Also known as radiotherapy, this treatment uses targeted radiation, such as x-ray beams, to kill or damage cancer cells. External beam radiation therapy (EBRT) is the most commonly used type of radiation for anal cancer.

EBRT focuses radiation from outside the body onto the cancer, with treatment carefully planned so as little harm as possible is done to normal body tissue around the cancer.

For treatment, you lie under a machine that delivers radiation to the targeted area. It takes 10–20 minutes to set up the machine, but the treatment takes only a few minutes and is painless. You will usually be able to go home afterwards.

This is the treatment of cancer with anti-cancer (cytotoxic) drugs. It aims to kill cancer cells while doing the least possible damage to healthy cells.

For anal cancer, the drugs are usually given into a vein through an intravenous (IV) drip on the first day and then in tablet form for the rest of the treatment.

These usually settle down in the weeks after treatment. They may include: 

• tiredness ( fatigue)
• appetite loss, nausea and vomiting – nausea and vomiting are usually prevented with medicines
• bowel changes, such as diarrhoea and more frequent, urgent or painful bowel movements
• passing urine more often, experiencing pain when urinating, or leaking urine (incontinence)
• skin changes, with redness, itching, peeling or blistering around the anus, genital areas and groin - your team will recommend creams for this
• pain in the anal region – talk to your treatment team about a pain management plan
• increased risk of infection – if you have a temperature over 38°C, contact your doctor or go to a hospital emergency department
• loss of pubic hair.

These can occur several months, or even years, after treatment ends. They vary a lot from person to person, but can include:

• bowel changes, with scar tissue in the anal canal or rectum leading to ongoing frequent, urgent or painful bowel movements
• dryness, shortening or narrowing of the vagina (vaginal stenosis) – vaginal dilators may be recommended during treatment and after, as well as vaginal moisturisers and lubricants
• narrowing of the anal canal (anal stenosis) – anal dilators may be recommended during and after treatment, and can help reduce the narrowing
• bladder incontinence – radiation therapy can damage and weaken the bladder leading to leaking or incontinence
• impacts on sexuality, including painful intercourse, difficulty getting erections, or loss of pleasure
• temporary or permanent effects on the ability to have children ( fertility). If you may want to have children in the future, talk to your doctor about what options are available.

An operation called local excision can remove very small tumours located near the entrance of the anus (anal margin), if they are not too close to the muscles of the anus.

The surgeon will give you a local or general anaesthetic and insert an instrument into the anus to remove the tumours. Once the wound heals, the anal canal will still work in the normal way.

For most people with anal cancer, chemoradiation is the main treatment.

If you cannot have chemoradiation because you have previously had radiation therapy to the pelvic region, or if anal cancer comes back, a major operation called an abdominoperineal resection may be an option.

In an abdominoperineal resection, the anus, rectum and part of the colon (large bowel) are removed. The surgeon uses the remaining colon to create a permanent stoma, an opening in the abdomen that allows faeces to leave the body.

A stoma bag is worn on the outside of the body to collect the faeces 

Your recovery time will depend on the type of surgery you had and your general health. You will be given medicine to control any pain you may experience.

Do not put anything into your anus after surgery until your doctor says the area is healed (usually 6–8 weeks)

How you might feel

It is common to feel shocked and upset about having cancer in such an intimate area of your body. Changes to the look and feel of your body can make you feel self-conscious and have less interest in sex.

You could also feel embarrassed and scared to ask for help. These feelings are natural. A side effect of chemoradiation can also be less interest in sex.

Possible side effects

Side effects of chemoradiation can cause sex to be painful. Pelvic radiation therapy can narrow the vagina and lead to thinning of the walls and dryness. The skin inside the anus may become sensitive.

Ask your doctor about dilators, lubricants and moisturiser. Anal penetration may also not be possible, at least for a period of time.

Explore different ways

How you used to enjoy having sex may be more difficult or not possible after treatment. This can be upsetting, but you can find new ways to become aroused.

You may want to try: switching sexual roles; oral sex; exploring different erogenous zones; mutual masturbation; genital rubbing; personal lubricants; vibrators and other sex toys. 

Talk to someone

It can help to share how you’re feeling about the diagnosis and treatment side effects, and how it may be impacting your relationships and sex life. Talking with a specialist such as a counsellor, sex therapist or psychologist can help.

Ask your doctor for a referral, and you can also call Cancer Council 13 11 20. 

For some people, anal cancer does come back after treatment. This is known as a recurrence. Depending on where the cancer comes back, treatment may include surgery, chemoradiation or chemotherapy.

In some cases of advanced cancer, treatment will focus on managing any symptoms, such as pain, and improving quality of life without trying to cure the disease. This is called palliative treatment.