Anal cancer treatment

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Dr Sarita Retief helps us better understand the treatment of all stages of anal cancer by sharing a patient story.

What is anal cancer?

Anal cancer is when normal cells lining the anus change into abnormal cells and grow out of control. The anus is the last part of the digestive tract, where bowel movements leave the body.

It can sometimes be difficult to distinguish from cancers that grow downwards from the rectum (rectal cancers) or cancers that grow inwards from the skin of the buttocks (skin cancers). The information below relates to true anal cancers, specifically squamous carcinoma.

Patient story

Linda has had a bit of an embarrassing situation. For the last few months she found some bloodstains on the toilet paper after wiping herself. It also became more and more painful to pass stools and her anal area itched at times. She mentioned it to her GP on a previous visit when she went to see him for a cold. He thought that it might be piles, prescribed  some ointment and told her that she must come back if it did not get better.

The pain increased and some days she found red blood in the toilet bowl. She knew that it must be something worse and that she had to get help. She went to her GP again. This time he examined her and immediately told her that he will have to refer her to a general surgeon as he was concerned about a growth in the area of the anus.

Dr D, the general surgeon, examined her and performed a biopsy. Two weeks later she saw him again for the biopsy result. What she feared most came true. She had anal cancer, squamous carcinoma, the most common type of anal cancer. He told her that she will have to be seen by an oncologist who will take over further management.

Surgery is not part of the initial treatment of anal cancer.

Oncology treatment 

Dr A was a lovely, friendly female oncologist that immediately made Linda feel at ease. They worked through Linda’s questions and concerns. Linda went for blood tests, including a HIV test as it’s considered a risk factor. She had a PET/CT scan and a MRI of her pelvis.

Luckily the cancer didn’t spread anywhere. Linda had Stage 2 anal cancer. All stages of anal cancer, except Stage 4, are treated the same way, namely with chemoradiation. This treatment consists of five to six weeks of daily radiation to the pelvis and anal area, together with chemotherapy to enhance the effect of radiation.

This treatment usually is curative. If Linda had Stage 4 anal cancer, she would have received chemotherapy and the treatment wouldn’t have been curative.

Dr A also discussed the necessity of a temporary colostomy (an operation to divert one end of the colon through an opening in the tummy) with Linda. The colostomy would make it easier and more hygienic to go through the treatment. It would be closed again about three months after the end of treatment.

Linda completed her treatment. At the end of radiation, she felt quite a bit of discomfort in her pelvic area. All side effects quickly disappeared about three weeks after radiation.

Linda still sees her oncologist regularly for check-ups and is in remission. Her anal function is slightly affected and she sometimes needs to dilate the anus to stretch scar tissue. She now is an advocate for early detection of anal cancer. She knows that it’s nothing to be embarrassed about and early detection saved her life.

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