Anal Cancer Treatment

Following the diagnosis and staging of anal cancer, specialists at Penn Medicine's Abramson Cancer Center will provide you with expert support and evaluation to discuss treatment options and individualized treatment plans.

Treatment for Anal Cancer by Type

Treatment for anal cancer depends on the type. Anal margin cancer, otherwise known as perianal cancer, is treated with surgery to remove the growth. Anal canal cancer is typically treated with a combination of chemotherapy and radiation. Surgery is rarely needed in cases of anal canal cancer.

In all cases of anal cancer, Penn cancer specialists are committed to doing everything they can to conserve the anus and anal tissue.

Learn about managing treatment side effects.

Chemotherapy for Anal Canal Cancer

Penn Medicine specializes in a team approach to cancer treatment with interdisciplinary care and innovative approaches that use chemotherapy to target tumors prior to and after surgery.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is usually delivered intravenously through a catheter or orally by pill.

Chemoradiotherapy

Chemoradiotherapy is the practice in which chemotherapy and radiation therapy are used simultaneously.

Clinical Trials for Anal Cancer

Today, more and more people are surviving cancer. Clinical trial benefit patients by providing access to breakthrough therapies and treatments. These new advances in cancer treatment are occurring every day at Penn Medicine, giving patients hope that even greater discoveries lie ahead. Through clinical trials:

  • Diagnosing cancer has become more precise.
  • Radiation and surgical techniques have advanced.
  • Medications are more successful.
  • Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes.
  • Strategies to address the late effects of cancer and its treatment are improving quality of life.

Penn Medicine is the only health care facility in the country that is using proton therapy to treat recurrent gastrointestinal tumors in clinical trials. Also, radiation oncologists at Penn Medicine will soon use proton therapy to treat gastrointestinal cancers in the upper digestive tract.

Integrative Medicine for Anal Cancer

In addition to standard treatments and clinical trials, patients at Penn Medicine may wish to add additional supportive services and therapies such as acupuncture, yoga and reiki. These therapies do not have curative intent, and are designed to complement standard treatments – not take their place.

Local Resection

Local resection surgery for anal canal cancer is very rare. If surgery for anal canal cancer is needed, Penn Medicine offers patients one of the most advanced colorectal surgery programs in the United States with a nationally recognized record for high-quality patient care and survivorship.

Local resection surgery removes cancer and surrounding tissues from the anal canal.

Close surveillance and follow-up with the surgeon and medical oncologist is needed to ensure that rare recurrences are detected early.

Radiation Therapy for Anal Canal Cancer

Radiation oncologists at Penn Medicine are recognized for techniques that target radiation precisely to the disease site while sparing nearby tissue.

Radiation therapy uses high-energy radiation to kill cancer cells. A radiation therapy schedule usually consists of a specific number of treatments given over an extended period of time. In many cases, radiation therapy is capable of killing all of the cancer cells.

Radiation therapy for anal cancer is commonly used first in combination with chemotherapy for anal canal cancer, or cancer that is inside the anal canal and cannot be seen. Anal canal cancer is very sensitive to chemotherapy and radiation treatments.

3-D Conformal Radiation Therapy

The imaging technology used by radiation oncologists at Penn Medicine helps shape the radiation treatment beam to the shape of the tumor. Known as conformal radiation therapy, this technology gives doctors more control when treating tumors.

In conformal radiation, a special computer uses CT imaging scans to create 3-D maps of the cancer's location in the body. The system permits the delivery of radiation from several directions and the beams can then be shaped, or conformed, to match the shape of the cancer. Conformal radiation therapy limits radiation exposure to nearby healthy tissue as well as the tissue in the beam's path.

Intensity-Modulated Radiation Therapy (IMRT)

This advanced type of radiation therapy uses a computer-controlled device, called a linear accelerator, to deliver precise doses of radiation to tumors or specific areas within the tumors. Radiation therapy, including IMRT, stops cancer cells from dividing and growing, thus slowing or stopping tumor growth.

In many cases, radiation therapy is capable of killing all of the cancer cells. Using 3-D computed tomography (CT) images along with computerized dose calculations, IMRT allows for the radiation dose to conform more precisely to the shape of the tumor by controlling — or modulating — the intensity of the radiation beam. The therapy allows higher radiation doses to be delivered to areas within the tumor while minimizing the dose to the surrounding area.

Volumetric-Modulated Arc Therapy (VMAT)

Volumetric modulated arc therapy (VMAT) is a type of specialized intensity-modulated radiation therapy, or IMRT. VMAT delivers radiation by rotating the radiation machine, through one or more arcs while radiation is continuously delivered.

VMAT allows Penn radiation oncologists to treat complex cancers while minimizing exposure to surrounding healthy tissue. VMAT shortens radiation delivery time, and offers patients more comfort because it does not require them to lie completely still for long periods of time.

Penn radiation oncologists use RapidArc™ radiotherapy technology to treat hard to reach tumors.

Proton Therapy

Penn Medicine is the only health care facility in the country that is using proton therapy to treat recurrent gastrointestinal tumors in clinical trials.

Penn Medicine's Roberts Proton Therapy Center is the largest and most advanced facility in the world for this precise form of cancer radiation. Patients have access to one of the most sophisticated weapons against cancer, seamlessly integrated with the full range of oncology services available at Penn Medicine. Proton therapy is external beam radiotherapy in which protons are directed at a tumor.

The radiation dose that is given through protons is very precise, and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation. The result is a better chance for curing cancer with fewer harmful side effects.

Proton therapy, like all forms of radiation therapy, works by aiming the energized particles, in this case protons, onto the target tumor. The particles damage the DNA of cells, ultimately causing their death. Unlike X-rays, protons can be manipulated to release most of their energy only when they reach their target. With more energy reaching the cancerous cells, more damage is administered by each burst of radiation.

Surgery for Anal Margin Cancer

Penn Medicine offers patients one of the most advanced colorectal surgery programs in the United States with a nationally recognized record for high-quality patient care and survivorship.

Local Resection

Local resection surgery for anal margin cancer, or cancer that can be seen on the outside of the anus, is generally the first treatment if the cancer is small, has not spread, and can be completely removed with surgery. The procedure involves surgically removing the tumor from the skin around the anus along with some of the surrounding healthy tissue. This procedure saves the sphincter muscles and anus so the patient can still control bowel movements.

Typically, if the tumor is removed completely, no further treatment is required. Close surveillance and follow-up with the surgeon and medical oncologist are needed to ensure that rare recurrences are detected early.