Anal Cancer

Diagnosis usually involves several steps to determine the cause of symptoms and, if cancer is present, how far it has spread.

1. Physical exam: A digital rectal exam (DRE) allows the doctor to feel for abnormal masses inside the anus.
2. Anoscopy: An anoscope, which is a short, lighted tube, provides a clear view inside the anal canal.
3. Biopsy: If anything looks suspicious, a small tissue sample is removed and examined under a microscope. A biopsy is the only way to confirm anal cancer.
4. Imaging tests: If cancer is confirmed, imaging helps determine the stage. This can take the form of:
   • CT or MRI scans.
   • PET scans.
   • Endoanal ultrasound.

These tests show whether cancer has spread to nearby lymph nodes or other organs.

Anal cancer is most often treated first with a combination of chemotherapy and radiation.

• Chemotherapy uses strong medicines to destroy cancer cells. Some are injected in a vein, and others come in pill form. The specific medicine(s) used and how often you receive them will be determined by your care team.
• Radiation therapy uses targeted high-energy beams, such as X-rays or protons, to treat cancer at specific sites in the body. Radiation is typically delivered daily over several weeks. 

Surgery may be recommended if the cancer does not respond to initial treatment or if it returns. Whenever possible, our surgeons use minimally invasive approaches, such as robotic or laparoscopic techniques.

At Hollings, surgeons can perform a procedure called an abdominoperineal resection (APR), which involves removing the last part of the intestine – the rectum and the anus. This involves the creation of a permanent opening in the abdomen, called a stoma or ostomy, through which stool is collected in a bag.

Other treatment options for anal cancer include:

• Targeted therapy.
• Immunotherapy (drugs that help the body’s immune system fight off cancer).
• Clinical trials.

Common signs include anal bleeding, persistent itching or discharge, a lump or growth that does not go away and changes in bowel habits. You should also take note of anal pain or discomfort, such as sharp pain during bowel movements, a frequent sense of pressure or fullness or a constant dull ache.

Only a biopsy can confirm anal cancer.

Anal cancer is rare, but its rates have increased slightly in recent years.

Lumps often feel hard, firm and fixed in place. They may also grow over time.

But not all lumps are cancer. Conditions like hemorrhoids, warts and skin tags are much more common. Still, any new lump should be checked by a healthcare provider.

Yes. Most people can still go to the bathroom normally after anal cancer treatment. However, the treatment can sometimes change how the bowel works, especially in the months after therapy.

Anal cancer is often treated with chemotherapy and radiation, which aim to destroy the cancer while preserving the anus and avoiding surgery. Because the anus and nearby tissues are involved in bowel control, treatment can temporarily affect how bowel movements feel or function.

Some people notice temporary bowel changes during or after treatment, such as:

• More frequent bowel movements.
• Feeling an urgent need to go to the bathroom right away.
• Loose stools or diarrhea.
• Mild leakage or difficulty controlling gas.
• Rectal irritation or discomfort.

These effects are common during treatment and usually improve over time as the body heals. Many people are able to return to normal daily activities, including regular bowel movements, after treatment.

If you have concerns about bowel function, talk with your care team. They can help you understand what to expect and how to manage any symptoms during recovery.

In most cases, no. One major goal of modern anal cancer treatment is to preserve normal bowel function. The majority of patients do not need a permanent colostomy (a bag that collects stool through an opening in the abdomen).

A colostomy is typically only needed if:

• The cancer does not respond to initial treatment.
• Surgery is required to remove the remaining cancer.