Anal Cancer

It’s important to understand that anal cancer is a completely different type of cancer than rectal cancer and colon cancer. Each has different kinds of treatments to stop cells from growing and spreading (metastasizing).

When you have anal cancer, it means cancer cells are growing in the tissues and muscles in the opening of your anal canal where poop (stool) leaves your body. Tumors may form in the skin near your anus or in the ring-like sphincter muscles that help your anus open and close.

Your providers will work with you to find out exactly what’s going on and confirm a diagnosis. There are two types of anal cancer:

• Squamous cell carcinoma.
• Adenocarcinoma.

Your treatment will be tailored to the type of anal cancer you have.

What to expect at your first visit

Whether your primary care provider referred you or you reached out to us after noticing symptoms, you’re probably wondering what’s going to happen next. Here’s what you can expect at your first appointment:

Your provider will start by sitting down and talking with you. They’ll want to hear what’s been going on — in your words. It’s important for you to share:

• What symptoms you’ve been having.
• How long you’ve had them.
• If they’re getting worse.
• How they’re affecting your life.
• If you’ve ever had human papilloma virus (HPV) or anal dysplasia.
• If anyone else in your family has had any kind of cancer.

During this time, feel free to ask questions. Your concerns are important to us. And understanding them can help us personalize your treatment even more closely to your needs.

Next, your provider will do a physical exam. This may include a digital rectal exam (DRE) and also a pelvic exam if you’re a woman or person assigned female at birth (AFAB). They may also use a cotton swab to collect cells from your anus (anal Pap test) to look at under a microscope. You may also get orders for other tests, like:

Endoscopic tests

We use special instruments to look inside your anus and rectum, which are part of your large intestine (colon). These thin, tube-like instruments have a light, magnifying lens and camera so we can see detailed views. You may have:

• Anoscopy: A procedure where specialists use an instrument called an anoscope to check your anus and the lower part of your rectum.
• Flexible sigmoidoscopy: An examination of the inside of your rectum and anus to check for tumors and anal polyps.
• Colonoscopy: An examination of your entire colon to check for tumors and polyps.

During endoscopic tests, we may take a tissue sample to look at under a microscope (biopsy). These tests help us know how much of the anus is involved in the disease.

Imaging tests

Your provider may order imaging tests so they can get a closer look at what’s going on and to see how large the tumor may be, and if it’s spread (cancer staging). These tests may include:

• Transrectal ultrasound.
• CT scan.
• MRI.
• PET scan.

Second opinions for anal cancer

Learning that you may have anal cancer can be emotional and overwhelming. But one thing is likely certain — you’ll want to make sure you have a team of healthcare providers you trust to give you the best possible treatment. At Cleveland Clinic, we encourage second opinions.

Getting a second opinion can help you feel in control of your care and give you peace of mind knowing you’re in the most capable and compassionate hands. And because we know that cancer doesn’t wait, we try to get you in to see us as soon as possible. Our team of experts will dive in and work together to help you through the process of finding the best personalized treatment plan.

Meet Our Anal Cancer Team

When you come to Cleveland Clinic, you’ll have a care team of different providers from different specialties, all handpicked based on your unique needs. This team works together to confirm your diagnosis and plan your treatment and follow-up care. Your team could include:

• Gastroenterologists.
• Colorectal surgeons.
• Radiation oncologists.
• Medical oncologists.
• Radiologists.
• Residents, fellows and medical students.
• Nurse practitioners.
• Physician assistants.
• Enterostomal therapists (care for people who’ve had an ostomy).

Your treatment for anal cancer depends on your test results, your overall health and your unique needs. You may have just one or two treatments or a combination of several, like:

Radiation therapy

We use radiation therapy to destroy cancer cells in your anus and surrounding area. Our specialists use a machine to send high-energy beams to anal tumors with external beam radiation therapy (EBRT). You may have:

• Three-dimensional conformal radiation therapy (3D-CRT): A computer creates a three-dimensional picture of the anal tumors so the radiation dose can match the tumor’s size and shape to protect nearby healthy tissue.
• Intensity-modulated radiation therapy (IMRT): Sends customized doses of radiation to kill cancer cells, while sparing healthy tissue.
• Stereotactic body radiation therapy (SBRT): Used to target small tumors with large doses of radiation without damaging healthy tissue or organs.

We may also use internal radiation therapy (brachytherapy). Our experts place radioactive seeds or beads inside your anus near the tumor to kill the cancer cells.

Chemotherapy

We treat you with medication (chemotherapy) that works throughout your body to destroy cancer cells. You may have chemotherapy along with radiation therapy. When we do this together, we call it chemoradiation.

Minimally invasive (laparoscopic or robotic) abdominoperineal resection

If your anal cancer doesn’t respond to other treatments or has spread or comes back (recurs) after treatment, your provider may recommend removing your anus, rectum and the lower part of your large intestine (sigmoid colon). We do this using minimally invasive laparoscopic or robotic abdominoperineal resection. After this surgery, you’ll need a colostomy for pooping. Your surgeon will do this during the resection. Before and after surgery, you’ll work with an enterostomal therapist to determine whether you’ll use a colostomy bag or irrigate your colostomy instead.

Immunotherapy

Immunotherapy, medications you take with or without chemotherapy, can help ease the symptoms of late-stage anal cancer. These drugs help your immune system to recognize the cancer as something bad and then to fight the cancer cells more effectively.

Taking the Next Step

Anal cancer can be uncomfortable in many ways — physically, mentally and emotionally. But if you notice changes in your bowel habits or the way your anus feels, it’s important to talk with experienced healthcare providers right away. We’re here to help you take the next step. Because the sooner we find out if you have anal cancer, the quicker you can get treatment with the best possible results.