Cancer
information
fact sheet
Understanding
Anal Cancer
A guide for people affected by cancer
This fact sheet has been prepared to What is anal cancer?
help you understand more about anal Anal cancer is cancer affecting the tissues of the anus.
cancer. Many people feel shocked and Cancer is a disease of the cells. Cells are the body’s
upset when told they have anal cancer. basic building blocks – they make up tissues and
We hope this fact sheet will help you, organs. The body constantly makes new cells to help
your family and friends understand how us grow, replace worn-out tissue and heal injuries.
anal cancer is diagnosed and treated.
Normally, cells multiply and die in an orderly way,
so that each new cell replaces one lost. Sometimes
About the anus cells become abnormal and keep growing. These
The anus is the opening at the end of the bowel. It abnormal cells may form a lump called a tumour.
is made up of the last few centimetres of the bowel
(anal canal) and the skin around the opening (anal If the cells in a tumour are cancerous, they can
margin). During a bowel movement, the muscles of spread through the bloodstream or lymph vessels
the anus (sphincters) relax to release the solid waste and form another tumour at a new site. This new
matter known as faeces, stools or poo. tumour is known as secondary cancer or metastasis.
Structure of Types of anal cancer
the anus
Squamous cell carcinoma (SCC)
Most anal cancers are SCCs. These start in the flat
(squamous) cells lining much of the anus. The term
“anal cancer” commonly refers to SCCs, and this
fact sheet focuses on this type of anal cancer.
Adenocarcinoma
Some anal cancers are adenocarcinomas. These
start in cells in the anal glands. This type of anal
cancer is treated in a similar way to bowel cancer.
→ See our Understanding Bowel Cancer booklet.
Rectum
(last 15–20 cm
of the bowel) Skin cancer
In rare cases, SCCs can affect the skin just
outside the anus. These are called perianal skin
Internal Transitional
sphincter zone cancers. If they are not too close to the sphincter
Anal canal
muscle
muscles, they can be treated in a similar way to
Dendate
line SCCs on other areas of the skin.
External
sphincter Anal verge → See our Understanding Skin Cancer booklet.
muscle
For copies of Cancer Council booklets, call 13 11 20
Anal margin
or visit your local website (see page 4 for details).
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Understanding Anal Cancer
How common is anal cancer? Diagnosis
Every year, about 460 people are diagnosed with anal The main tests for diagnosing anal cancer are a
cancer in Australia. It is more common over the age physical examination and an endoscopy with biopsy.
of 50 and is slightly more common in women than
in men. The number of people diagnosed with anal Physical examination – The doctor inserts a
cancer has increased over recent decades. gloved finger into your anus to feel for any lumps
or swelling. This is called a digital anorectal
examination (DARE).
What are the risk factors?
About 80% of anal cancers are caused by Endoscopy with biopsy – The doctor inserts
infection with a very common virus called human a narrow instrument called a sigmoidoscope or
papillomavirus (HPV). HPV can infect the surface colonoscope into your anus to see the lining of
of different areas, including the anus, cervix, vulva, the anal canal. This may be done under a general
vagina, penis, mouth and throat. Unless they are anaesthetic so that a tissue sample (biopsy) can
tested, most people won’t know they have HPV be taken. The biopsy will be sent to a laboratory
infection as it usually doesn’t cause symptoms. for testing.
HPV infection is the main risk factor for anal cancer, If anal cancer is found, you may need one or
but other factors that may increase the risk include: more imaging scans to check if it has spread.
• having a weakened immune system, e.g. because These scans may include an MRI, an endorectal
of human immunodeficiency virus (HIV) infection, ultrasound, a CT scan or a PET–CT scan. To find
an organ transplant, or an autoimmune disease out about these tests, visit your local Cancer
such as coeliac disease, lupus or Graves’ disease Council website or call Cancer Council 13 11 20.
• being a man who has had sex with other men
• having anal warts
• having had an abnormal cervical screening test
Staging anal cancer
or cancer of the cervix, vulva or vagina
• smoking tobacco Staging describes how far the cancer has spread.
• being aged over 50. Knowing the stage helps doctors plan the best
treatment for you. Anal cancer is staged using the
Some people with anal cancer do not have any TNM (tumour–nodes–metastasis) system.
of these risk factors.
indicates how far the tumour has
T
grown into the bowel wall and
(tumour)
What are the symptoms? 0–4
nearby areas: T1 is a smaller
In its early stages, anal cancer often has no obvious tumour; T4 is a larger tumour
symptoms, but some people may have symptoms shows if the cancer has spread to
such as: nearby lymph nodes (small glands):
• blood or mucus in faeces or on toilet paper N0 means no cancer is in the lymph
• itching, discomfort or pain around the anus, or a N nodes; N1 means cancer is in the
feeling of fullness, discomfort or pain in the rectum (nodes) lymph nodes around the rectum;
• a lump near the edge of the anus 0–3 N2 means cancer is in pelvic and/
• ulcers around the anus or groin lymph nodes on one side;
• difficulty controlling bowel movements. N3 means cancer is in other nearby
lymph nodes
Not everyone with these symptoms has anal cancer.
shows if the cancer has spread to
Other conditions, such as piles (haemorrhoids) or M
other, distant parts of the body:
tears in the anal canal (anal fissures), can also cause (metastasis)
M0 means cancer has not spread;
these changes. If the symptoms are ongoing, see 0–1
M1 means cancer has spread
your general practitioner (GP) for a check-up.
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Understanding Anal Cancer
Treatment Side effects of chemoradiation
Because anal cancer is rare, it is recommended Both radiation therapy and chemotherapy can have
that you are treated in a specialised centre with side effects. These can occur during or soon after
a multidisciplinary team (MDT) who regularly the treatment (early side effects), or many months
manages this cancer. The team will work out the or years later (late side effects).
best treatment for you, depending on the type and
location of the cancer; whether the cancer has Early side effects – These usually settle down in
spread (its stage); your age and fitness; and your the weeks after treatment. They may include:
preferences. You may want to get a second opinion • tiredness
from another specialist team to confirm or explain • appetite loss, nausea and vomiting – nausea and
the treatment options. vomiting are usually prevented with medicines
• bowel changes, such as diarrhoea and more
Understanding the disease, the available treatments, frequent, urgent or painful bowel movements
possible side effects and any extra costs can help • passing urine more often, experiencing pain when
you weigh up the treatment options and make a urinating, or leaking urine (incontinence)
well-informed decision. Most anal cancers are • skin changes, with redness, itching, peeling or
treated with a combination of radiation therapy and blistering around the anus, genital areas and
chemotherapy, which is known as chemoradiation groin – your team will recommend creams for this
or chemoradiotherapy. Surgery may also be used in • pain in the anal region – talk to your treatment
some cases (see next page). team about a pain management plan
• increased risk of infection – if you have a
temperature over 38°C, contact your doctor or
Chemoradiation go to a hospital emergency department
This treatment combines a course of radiation • loss of pubic hair.
therapy with some chemotherapy sessions. The
chemotherapy makes the cancer cells more Late side effects – These can occur several
sensitive to the radiation therapy. months, or even years, after treatment ends. They
vary a lot from person to person, but may include:
For anal cancer, a typical treatment plan might • bowel changes, with scar tissue in the anal canal
involve a session of radiation therapy every weekday or rectum leading to ongoing frequent, urgent or
for several weeks, as well as chemotherapy on some painful bowel movements
days during the first and fifth weeks. This approach • dryness, shortening or narrowing of the vagina
allows for lower doses of radiation therapy. (vaginal stenosis) – can be prevented or minimised
by using vaginal dilators regularly
Radiation therapy – Also known as radiotherapy, • impacts on sexuality, including painful intercourse,
this treatment uses targeted radiation, such as x-ray difficulty getting erections or loss of pleasure
beams, to kill or damage cancer cells. Treatment • effects on the ability to have children (fertility).
is carefully planned to do as little harm as possible → See our Understanding Radiation Therapy and
to the normal body tissue around the cancer. During Understanding Chemotherapy booklets.
a treatment session, you lie under a machine that
delivers radiation to the treatment area. It usually
takes 10–20 minutes to set up the machine, but
the treatment itself takes only a few minutes and is Effects on sexuality and fertility
painless. You will be able to go home afterwards. Chemoradiation for anal cancer can have a range
of effects on sexuality and may also affect fertility.
Chemotherapy – This is the treatment of cancer Ask your doctor about ways to manage these
with anti-cancer (cytotoxic) drugs. It aims to kill changes, as early treatment and support can help.
cancer cells while doing the least possible damage to You can also read our booklets on sexuality and
healthy cells. For anal cancer, the drugs are usually fertility and listen to our “Sex and Cancer” podcast.
given into a vein through an intravenous (IV) drip.
4
Understanding Anal Cancer
Surgery Questions for your doctor
Surgery may be used to treat very early anal cancer You may find this checklist helpful when thinking
or in a small number of other situations. about the questions you want to ask your doctor.
Surgery for very small tumours – An operation • What type of anal cancer do I have? What part of
called local excision can remove very small tumours the anus is affected? Has the cancer spread?
located near the entrance of the anus (anal margin) if • What treatment do you recommend? What are the
they are not too close to the muscles of the anus. The risks and possible side effects?
surgeon will give you a local or general anaesthetic • Are there any other treatment options for me?
and insert an instrument into the anus to remove the • Will the treatment affect my sexual function or
tumours. Once the wound heals, the anal canal will pleasure? Will the treatment affect my fertility?
still work in the normal way. • Do I have HPV? Can I pass on HPV to my partner?
Should I or my partner get vaccinated against HPV?
Abdominoperineal resection – For most people • Are there any clinical trials or studies I could join?
with anal cancer, chemoradiation is the main • How often will I need check-ups? Can I examine
treatment. It is usually very effective and allows you myself in between check-ups?
to keep your anal canal. A major operation called • If the cancer comes back, how will I know? What
an abdominoperineal resection may be an option if treatments could I then have?
you cannot have chemoradiation because you have
previously had radiation therapy to the pelvic region.
This operation may also be used if anal cancer
comes back after chemoradiation. Where to get help and information
Call Cancer Council 13 11 20 for more information
In an abdominoperineal resection, the anus, rectum about anal cancer. Health professionals can listen to
and part of the colon (large bowel) are removed. your concerns, put you in touch with local services
The surgeon uses the remaining colon to create a and send you free copies of our booklets. You can
permanent stoma, an opening in the abdomen that also visit your local Cancer Council website:
allows faeces to leave the body. A stoma bag is worn
on the outside of the body to collect the faeces. ACT.................................................. actcancer.org
→ See our Understanding Bowel Cancer booklet. NSW.................................. cancercouncil.com.au
NT................................................ nt.cancer.org.au
QLD............................................ cancerqld.org.au
Follow-up appointments SA................................................ cancersa.org.au
After treatment, you will need check-ups every TAS............................................. cancertas.org.au
3–12 months for several years to confirm that the VIC.............................................. cancervic.org.au
cancer hasn’t come back. Between visits, let your WA.............................................. cancerwa.asn.au
doctor know immediately if you have new symptoms Australia .......................................... cancer.org.au
in the anal region or any other health problems.
CAN6230 07/20 © Cancer Council Australia 2020
Acknowledgements: This information is based on clinical practice guidelines
and has been developed with help from health professionals and people affected
by anal cancer. It was reviewed by: Dr Chip Farmer, Colorectal Surgeon, The Alfred,
The Avenue and Cabrini Hospitals, VIC; Tara Faure, Lower GI Nurse Consultant,
Peter MacCallum Cancer Centre, VIC; Dr Debra Furniss, Radiation Oncologist,
GenesisCare, QLD; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA;
Max Niggl, Consumer; Julie O’Rourke, CNC Radiation Oncology, Cancer Rapid
Assessment Unit, Cancer and Ambulatory Support, Canberra Health Services, ACT;
For information and support
Dr Satish Warrier, Colorectal Surgeon, Peter MacCallum Cancer Centre, VIC. on cancer-related issues,
call Cancer Council 13 11 20.
Note to reader: Always consult your doctor about matters that affect your health. This is a confidential service.
This fact sheet is intended as a general introduction and is not a substitute for
professional medical, legal or financial advice. Information about cancer is constantly
being updated and revised by the medical and research communities. While all care
is taken to ensure accuracy at the time of publication, Cancer Council Australia and
its members exclude all liability for any injury, loss or damage incurred by use of or
reliance on the information provided in this fact sheet.
