Anal cancer

Causes and risk factors of anal cancer

Doctors don’t know the exact causes of anal cancer. But there are risk factors that can increase your chance of developing it.

Most anal cancers are caused by the human papillomavirus (HPV), a common virus that’s passed on through sexual contact.

Most people have HPV at some point and never know they have had it. The immune system usually gets rid of HPV. But a small number of HPV infections eventually lead to cancer developing.

Macmillan Cancer Support have more information about causes and risk factors of anal cancer.

If you have symptoms, you'll usually start by seeing your GP. They will examine you and may carry out a few tests.

Rectal examination

A rectal examination is when the doctor gently inserts a gloved, lubricated finger into your back passage (rectum) to feel for any lumps or swellings. This may feel uncomfortable, but it's over quickly. Do tell your GP if it hurts, since that's important information to pass on to the hospital specialist.

Blood test

You may be asked to give a blood sample. This checks for anaemia, which means a low number of red blood cells, and also shows how well your liver and kidneys are working.

Seeing a specialist

Your GP will refer you to a hospital specialist, usually either a surgeon or a doctor who specialises in bowel conditions (a gastroenterologist). If your GP suspects cancer, they will arrange a hospital appointment for you as quickly as possible.

At the hospital

At the hospital, the specialist will ask about your general health, any previous medical problems, and whether cancer runs in your family. They may also ask some personal questions, since these help find out whether you have any risk factors linked with anal cancer, such as HPV.

The specialist will feel your tummy, and may examine your anus and back passage with another rectal examination. Sometimes an internal examination of the vagina is done as well, since it lies close to the anal canal.

The specialist will also check the lymph nodes in your groin, since these are closest to the anus. If they feel swollen, you may need further tests to see whether the cancer has reached the lymph nodes. The specialist will then talk you through which tests you need.

Anal examination and biopsy

You may have an anal examination along with a biopsy. The specialist examines the anal canal using a thin tube called an endoscope, which has a light and camera on the end.

A biopsy means the doctor takes a small sample of cells from any abnormal area so it can be examined under a microscope. This is usually done under general anaesthetic.

Fine needle aspiration (FNA) of the lymph nodes

This test checks whether cancer cells have reached the lymph nodes. The doctor passes a fine needle into the lymph nodes and draws out some cells into a syringe. It may feel slightly uncomfortable, but it's over very quickly, and you won't usually need a local anaesthetic. An ultrasound scan may be used alongside it to help guide the needle.

Further tests for anal cancer

If the biopsy confirms anal cancer, you'll need further tests to learn more about where the cancer is and whether it has spread. A scan is usually done for this, and you may have a CT scan, an MRI scan, or a PET or PET-CT scan.

Waiting for test results can be a hard time to get through. Macmillan Cancer Support has more information that may help while you wait.

Staging and grading of anal cancer

Your test results help doctors understand the size and position of the cancer and whether it has spread. This is known as staging.

A doctor also grades the cancer by how the cells look under the microscope, which gives an idea of how quickly it might grow or spread.

Knowing both the stage and grade of the anal cancer helps your doctors plan the best treatment for you.

Treatment for anal cancer

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your doctor, cancer specialist or nurse will explain the different treatments and their side effects. They’ll also talk to you about things to consider when making treatment decisions.

The treatment you have depends on the stage of the cancer. It also depends on your general health and preferences.

The main treatment for anal cancer is chemoradiation. This is when you have chemotherapy and radiotherapy together. Some people have these treatments on their own. Or you may have surgery to remove the cancer.

It’s important to talk about your treatment options with your doctor. They can explain why they are suggesting a certain treatment plan and how the treatment may affect you.

Treatment for anal cancer can include the following.

Chemoradiation

The main treatment for anal cancer is chemoradiation. This is when you have radiotherapy and chemotherapy together.

Radiotherapy treats cancer by using high-energy rays that destroy cancer cells.

Chemotherapy uses anti-cancer drugs to destroy cancer cells. It makes radiotherapy work better.

Chemoradiation is usually successful. Most people don’t need surgery after it.

Surgery

Surgery isn’t often used to treat anal cancer. This is because chemoradiation is often the only treatment needed. You may be offered surgery for other reasons, like if you have a very small tumour in the anal margin.

Some people may need a temporary or sometimes a permanent colostomy (stoma) after surgery. This is an opening the surgeon makes through the tummy (abdominal) wall. It connects the bowel to the surface of the tummy.

Radiotherapy

You may have radiotherapy on its own if you’re not well enough to have chemoradiation. Radiotherapy can also be used to help with symptoms if the cancer has spread.

Chemotherapy

You may have chemotherapy on its own if the cancer has spread to other parts of the body. It may help to control the cancer and improve symptoms.

Clinical trials

Your cancer doctor may invite you to take part in a clinical trial.

After anal cancer treatment

After treatment has finished, you’ll have regular check-ups every few months for the first 2 years. These usually continue for up to 5 years. You have them less often as time goes on.

At your check-ups, a specialist doctor will:

• examine you
• ask how you’re feeling and whether you have any ongoing treatment side effects
• ask whether you have any new symptoms

You may also have other tests like MRI scans or CT scans to check how well treatment has worked. Your doctor and specialist nurse will explain more about this.

If you notice any new symptoms between check-ups, tell your GP, cancer doctor or nurse straight away. Your doctor will check what may be causing your symptoms and whether your symptoms are late effects of treatment.

Macmillan Cancer Support have more information about follow-up care after treatment.

Support after anal cancer

People often have many different feelings when they finish anal cancer treatment. You may feel relieved that treatment has finished, but worried about what will happen in the future.

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan anal cancer forum – you can talk to others affected by anal cancer, ask questions and share your experience
• use the Cancer Care Map to find cancer support services near you

Sex and fertility

Anal cancer and its treatment can affect your sex life.

Many people find it difficult to talk about this because they feel embarrassed or self-conscious. Your doctor or nurse will be used to talking about these issues. So it can help to talk to them if you’re having problems with your sex life.

Changes may get better over time, but sometimes they’re permanent. If you have any problems or are worried about this, talk to your doctor or nurse.

Macmillan have more information about how anal cancer treatment can affect your sex life.

Body image

Anal cancer and its treatments can affect how you think and feel about your body (body image).

Macmillan Cancer Support have more information about managing body image concerns.

Wellbeing and recovery

It can take time to recover after anal cancer treatment. Some days you may feel better than others.

Looking after yourself can help speed up your recovery. Even small changes may improve your wellbeing and long-term health.

Even if you already have a healthy lifestyle, you may choose to make some positive changes after treatment.

Macmillan Cancer Support have more information on leading a healthy lifestyle after treatment.

It’s important to know where to get support or information from if you need it. People often need support even some time after kidney cancer treatment. But it can be difficult to know who to ask for help.

Ask your GP or someone from your cancer team for advice about support in your area.

Macmillan Cancer Support has more advice on:

• finishing cancer treatment
• being physically active after treatment
• bowel changes after cancer treatment

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