Anal Cancer Treatments

Treatment for anal cancer begins with knowing the size, location, and stage of the tumor. Columbia’s anal cancer specialists are national leaders and experts in the most advanced therapies available for anal cancer today. 

Every treatment plan at Columbia is tailored to your cancer stage, tumor biology, overall health, and personal goals, so you get care that is both advanced and designed for you. 

Treatment options may include: 

• Radiation therapy 
• Chemotherapy
• Immunotherapy
• Surgery
• Clinical trials
• Palliative and supportive care services

Your care team may recommend one or a combination of these treatment options.

Radiation therapy 

Radiation therapy is often the first treatment for anal cancer and, in many cases, can remove the tumor while preserving normal bowel function. The goal of radiation therapy is to treat the cancer safely in as few sessions as possible.  

This treatment uses high doses of radiation to kill cancer cells. For anal cancer, radiation therapy is often given in combination with medicine (chemotherapy) in a treatment known as chemoradiation. Combining these two treatments weakens the cancer and makes radiation therapy more effective.  

Key benefits of radiation therapy include: 

• Targets and destroys cancer cells with precision 
• Often eliminates the need for surgery 
• Preserves the anal sphincter and helps avoid permanent colostomy 
• Effective for both early-stage and locally advanced anal cancers 

At Columbia, our radiation oncologists are world-leaders in using intensity-modulated radiation therapy (IMRT). This advanced approach shapes radiation to target the tumor precisely while protecting healthy tissue, helping reduce side effects and improve treatment outcomes.  

Key features of our radiation oncology program include: 

• Advanced image-guidance to make radiation therapy even more precise, which can give you the best possible outcome. 
• Carefully tuned doses to maximize tumor control. 
• Reduced risk of treatment-related bowel and skin complications. 
• Ethos™ Adaptive Radiation Linear Accelerator to provide adaptive radiation treatments in less than 30 minutes per treatment for cancers of the anus. This allows for the most precise treatment, targeting cancer while reducing side effects as much as possible. 

Radiation therapy is usually given five days a week over several weeks. Your care team watches your progress closely and adjusts your treatment as needed to keep you comfortable while giving you the best chance for a successful outcome. 

Chemotherapy

Chemotherapy uses oral and/or intravenous medication to kill fast-growing cells like cancer cells. For anal cancer, chemotherapy is usually given in combination with radiation therapy or surgery.  Combining these therapies can weaken the cancer cells so that the treatment works better. Chemotherapy is also used in cases where the cancer has spread beyond the anus or if it comes back after your initial treatment.  

Your care team at Columbia will customize your chemotherapy based on your tumor’s unique genetic makeup to find the most effective treatment while minimizing side effects for you. 

Immunotherapy 

Immunotherapy works by using the power of your own immune system to fight cancer. Recently, doctors have found that a type of immunotherapy called checkpoint inhibitors can be effective in treating anal cancer that is metastatic (has spread to other parts of the body).  It may be used on its own or in combination with chemotherapy. 

These medications work by ‘taking the brakes off’ of the immune system, allowing it to recognize and attack cancer cells. Immunotherapy is not currently standard treatment for early-stage anal cancer but may be used if your cancer returns or spreads.   

Additional research into promising new immunotherapies for anal cancer is ongoing at Columbia and we offer several clinical trials that are testing new immunotherapy treatments. You can speak with your doctor about whether immunotherapy or a clinical trial may be right for you. 

Surgery

Surgery is usually not the first treatment for anal cancer but could be recommended depending on the stage and location of your tumor. Your care team may discuss surgery with you in combination with chemotherapy or radiation therapy. At Columbia, our colorectal surgeons are experts in advanced minimally invasive and robotic surgery designed to reduce recovery time and side effects while preserving bowel function whenever possible.  

There are two main types of surgery for anal cancer: 

• Local Resection (local excision): If your tumor is small and hasn’t spread, your doctor may recommend a local resection. In this procedure, the surgeon removes the tumor along with a small margin of healthy tissue to ensure all cancer cells are gone. Because the tumors are small, this surgery often doesn’t affect normal bowel function. If bowel movements are temporarily affected, our expert team will work closely with you to restore normal function as quickly as possible. 
• Abdominoperineal resection (APR): Another procedure called an abdominoperineal resection or APR may be recommended when other therapies and treatments are ineffective. To remove cancerous cells and affected areas, your surgeon will remove the anus, rectum, and the lower part of the colon. Once these are removed, a permanent colostomy will be created to drain stool from the colon. This type of invasive surgery for anal cancer is used less frequently. 

Clinical trials at Columbia 

At Columbia, you may be able to participate in a clinical trial. Clinical trials give patients access to promising new therapies that are not yet widely available. These include new immunotherapies, tissue preserving surgeries, and targeted treatments for anal cancer.  

Your care team can guide you on whether a clinical trial is the right option for you. 

Palliative and supportive care 

Supportive and palliative care is an essential part of anal cancer treatment at Columbia. Our team includes symptom management specialists, nutritionists, pain experts, social workers, and rehabilitation therapists who work alongside your medical team to address the physical, emotional, and practical challenges of cancer.  

Supportive and palliative care is available at any stage of treatment, not just at the end of life. It is designed to: 

• Manage side effects of treatment 
• Improve comfort and well-being 
• Support recovery and survivorship 
• Provide resources for emotional and mental health 

Your treatment, your voice 

While your treatment plan is guided by the latest research and expertise, your goals and preferences are central to every decision. Your care team will discuss all available options with you, take into account your lifestyle and the quality of life you envision for yourself post-treatment, and ensure that you are an active partner in shaping your care plan.