Anal cancer

Anal cancer is a cancer that starts in the anus. The anus is the opening at the end of the large bowel, which is part of the digestive system. It's where you pass poo (stools) out of the body. The large bowel also includes the colon and rectum.

Other types of bowel cancer include:

• colon cancer
• rectal cancer
• small bowel cancer

In this video, Clinical Oncologist Katherine Aitkens explains bowel cancer, including anal cancer. She gives an overview of bowel cancer symptoms, diagnosis and treatment.

In the UK, about 1,500 people develop anal cancer each year. It's a rare cancer, but the number of people being diagnosed is increasing, especially women and people assigned female at birth.

Anal cancer is much more common in women than in men and people assigned male at birth.

There are different types of anal cancer. Knowing the type you have helps your doctor plan your individual treatment.

Most anal cancers develop in the squamous cells which make up the lining of the anal canal. The information on this page is about squamous cell cancer of the anus.

If you have symptoms of anal cancer, you'll usually start by seeing your doctor. The doctor will examine you and may suggest some of the following tests.

In a rectal examination, the doctor gently puts a gloved, lubricated finger into your back passage (rectum) to feel for any lumps or swellings. It may be uncomfortable, but it doesn't take long. If it's painful, tell your doctor, because the hospital specialist needs to know.

You may be asked to have some blood tests. One reason is to check for anaemia, which means a low number of red blood cells. The tests also show how well your liver and kidneys are working.

Your doctor will refer you to a hospital specialist, usually either a surgeon or a specialist in bowel conditions (a gastroenterologist).

If your doctor thinks you might have anal cancer, they'll arrange an appointment for you at the hospital as quickly as possible.

At the hospital, the specialist will ask you about:

• your general health
• any previous medical problems
• whether you have a family history of cancer

They may also ask some personal questions. These are to find out whether you have any risk factors linked with anal cancer, such as the HPV.

The specialist will feel your tummy. They might examine your anus and back passage by doing another rectal examination.

Sometimes they do an internal examination of the vagina, because it's close to the anal canal.

The specialist will also examine the lymph nodes in your groin, as these are closest to the anus. If they're swollen, you may have further tests to check whether there's cancer in the lymph nodes.

The specialist will talk to you about the tests you need to have.

You may have an anal examination and a biopsy. A specialist looks at the inside of the anal canal using a thin tube called an endoscope, which has a light and a camera on the end.

A biopsy means the doctor takes a small sample of cells from any abnormal areas so they can be looked at under a microscope. You'll usually have this done under general anaesthetic.

You may be offered a fine needle aspiration (FNA) to check whether cancer cells have reached the lymph nodes. The doctor passes a fine needle into the lymph nodes and draws (aspirates) some cells into a syringe. It might feel a little uncomfortable, but it's very quick.

You don't usually need a local anaesthetic. You might have an ultrasound scan at the same time, which helps guide the needle.

If the biopsy shows you have anal cancer, you'll need further tests. These find out more about where the cancer is and whether it has spread.

You'll usually have a scan to learn more about the cancer. You may have any of the following:

• CT scan
• MRI scan
• PET or PET-CT scan

Waiting for test results can be a difficult time, and more information and support can help.

The results of your tests help your doctors learn more about the size and position of the cancer, and whether it has spread. This is called staging.

A doctor decides the grade of the cancer by looking at how the cancer cells appear under the microscope. The grade gives an idea of how quickly the cancer might grow or spread.

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

A team of specialists will meet to talk about 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 with you about the things to think about when you make decisions on treatment.

The treatment you have for anal cancer depends on the stage of the cancer. It also depends on your general health and on what you prefer.

The main treatment is chemoradiation, which means having chemotherapy and radiotherapy together. Some people have these treatments on their own. Or you may have surgery to remove the cancer.

Do talk about your options with your doctor. They can explain why they are suggesting a certain treatment plan and how it may affect you.

Treatment for anal cancer can include the following.

Anal cancer is mainly treated with chemoradiation, which means you have radiotherapy and chemotherapy together.

Radiotherapy uses high-energy rays to destroy cancer cells. Chemotherapy uses anti-cancer drugs, which also destroy cancer cells, and it helps the radiotherapy work better.

Chemoradiation is usually successful, and most people don't need surgery after it.

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

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

If you're not well enough to have chemoradiation for anal cancer, your doctor may suggest radiotherapy on its own. Radiotherapy can also help ease symptoms if the cancer has spread.

If anal cancer has spread to other parts of the body, you may be given chemotherapy on its own. It can help to control the cancer and ease symptoms.

Anal cancer and its treatment can affect your sex life.

Many people find this hard to talk about because they feel embarrassed or self-conscious. Your doctor or nurse is used to talking about these things, so it can help to bring it up with them if you're having problems with your sex life.

Some changes get better over time, but sometimes they're permanent. If you have any problems or you're worried about this, talk to your doctor or nurse.

Recovery after anal cancer treatment can take time, and some days you'll feel better than others.

Looking after yourself can speed up your recovery. Even small changes may improve your wellbeing and your long-term health. You may already live a healthy life, but you might still choose to make some positive changes after treatment.

It's good to know where to find support or information when you need it. People often need support even some time after kidney cancer treatment, yet it isn't always easy to know who to ask. Talk to your doctor or someone from your cancer team, and ask them for advice about support in your area.