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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: May 24, 2024.</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 type of cancer that forms 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__621">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__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 type of cancer that forms in
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the tissues of the anus.</h3><p id="CDR0000258179__146">The anus is the end of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045097/" class="def">large intestine</a>. It is where stool (solid waste) leaves the body. The anus is formed partly from the outer skin layers of the body and partly from the intestine. The anus is connected to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> by the anal canal, which is about 1 to 1½ inches long. This area is controlled by two ring-like sphincter muscles, which contract to hold stool in and relax to allow its passage out of the body. <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=604040_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/NBK65930.11/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">Anal cancer can start in the lining of the anal canal, called the mucosa, or in the perianal skin, the squamous cells outside of the anus that contain hair follicles and sweat glands.</p><p id="CDR0000258179__639">
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<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 anal cancers, although local therapy (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:</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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000753084/" class="def">high-risk human papillomavirus</a> (HPV), especially HPV type 16 or 18 </div></li><li class="half_rhythm"><div>having a condition 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">HIV</a> or an organ <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 sexual 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>
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</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: </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__320"> In addition to asking about your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642019/" class="def">personal</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642015/" class="def">family health history</a> and doing a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">physical exam</a>, your doctor may perform the following tests and procedures:</p><ul id="CDR0000258179__22"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045668/" class="def">Digital rectal examination</a> (DRE)</b> is an exam of the anus and rectum. The doctor or nurse 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=604040_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/NBK65930.11/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> is an exam of the anus and lower rectum using a short, lighted tube called an anoscope. </div></li><li class="half_rhythm"><div><b>Proctoscopy</b> is 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 proctoscope. A proctoscope is a thin, tube-like instrument with a light and a lens for viewing the inside of the rectum and anus. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.</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> is 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 (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. </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> is the removal of cells 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__621"><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__623">The process used to find out if cancer has spread within the anus 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__624"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b> uses a computer linked to an x-ray machine to make 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. The pictures are taken from different angles and are used to create 3-D views of tissues and organs. A dye may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a vein or swallowed to help the organs or tissues 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> is 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> is 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> uses a small amount of radioactive glucose that is injected into a vein. The PET scanner rotates around the body and makes pictures of where glucose is being used in the body. Cancer 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> is 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 nurse looks at the vagina and cervix for signs 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 lubricated, 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 abnormal areas.<div id="CDR0000258179__631" 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=604040_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/NBK65930.11/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__636"><h3>Some people decide to get a second opinion.</h3><p id="CDR0000258179__637">You may want to get a second opinion to confirm your anal cancer diagnosis and treatment plan. If you seek a second opinion, you will need to get medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans. They may agree with the first doctor, suggest changes or another treatment approach, or provide more information about your cancer.</p><p id="CDR0000258179__638">Learn more about choosing a doctor and getting a second opinion at <a href="https://www.cancer.gov/about-cancer/managing-care/finding-cancer-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Finding Cancer Care</a>. You can contact <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI’s Cancer Information Service</a> via chat, email, or phone (both in English and Spanish) for help finding a doctor, hospital, or getting a second opinion. For questions you might want to ask at your appointments, visit <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>.</p></div><div id="CDR0000258179__23"><h3>Certain factors affect the prognosis (chance of recovery) and treatment options.</h3><p id="CDR0000258179__147">The prognosis depends on:</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:</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 person has HIV</div></li><li class="half_rhythm"><div>whether cancer remains after initial treatment or has recurred (come back) </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__31">The following stages are used for anal cancer:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000258179__271">Stage 0 (carcinoma in situ)</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__36">Stage I (also called stage 1) anal cancer</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__39">Stage II (also called stage 2) anal cancer</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__277">Stage III (also called stage 3) anal cancer</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258179__45">Stage IV (also called stage 4) anal cancer</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__31"><h3>The following stages are used for anal cancer:</h3><div id="CDR0000258179__271"><h4>Stage 0 (carcinoma in situ)</h4><p id="CDR0000258179__273">In stage 0, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> cells are found in the mucosa (innermost layer) of the anus. These abnormal cells may become cancer and spread into nearby normal tissue. 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=604040_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/NBK65930.11/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 (also called stage 1) anal cancer</h4><p id="CDR0000258179__38">In stage I, cancer has formed and the tumor 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 (also called stage 2) anal cancer</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 tumor 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 (also called stage 3) anal cancer</h4><p id="CDR0000258179__279">Stage III anal cancer is divided into stages IIIA, IIIB, and IIIC.</p><ul id="CDR0000258179__280"><li class="half_rhythm"><div>In stage IIIA, the tumor 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 anus 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 organs, 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>. Cancer 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 (also called stage 4) anal cancer</h4><p id="CDR0000258179__281">In stage IV, the tumor is any size. Cancer may have spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> or nearby organs 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><p id="CDR0000258179__625">Stage IV anal cancer is also called metastatic anal cancer. Metastatic cancer happens when cancer cells travel through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymphatic system</a> or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if anal cancer spreads to the liver, the cancer cells in the liver are actually anal cancer cells. The disease is called metastatic anal cancer, not liver cancer. Learn more in <a href="https://www.cancer.gov/types/metastatic-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Metastatic Cancer: When Cancer Spreads</a>.</p></div></div><div id="CDR0000258179__317"><h3>Anal cancer can recur (come back) after it has been treated.</h3><p id="CDR0000258179__626">Recurrent anal cancer is cancer that has come back after it has been treated. If anal cancer comes back, it may come back in the anus or in other parts of the body, such as the liver or
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lungs. Tests will be done to help determine where the cancer has returned. The type of treatment for recurrent anal cancer will depend on where it has come back.</p><p id="CDR0000258179__627">Learn more in <a href="https://www.cancer.gov/types/recurrent-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Recurrent Cancer: When Cancer Comes Back</a>. Information to help you cope and talk with your health care team can be found in the booklet <a href="https://www.cancer.gov/publications/patient-education/when-cancer-returns" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">When Cancer Returns</a>.</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 people 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__177">Follow-up care may be needed.</a></div></li></ul></div><div id="CDR0000258179__51"><h3>There are different types of treatment for people with anal cancer.</h3><p id="CDR0000258179__628">Different types of treatments are available for anal cancer. You and your cancer care team will work together to decide your treatment plan, which may include more than one type of treatment. Many factors will be considered, such as the stage of the cancer, your overall health, and your preferences. Your plan will include information about your cancer, the goals of treatment, your treatment options and the possible side effects, and the expected length of treatment. </p><p id="CDR0000258179__629">Talking with your cancer care team before treatment begins about what to expect will be helpful. You’ll want to learn what you need to do before treatment begins, how you’ll feel while going through it, and what kind of help you will need. To learn more, visit <a href="https://www.cancer.gov/about-cancer/treatment/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor About Treatment</a>. </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>Local resection is a surgical procedure in which the tumor is cut from the anus along with some of the healthy tissue 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 person 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> is 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 chemotherapy.<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=604040_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/NBK65930.11/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> 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 cells or keep them from growing. There are two types of radiation therapy used to treat anal cancer: </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__620">Learn more about <a href="https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Radiation Therapy to Treat Cancer</a> and <a href="https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Radiation Therapy Side Effects</a>.</p></div><div id="CDR0000258179__64"><h4>Chemotherapy</h4><p id="CDR0000258179__66">Chemotherapy (also called chemo) uses drugs 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 vein 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><p id="CDR0000258179__632">Chemotherapy drugs used to treat anal cancer include:</p><ul id="CDR0000258179__633"><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/capecitabine" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">capecitabine</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/drugs/cisplatin" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">cisplatin</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/drugs/fluorouracil" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">fluorouracil</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/drugs/mitomycin" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">mitomycin</a>
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</div></li></ul><p id="CDR0000258179__634">Combinations of these drugs may be used. Other chemotherapy drugs not listed here may also be used.</p><p id="CDR0000258179__635">Chemotherapy may be combined with other types of treatment, such as radiation therapy.</p><p id="CDR0000258179__630">Learn more about how chemotherapy works, how it is given, common side effects, and more at <a href="https://www.cancer.gov/about-cancer/treatment/types/chemotherapy" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Chemotherapy to Treat Cancer</a> and <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>.</p></div></div><div id="CDR0000258179__79"><h3>New types of treatment are being tested in clinical trials. </h3><p id="CDR0000258179__79_md_3">A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. For some patients, taking part in a clinical trial may be an option.</p><p id="CDR0000258179__79_md_4">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. Clinical trials supported by other organizations can be found on the <a href="https://www.clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> website.</p><p id="CDR0000258179__79_md_5">To learn more about clinical trials, see <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Clinical Trials Information for Patients and Caregivers</a>.</p><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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</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__325">Immunotherapy helps a person’s immune system fight cancer. Your doctor may suggest biomarker tests to help predict your response to certain immunotherapy drugs. Learn more about <a href="https://www.cancer.gov/about-cancer/treatment/types/biomarker-testing-cancer-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Biomarker Testing for Cancer</a>. </p><p id="CDR0000258179__326">Immunotherapy drugs used to treat anal cancer include:</p><ul id="CDR0000258179__327"><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/drugs/nivolumab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">nivolumab</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/drugs/pembrolizumab" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">pembrolizumab</a>
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</div></li></ul><p id="CDR0000258179__328">Learn more about <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>.</p></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__177"><h3>Follow-up care 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__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__321">Learn more about this treatment in the <a href="#CDR0000258179__55">Treatment Option Overview</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__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:</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 tumors of the skin around the outside of the anus and tumors inside the anal 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>
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</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 cancer remains or comes back after treatment with radiation therapy and chemotherapy, or other options that 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">Those 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__322">Learn more about these treatments in the <a href="#CDR0000258179__55">Treatment Option Overview</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__107">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046656/" class="def">stage IV anal cancer</a> may include:</p><ul id="CDR0000258179__108"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">palliative</a> surgery to relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> and improve <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 chemotherapy 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 immunotherapy </div></li><li class="half_rhythm"><div>a clinical trial of new treatment options</div></li></ul><p id="CDR0000258179__323">Learn more about these treatments in the <a href="#CDR0000258179__55">Treatment Option Overview</a>.</p><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 people who have anal cancer and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044366/" class="def">HIV</a> is similar to treatment for other people, 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 people who have HIV. Treatment for people with a history of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045950/" class="def">AIDS</a>-related complications may require lower doses of anticancer drugs 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__111">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> anal cancer may include:</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 chemotherapy, for recurrence after surgery</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>
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</div></li><li class="half_rhythm"><div>a clinical trial of chemotherapy options </div></li><li class="half_rhythm"><div>a clinical trial of immunotherapy</div></li></ul><p id="CDR0000258179__324">Learn more about these treatments in the <a href="#CDR0000258179__55">Treatment Option Overview</a>.</p><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 anal cancer, visit:</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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<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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<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 class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK65930</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26389368" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26389368</a></span></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/NBK65930.11/?report=reader">PubReader</a></li><li><a href="/books/NBK65930.11/?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. 2024 May 24. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK65930.12/">NBK65930.12</a></span> August 7, 2024</li><li><span class="bk_col_itm">NBK65930.11</span> May 24, 2024 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK65930.10/">NBK65930.10</a></span> December 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 Stage IV Anal Cancer</a></li><li><a href="#CDR0000258179__309" ref="log$=inpage&link_id=inpage">Treatment of HIV and Anal Cancer</a></li><li><a href="#CDR0000258179__110" ref="log$=inpage&link_id=inpage">Treatment of Recurrent Anal Cancer</a></li><li><a href="#CDR0000258179__165" ref="log$=inpage&link_id=inpage">To Learn More About Anal Cancer</a></li><li><a href="#CDR0000258179__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" 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/NBK65778/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389388" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Melanoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Melanoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389197" ref="ordinalpos=1&linkpos=2&log$=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> Retinoblastoma 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" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Retinoblastoma Treatment (PDQ®): 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