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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65930_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65930_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65930_"><span class="title" itemprop="name">Anal Cancer Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: December 16, 2022.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000258179__186">This PDQ cancer information summary has current information about the treatment of anal cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000258179__187">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.</p></div><div id="CDR0000258179__1"><h2 id="_CDR0000258179__1_">General Information About Anal Cancer</h2><div id="CDR0000258179__1.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258179__2">Anal cancer is a disease in which malignant (cancer) cells form in
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the tissues of the anus. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__7">Most anal cancers are related to human papillomavirus (HPV) infection.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__15">Signs of anal cancer include bleeding from the anus or rectum or a lump near the anus. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__19">Tests that examine the rectum and anus are used to diagnose anal cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__23">Certain factors affect the prognosis (chance of recovery) and treatment options.</a></div></li></ul></div><div id="CDR0000258179__2"><h3>Anal cancer is a disease in which malignant (cancer) cells form in
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the tissues of the anus. </h3><p id="CDR0000258179__146">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046523/" class="def">anus</a> is the end of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045097/" class="def">large intestine</a>, below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a>, through which <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046605/" class="def">stool</a> (solid waste) leaves the body. The anus is formed partly from the outer skin layers of the body and partly from the intestine. Two ring-like muscles, called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257222/" class="def">sphincter</a> muscles, open and close the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044185/" class="def">anal</a> opening and let stool pass out of the body. The anal canal, the part of the anus between the rectum and the anal opening, is about 1-1½ inches long. <div id="CDR0000258179__162" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Anatomy%20of%20the%20lower%20gastrointestinal%20(digestive)%20system%20showing%20the%20colon%2C%20rectum%2C%20and%20anus&p=BOOKS&id=587751_CDR0000415499.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65930.10/bin/CDR0000415499.jpg" alt="Gastrointestinal (digestive) system anatomy; drawing shows the esophagus, liver, stomach, colon, small intestine, rectum, and anus." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Anatomy of the lower gastrointestinal (digestive) system showing the colon, rectum, and anus. Other organs that make up the digestive system are also shown.</p></div></div></p><p id="CDR0000258179__115"> The skin around the outside of the anus is called the perianal area. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">Tumors</a> of the perianal skin that do not involve the anal
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sphincter are usually treated the same as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444966/" class="def">anal cancers</a>, although <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045755/" class="def">local therapy</a> (treatment directed to a limited area of skin) may be used for some.</p></div><div id="CDR0000258179__7"><h3>Most anal cancers are related to human papillomavirus (HPV) infection.</h3><p id="CDR0000258179__118"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">Risk factors</a> for anal cancer include the following:</p><ul id="CDR0000258179__119"><li class="half_rhythm"><div>Being <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infected</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045714/" class="def">human papillomavirus</a> (HPV).</div></li><li class="half_rhythm"><div>Having a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> or disease that causes a weakened <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a>, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044366/" class="def">human immunodeficiency virus</a> (HIV) or an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046631/" class="def">transplant</a>.</div></li><li class="half_rhythm"><div>Having a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642021/" class="def">personal history</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044776/" class="def">vulvar</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000523460/" class="def">vaginal</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444973/" class="def">cervical cancers</a>.</div></li><li class="half_rhythm"><div>Having many <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476620/" class="def">sexual</a> partners.</div></li><li class="half_rhythm"><div>Having receptive anal intercourse (anal sex).</div></li><li class="half_rhythm"><div>Smoking <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000748148/" class="def">cigarettes</a>. </div></li></ul></div><div id="CDR0000258179__15"><h3>Signs of anal cancer include bleeding from the anus or rectum or a lump near the anus. </h3><p id="CDR0000258179__132">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by anal cancer or by other conditions. Check with your doctor if you have any of the following: </p><ul id="CDR0000258179__117"><li class="half_rhythm"><div>Bleeding from the anus or rectum.</div></li><li class="half_rhythm"><div>A lump near the anus.</div></li><li class="half_rhythm"><div>Pain or pressure in the area around the anus.</div></li><li class="half_rhythm"><div>Itching or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443583/" class="def">discharge</a> from the anus.</div></li><li class="half_rhythm"><div>A change in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046500/" class="def">bowel</a> habits.</div></li></ul></div><div id="CDR0000258179__19"><h3>Tests that examine the rectum and anus are used to diagnose anal cancer.</h3><p id="CDR0000258179__21">The following tests and procedures may be used:</p><ul id="CDR0000258179__22"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000798522/" class="def">health history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045668/" class="def">Digital rectal examination</a> (DRE)</b>: An exam of the anus and rectum. The doctor or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269445/" class="def">nurse</a> inserts a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046302/" class="def">lubricated</a>, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual.<div id="CDR0000258179__182" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Digital%20rectal%20exam%20(DRE)&p=BOOKS&id=587751_CDR0000457840.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65930.10/bin/CDR0000457840.jpg" alt="Digital rectal exam; drawing shows a side view of the male reproductive anatomy and the urinary anatomy, including the prostate, rectum, and bladder. Also shown is a gloved, lubricated finger inserted into the rectum to feel the rectum, anus, and prostate." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Digital rectal exam (DRE). The doctor inserts a gloved, lubricated finger into the rectum and feels the rectum, anus, and prostate (in males) to check for anything abnormal.</p></div></div></div></li><li class="half_rhythm"><div><b>Anoscopy</b>: An exam of the anus and lower rectum using a short, lighted tube called an anoscope. </div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046535/" class="def">Proctoscopy</a></b>: A procedure to look inside the rectum and anus to check for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> areas, using a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000742474/" class="def">proctoscope</a>. A proctoscope is a thin, tube-like instrument with a light and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000572035/" class="def">lens</a> for viewing the inside of the rectum and anus. It may also have a tool to remove <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> samples, which are checked under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> for signs of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>.</div></li><li class="half_rhythm"><div><b>Endo-anal or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000357580/" class="def">endorectal ultrasound</a></b>: A procedure in which an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000367430/" class="def">ultrasound transducer</a> (probe) is inserted into the anus or rectum and used to bounce high-energy sound waves (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046157/" class="def">ultrasound</a>) off internal tissues or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and make echoes. The echoes form a picture of body tissues called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046587/" class="def">sonogram</a>. </div></li><li class="half_rhythm"><div>
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<b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">Biopsy</a></b>: The removal of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> or tissues so they can be viewed under a microscope by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> to check for signs of cancer. If an abnormal area is seen during the anoscopy, a biopsy may be done at that time. </div></li></ul></div><div id="CDR0000258179__23"><h3>Certain factors affect the prognosis (chance of recovery) and treatment options.</h3><p id="CDR0000258179__147">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a> depends on the following:</p><ul id="CDR0000258179__148"><li class="half_rhythm"><div>The size of the tumor.</div></li><li class="half_rhythm"><div>Whether the cancer has spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>.</div></li></ul><p id="CDR0000258179__25">The treatment options depend on the following:</p><ul id="CDR0000258179__149"><li class="half_rhythm"><div>The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer.</div></li><li class="half_rhythm"><div> Where the tumor is in the anus.</div></li><li class="half_rhythm"><div>Whether the patient has human immunodeficiency virus (HIV).</div></li><li class="half_rhythm"><div>Whether cancer remains after initial treatment or has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurred</a>. </div></li></ul></div></div><div id="CDR0000258179__26"><h2 id="_CDR0000258179__26_">Stages of Anal Cancer</h2><div id="CDR0000258179__26.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258179__27">After anal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the anus or to other parts of the body. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__171">There are three ways that cancer spreads in the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__183">Cancer may spread from where it began to other parts of the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__31">The following stages are used for anal cancer:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000258179__271">Stage 0</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__36">Stage I</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__39">Stage II</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__277">Stage III</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__45">Stage IV</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000258179__317">Anal cancer can recur (come back) after it has been treated.</a></div></li></ul></div><div id="CDR0000258179__27"><h3>After anal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the anus or to other parts of the body. </h3><p id="CDR0000258179__29">The process used to find out if <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread within the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046523/" class="def">anus</a> or to other
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parts of the body is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. The information gathered from this
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staging process determines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the disease. It is important to know
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the stage in order to plan treatment. The following tests may be used in the staging process: </p><ul id="CDR0000258179__158"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b>: A procedure that makes a series of detailed pictures of areas inside the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, or chest, taken from different angles. The pictures are made by a computer linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or swallowed to help the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304687/" class="def">Chest x-ray</a></b>: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic resonance imaging)</b>: A procedure that uses a magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046140/" class="def">PET scan</a> (positron emission tomography scan)</b>: A procedure to find <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> in the body. A small amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044033/" class="def">glucose</a> (sugar) is injected into a vein. The PET <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386220/" class="def">scanner</a> rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322873/" class="def">Pelvic exam</a></b>: An exam of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046646/" class="def">vagina</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046133/" class="def">cervix</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046645/" class="def">uterus</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045687/" class="def">fallopian tubes</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a>. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046588/" class="def">speculum</a> is inserted into the vagina and the doctor or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269445/" class="def">nurse</a> looks at the vagina and cervix for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> of disease. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045978/" class="def">Pap test</a> of the cervix is usually done. The doctor or nurse also inserts one or two <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046302/" class="def">lubricated</a>, gloved fingers of one hand into the vagina and places the other hand over the lower <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> areas.<div id="CDR0000258179__265" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Pelvic%20exam&p=BOOKS&id=587751_CDR0000609924.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65930.10/bin/CDR0000609924.jpg" alt="Pelvic exam; drawing shows a side view of the female reproductive anatomy during a pelvic exam. The uterus, left fallopian tube, left ovary, cervix, vagina, bladder, and rectum are shown. Two gloved fingers of one hand of the doctor or nurse are shown inserted into the vagina, while the other hand is shown pressing on the lower abdomen. The inset shows a woman covered by a drape on an exam table with her legs apart and her feet in stirrups." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Pelvic exam. A doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and presses on the lower abdomen with the other hand. This is done to feel the size, shape, and position of the uterus and ovaries. The vagina, cervix, fallopian tubes, and rectum are also checked.</p></div></div></div></li></ul></div><div id="CDR0000258179__171"><h3>There are three ways that cancer spreads in the body.</h3><p id="CDR0000258179__171_md_69">Cancer can spread through <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>, and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>:</p><ul id="CDR0000258179__171_md_70"><li class="half_rhythm"><div>Tissue. The cancer spreads from where it began by growing into nearby areas.
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</div></li><li class="half_rhythm"><div>Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a> to other parts of the body.
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</div></li><li class="half_rhythm"><div>Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> to other parts of the body.
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</div></li></ul></div><div id="CDR0000258179__183"><h3>Cancer may spread from where it began to other parts of the body.</h3><p id="CDR0000258179__183_md_66">When cancer spreads to another part of the body, it is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046710/" class="def">metastasis</a>. Cancer cells break away from where they began (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>) and travel through the lymph system or blood.</p><ul id="CDR0000258179__183_md_67"><li class="half_rhythm"><div>Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> tumor) in another part of the body.</div></li><li class="half_rhythm"><div>Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.</div></li></ul><p id="CDR0000258179__185">The metastatic tumor is the same type of cancer as the primary tumor. For example, if anal cancer spreads to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, the cancer cells in the lung are actually anal cancer cells. The disease is metastatic anal cancer, not <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445043/" class="def">lung cancer</a>.</p><div id="CDR0000258179__266" class="box"><h3><span class="title">metastasis: how cancer spreads</span></h3><div class="caption"><p>Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.</p></div><p><a href="https://www.youtube.com/watch?v=fQwar_-QdiQ" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></div><div id="CDR0000258179__31"><h3>The following stages are used for anal cancer:</h3><div id="CDR0000258179__271"><h4>Stage 0</h4><p id="CDR0000258179__273">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000413881/" class="def">stage 0</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> are found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257213/" class="def">mucosa</a> (innermost layer) of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046523/" class="def">anus</a>. These abnormal cells may become <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> and spread into nearby normal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>. Stage 0 is also called high-grade intraepithelial lesion (HSIL).</p><div id="CDR0000258179__163" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Tumor%20sizes%20are%20often%20measured%20in%20centimeters%20(cm)%20or%20inches&p=BOOKS&id=587751_CDR0000415526.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65930.10/bin/CDR0000415526.jpg" alt="Drawing shows different sizes of a tumor in centimeters (cm) compared to the size of a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm). Also shown is a 10-cm ruler and a 4-inch ruler." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Tumor sizes are often measured in centimeters (cm) or inches. Common food items that can be used to show tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm or 2 inches), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).</p></div></div></div><div id="CDR0000258179__36"><h4>Stage I</h4><p id="CDR0000258179__38">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045306/" class="def">stage I</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has formed and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is 2 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> or smaller.</p></div><div id="CDR0000258179__39"><h4>Stage II</h4><p id="CDR0000258179__274"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045307/" class="def">Stage II anal cancer</a> is divided into stages IIA and IIB.</p><ul id="CDR0000258179__282"><li class="half_rhythm"><div>In stage IIA, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is larger than 2 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> but not larger than 5 centimeters.</div></li><li class="half_rhythm"><div>In stage IIB, the tumor is larger than 5 centimeters.</div></li></ul></div><div id="CDR0000258179__277"><h4>Stage III</h4><p id="CDR0000258179__279"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045310/" class="def">Stage III anal cancer</a> is divided into stages IIIA, IIIB, and IIIC.</p><ul id="CDR0000258179__280"><li class="half_rhythm"><div>In stage IIIA, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is 5 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> or smaller and has spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> near the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046523/" class="def">anus</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046375/" class="def">groin</a>.</div></li><li class="half_rhythm"><div>In stage IIIB, the tumor is any size and has spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046646/" class="def">vagina</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046640/" class="def">urethra</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046501/" class="def">bladder</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> has not spread to lymph nodes.</div></li><li class="half_rhythm"><div>In stage IIIC, the tumor is any size and may have spread to nearby organs. Cancer has spread to lymph nodes near the anus or groin.</div></li></ul></div><div id="CDR0000258179__45"><h4>Stage IV</h4><p id="CDR0000258179__281">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046656/" class="def">stage IV</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is any size. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> may have spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> or nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and has spread to other parts of the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>.</p></div></div><div id="CDR0000258179__317"><h3>Anal cancer can recur (come back) after it has been treated.</h3><p id="CDR0000258179__319">The cancer may come back in the anus or other parts of the body, such as the liver or lungs.</p></div></div><div id="CDR0000258179__50"><h2 id="_CDR0000258179__50_">Treatment Option Overview</h2><div id="CDR0000258179__50.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258179__51">There are different types of treatment for patients with anal cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__55">The following types of treatment are used:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000258179__57">Surgery</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__61">Radiation therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__64">Chemotherapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000258179__79">New types of treatment are being tested in clinical trials. </a></div><ul><li class="half_rhythm"><div><a href="#CDR0000258179__133">Radiosensitizers</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__307">Immunotherapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000258179__267">Treatment for anal cancer may cause side effects.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__173">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__175">Patients can enter clinical trials before, during, or after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__177">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000258179__51"><h3>There are different types of treatment for patients with anal cancer.</h3><p id="CDR0000258179__53">Different types of treatments are available for patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444966/" class="def">anal cancer</a>. Some treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> (the currently used treatment), and some are being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>. A treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to help improve current treatments or obtain information on new treatments for patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p></div><div id="CDR0000258179__55"><h3>The following types of treatment are used:</h3><div id="CDR0000258179__57"><h4>Surgery</h4><ul id="CDR0000258179__145"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045755/" class="def">Local</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">resection</a>: A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgical</a> procedure in which the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is cut from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046523/" class="def">anus</a> along with some of the healthy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> around it. Local resection may be used if the cancer is small and has not spread. This procedure may save the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257222/" class="def">sphincter</a> muscles so the patient can still control <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046500/" class="def">bowel</a> movements. Tumors that form in the lower part of the anus can often be removed with local resection.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000377733/" class="def">Abdominoperineal resection</a>: A surgical procedure in which the anus, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a>, and part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000357588/" class="def">sigmoid colon</a> are removed through an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046353/" class="def">incision</a> made in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>. The doctor sews the end of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046335/" class="def">intestine</a> to an opening, called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045104/" class="def">stoma</a>, made in the surface of the abdomen so body waste can be collected in a disposable bag outside of the body. This is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046464/" class="def">colostomy</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">Lymph nodes</a> that contain cancer may also be removed during this operation. This procedure is used only for cancer that remains or comes back after treatment with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>.<div id="CDR0000258179__164" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Resection%20of%20the%20colon%20with%20colostomy&p=BOOKS&id=587751_CDR0000415509.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65930.10/bin/CDR0000415509.jpg" alt="Three-panel drawing showing anal cancer surgery with colostomy; first panel shows area of anus with cancer, middle panel shows cancer and nearby tissue removed and stoma created, last panel shows a colostomy bag attached to the stoma." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Resection of the colon with colostomy. Part of the colon containing the cancer and nearby healthy tissue are removed, a stoma is created, and a colostomy bag is attached to the stoma.</p></div></div></div></li></ul></div><div id="CDR0000258179__61"><h4>Radiation therapy</h4><p id="CDR0000258179__63"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> or keep them from growing. There are two types of radiation therapy: </p><ul id="CDR0000258179__188"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a> uses a machine outside the body to send radiation toward the area of the body with cancer. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> uses a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance sealed in needles, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">seeds</a>, wires, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheters</a> that are placed directly into or near the cancer.</div></li></ul><p id="CDR0000258179__189">The way the radiation therapy is given depends on the type and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer being treated. External and internal radiation therapy are used to treat anal cancer.</p></div><div id="CDR0000258179__64"><h4>Chemotherapy</h4><p id="CDR0000258179__66"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>).</p></div></div><div id="CDR0000258179__79"><h3>New types of treatment are being tested in clinical trials. </h3><p id="CDR0000258179__170">This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied.
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Information about clinical trials is available from the <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><div id="CDR0000258179__133"><h4>Radiosensitizers</h4><p id="CDR0000258179__135"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046553/" class="def">Radiosensitizers</a> are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.
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</p></div><div id="CDR0000258179__307"><h4>Immunotherapy</h4><p id="CDR0000258179__305"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">Immunotherapy</a> is a treatment that uses the patient's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045617/" class="def">biologic therapy</a>.</p><p id="CDR0000258179__306"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000772606/" class="def">Immune checkpoint inhibitor</a> therapy is a type of immunotherapy.</p><ul id="CDR0000258179__302"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000777027/" class="def">PD-1</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797389/" class="def">PD-L1</a> inhibitor therapy: PD-1 is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a> on the surface of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044928/" class="def">T cells</a> that helps keep the body’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045722/" class="def">immune responses</a> in check. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other. This allows the T cells to kill cancer cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000764538/" class="def">Pembrolizumab</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767747/" class="def">nivolumab</a> are types of PD-1 inhibitors.</div></li></ul><div id="CDR0000258179__296" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Immune%20checkpoint%20inhibitor&p=BOOKS&id=587751_CDR0000774646.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65930.10/bin/CDR0000774646.jpg" alt="Immune checkpoint inhibitor; the panel on the left shows the binding of proteins PD-L1 (on the tumor cell) to PD-1 (on the T cell), which keeps T cells from killing tumor cells in the body. Also shown are a tumor cell antigen and T cell receptor. The panel on the right shows immune checkpoint inhibitors (anti-PD-L1 and anti-PD-1) blocking the binding of PD-L1 to PD-1, which allows the T cells to kill tumor cells." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Immune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).</p></div></div><div id="CDR0000258179__303" class="box"><h3><span class="title">immune checkpoint inhibitors</span></h3><div class="caption"><p>Immunotherapy uses the body’s immune system to fight cancer. This animation explains one type of immunotherapy that uses immune checkpoint inhibitors to treat cancer.</p></div><p><a href="https://www.youtube.com/watch?v=GIUu239FWMg" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></div></div><div id="CDR0000258179__267"><h3>Treatment for anal cancer may cause side effects.</h3><p id="CDR0000258179__267_md_73">For information about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> caused by treatment for cancer, visit our <a href="https://www.cancer.gov/about-cancer/treatment/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Side Effects</a> page.</p></div><div id="CDR0000258179__173"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000258179__173_md_23">For some patients, taking part in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a>.</p><p id="CDR0000258179__173_md_24">Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.</p><p id="CDR0000258179__173_md_25">Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.</p></div><div id="CDR0000258179__175"><h3>Patients can enter clinical trials before, during, or after starting their cancer treatment.</h3><p id="CDR0000258179__175_md_29">Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of cancer treatment.</p><p id="CDR0000258179__175_md_30">Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trials search</a> webpage. Clinical trials supported by other organizations can be found on the <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> website.</p></div><div id="CDR0000258179__177"><h3>Follow-up tests may be needed.</h3><p id="CDR0000258179__177_md_33">As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.</p><p id="CDR0000258179__177_md_34">Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). </p></div></div><div id="CDR0000258179__139"><h2 id="_CDR0000258179__139_">Treatment of Stage 0 (Carcinoma in Situ)</h2><p id="CDR0000258179__269">For information about the treatments listed below, see the <a href="#CDR0000258179__55">Treatment Option Overview</a> section.</p><p id="CDR0000258179__91">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000413881/" class="def">stage 0</a> is usually <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045755/" class="def">local</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">resection</a>.</p><p id="CDR0000258179__TrialSearch_139_19">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000258179__140"><h2 id="_CDR0000258179__140_">Treatment of Stages I, II, and III Anal Cancer</h2><p id="CDR0000258179__314">For information about the treatments listed below, see the <a href="#CDR0000258179__55">Treatment Option Overview</a> section.</p><p id="CDR0000258179__95">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045306/" class="def">stage I</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045307/" class="def">stage II</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045310/" class="def">stage III anal cancer</a> may include the following:</p><ul id="CDR0000258179__96"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045755/" class="def">Local</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">resection</a> for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> of the skin around the outside of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046523/" class="def">anus</a> and tumors inside the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044185/" class="def">anal</a> opening that do not involve the anal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257222/" class="def">sphincter</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External-beam radiation therapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> alone.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000377733/" class="def">Abdominoperineal resection</a>, if <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> remains or comes back after treatment with radiation therapy and chemotherapy. Other options may include treatment with additional <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000306495/" class="def">chemoradiation</a> therapy, chemotherapy alone, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">immunotherapy</a>.</div></li></ul><p id="CDR0000258179__141">Patients who have had treatment that saves the sphincter muscles may receive <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> exams every 3 months for the first 2 years, including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045668/" class="def">rectal exams</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045678/" class="def">endoscopy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a>, as needed to check for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045861/" class="def">recurrence</a>.</p><p id="CDR0000258179__TrialSearch_140_19">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000258179__106"><h2 id="_CDR0000258179__106_">Treatment of Stage IV Anal Cancer</h2><p id="CDR0000258179__315">For information about the treatments listed below, see the <a href="#CDR0000258179__55">Treatment Option Overview</a> section.</p><p id="CDR0000258179__107">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046656/" class="def">stage IV anal cancer</a> may include the following:</p><ul id="CDR0000258179__108"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">Palliative</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> and improve the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.</div></li><li class="half_rhythm"><div>Palliative <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>.</div></li><li class="half_rhythm"><div>Palliative <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> with or without radiation therapy.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000772606/" class="def">immune checkpoint inhibitors</a>. </div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of new treatment options.</div></li></ul><p id="CDR0000258179__TrialSearch_106_19">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000258179__309"><h2 id="_CDR0000258179__309_">Treatment of HIV and Anal Cancer</h2><p id="CDR0000258179__310">In general, treatment for patients who have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444966/" class="def">anal cancer</a> and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044366/" class="def">human immunodeficiency virus</a> (HIV) is similar to treatment for other patients, and these patients have similar outcomes. However, this treatment can further damage the weakened <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune systems</a> of patients who have HIV. Treatment in patients with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642021/" class="def">history</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045950/" class="def">AIDS</a>-related <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463706/" class="def">complications</a> may require lower <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000639945/" class="def">anticancer</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> than doses used for patients who do not have HIV.</p></div><div id="CDR0000258179__110"><h2 id="_CDR0000258179__110_">Treatment of Recurrent Anal Cancer</h2><p id="CDR0000258179__270">For information about the treatments listed below, see the <a href="#CDR0000258179__55">Treatment Option Overview</a> section.</p><p id="CDR0000258179__111">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444966/" class="def">anal cancer</a> may include the following:</p><ul id="CDR0000258179__112"><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>, for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045861/" class="def">recurrence</a> after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>.</div></li><li class="half_rhythm"><div>Surgery, for recurrence after radiation therapy and/or chemotherapy.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of radiation therapy with chemotherapy and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046553/" class="def">radiosensitizers</a>. </div></li><li class="half_rhythm"><div>A clinical trial of chemotherapy options. </div></li><li class="half_rhythm"><div>A clinical trial of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000772606/" class="def">immune checkpoint inhibitors</a>.</div></li></ul><p id="CDR0000258179__TrialSearch_110_19">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000258179__165"><h2 id="_CDR0000258179__165_">To Learn More About Anal Cancer</h2><p id="CDR0000258179__166">For more information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444966/" class="def">anal cancer</a>, see the following:</p><ul id="CDR0000258179__181"><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/types/anal" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Anal Cancer Home Page</a>
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</div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Tobacco</a> (includes help with quitting)</div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Human Papillomaviruses and Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/types/immunotherapy" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Immunotherapy to Treat Cancer</a>
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</div></li></ul><p id="CDR0000258179__165_md_40">For general cancer information and other resources from the National Cancer Institute, visit:</p><ul id="CDR0000258179__165_md_41"><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">About Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Staging</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/publications/patient-education/chemo-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Chemotherapy and You: Support for People With Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/publications/patient-education/radiation-therapy-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Radiation Therapy and You: Support for People With Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a>
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</div></li><li class="half_rhythm"><div><a href="https://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors and Caregivers</a>
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</div></li></ul></div><div id="CDR0000258179__AboutThis_1"><h2 id="_CDR0000258179__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000258179__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000258179__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="https://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000258179__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000258179__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000258179__AboutThis_6">This PDQ cancer information summary has current information about the treatment of anal cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000258179__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000258179__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
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</p><p id="CDR0000258179__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>.
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</p></div><div id="CDR0000258179__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000258179__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000258179__AboutThis_12">Clinical trials can be found online at <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. For more information, call the <a href="https://www.cancer.gov/contact/contact-center" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Information Service</a> (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000258179__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000258179__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000258179__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000258179__AboutThis_21">PDQ® Adult Treatment Editorial Board. PDQ Anal Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/anal/patient/anal-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/anal/patient/anal-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389368]</p><p id="CDR0000258179__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 3,000 scientific images.
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</p></div><div id="CDR0000258179__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000258179__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000258179__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000258179__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65930.10/?report=reader">PubReader</a></li><li><a href="/books/NBK65930.10/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65930" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65930" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Adult Treatment Editorial Board. Anal Cancer Treatment (PDQ®): Patient Version. 2022 Dec 16. 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class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000258179__1" ref="log$=inpage&link_id=inpage">General Information About Anal Cancer</a></li><li><a href="#CDR0000258179__26" ref="log$=inpage&link_id=inpage">Stages of Anal Cancer</a></li><li><a href="#CDR0000258179__50" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000258179__139" ref="log$=inpage&link_id=inpage">Treatment of Stage 0 (Carcinoma in Situ)</a></li><li><a href="#CDR0000258179__140" ref="log$=inpage&link_id=inpage">Treatment of Stages I, II, and III Anal Cancer</a></li><li><a href="#CDR0000258179__106" ref="log$=inpage&link_id=inpage">Treatment of 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class="invert">Review</span> Gallbladder Cancer Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389384" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Urethral Cancer Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" 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