for anal cancer

For some people with anal cancer, treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment but find it hard not to worry about cancer coming back. (When cancer comes back after treatment, it is called recurrence.) This is a very common concern in people who have had cancer.

It may take a while before your fears lessen. But it may help to know that many cancer survivors have learned to live with this uncertainty and are living full lives. Our document, Living with Uncertainty: The Fear of Cancer Recurrence gives more detailed information on this.

For other people, the cancer may never go away completely. These people may get regular treatments with chemotherapy, radiation, or other treatments to try to help keep the cancer in check. Learning to live with cancer that does not go away can be difficult and very stressful. It has its own type of uncertainty. Our document, When Cancer Doesn’t Go Away, talks more about this.

Follow-up care

After your treatment is over, follow-up is very important. During these visits, your doctors will ask about symptoms, do physical exams, and order blood or imaging tests. Follow-up is needed to watch for treatment side effects and to check for cancer that has come back or spread.

Follow-up doctor visits after chemoradiation may be scheduled as often as every 3 months for at least 2 years. During these visits, your doctor will ask about symptoms and do a physical exam, which will include a rectal exam and an exam of the anus. Blood tests and imaging studies such as CT scans or x-rays may also be ordered.

Almost any cancer treatment can have side effects. Some may last for a few weeks or months, but others can be permanent. Please tell your cancer care team about any symptoms or side effects that bother you so they can help you manage them. Use this time to ask your health care team questions and discuss any concerns you might have.

It is also important to keep health insurance. While you hope your cancer won’t come back, it could happen. If it does, you don’t want to have to worry about paying for treatment. Should your cancer come back, our document When Your Cancer Comes Back: Cancer Recurrence helps you manage and cope with this phase of your treatment.

For patients with colostomies

Permanent colostomies are rarely needed now in the treatment of anal cancer. If you have a colostomy, follow-up is an important concern. You may feel worried or isolated. But there are nurses with special training to help people with their colostomies. They can teach you how to take care of your colostomy. Ask the American Cancer Society about programs offering information and support in your area. For more information on colostomies, refer to the American Cancer Society document, Colostomy: A Guide.

Seeing a new doctor

At some point after your cancer is found and treated, you might find yourself in the office of a new doctor who does not know about your cancer. It is important that you be able to give your new doctor the exact details of your diagnosis and treatment. Make sure you have this information handy and always keep copies for yourself:

  • A copy of your pathology report from any biopsy or surgery
  • If you had surgery, a copy of your operative report
  • If you were in the hospital, a copy of the discharge summary that the doctor wrote when you were sent home from the hospital
  • If you had radiation treatment, a copy of the treatment summary
  • If you had chemotherapy (or other drugs), a list of your drugs, drug doses, and when you took them
  • Copies of your x-rays and imaging tests (these can be put onto a DVD)

 

Lifestyle changes after treatment for anal cancer

You can’t change the fact that you have had cancer. What you can change is how you live the rest of your life — making choices to help you stay healthy and feel as well as you can. This can be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even start during cancer treatment.

Make healthier choices

For many people, finding out they have cancer helps them focus on their health in ways they may not have thought much about in the past. Are there things you could do that might make you healthier? Maybe you could try to eat better or get more exercise. Maybe you could cut down on the alcohol, or give up tobacco. Even things like keeping your stress level under control may help. Now is a good time to think about making changes that can have good effects for the rest of your life. You will feel better and you will also be healthier.

You can start by working on those things that worry you most. Get help with those that are harder for you. For instance, if you are thinking about quitting smoking and need help, call the American Cancer Society for information and support.

Eating better

Eating right can be hard for anyone, but it can get even tougher during and after cancer treatment. Treatment may change your sense of taste. Nausea can be a problem. You may not feel like eating and lose weight when you don’t want to. Or you may have gained weight that you can’t seem to lose. All of these things can be very frustrating.

If treatment caused weight changes or eating or taste problems, do the best you can and keep in mind that these problems usually get better over time. You may find it helps to eat small portions every 2 to 3 hours until you feel better. You may also want to ask your cancer team about seeing a dietitian, an expert in nutrition who can give you ideas on how to deal with these treatment side effects.

One of the best things you can do after cancer treatment is put healthy eating habits into place. You may be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Getting to and staying at a healthy weight, eating a healthy diet, and limiting your alcohol intake may lower your risk for a number of types of cancer, as well as having many other health benefits.

Rest, fatigue, and exercise

Feeling tired (fatigue) is a very common problem during and after cancer treatment. This is not a normal type of tiredness but a bone-weary exhaustion that doesn’t get better with rest. For some people, fatigue lasts a long time after treatment and can keep them from staying active. But exercise can actually help reduce fatigue and the sense of depression that sometimes comes with feeling so tired.

If you are very tired, though, you will need to balance activity with rest. It is OK to rest when you need to. To learn more about fatigue, please see our document, Fatigue in People With Cancer.

If you were very ill or weren’t able to do much during treatment, it is normal that your fitness, staying power, and muscle strength declined. You need to find an exercise plan that fits your own needs. Talk with your health care team before starting. Get their input on your exercise plans. Then try to get an exercise buddy so that you’re not doing it alone.

Exercise can improve your physical and emotional health.

  • It improves your cardiovascular (heart and circulation) fitness.
  • It makes your muscles stronger.
  • It reduces fatigue.
  • It lowers anxiety and depression.
  • It can help you feel generally happier.
  • It can help you feel better about yourself.

Long term, we know that getting regular physical activity plays a role in helping to lower the risk of some cancers, as well as having other health benefits.

 

How does having anal cancer affect your emotional health?

Once your treatment ends, you may be surprised by the flood of emotions you go through. This happens to a lot of people. You may find that you think about the effect of your cancer on things like your family, friends, and career. Money may be a concern as the medical bills pile up. Or you may begin to think about the changes that cancer has brought to your relationship with your spouse or partner. Unexpected issues may also cause concern — for instance, as you get better and need fewer doctor visits, you will see your health care team less often. This can be hard for some people.

This is a good time to look for emotional and social support. You need people you can turn to. Support can come in many forms: family, friends, cancer support groups, church or spiritual groups, online support communities, or private counselors.

The cancer journey can feel very lonely. You don’t need to go it alone. Your friends and family may feel shut out if you decide not include them. Let them in — and let in anyone else who you feel may help. If you aren’t sure who can help, call your American Cancer Society at 1-800-227-2345 and we can put you in touch with a group or resource that may work for you.

You can’t change the fact that you have had cancer. What you can change is how you live the rest of your life — making healthy choices and helping your body and mind feel well.

 

By American Cancer Society