Radiation therapy
Radiation therapy uses high-energy X-rays to kill cancer cells. We use radiation therapy to treat people for types of anal cancer.
MSK’s GUIDE TO
Anal Cancer Treatment
Overview
We know you want excellent anal cancer treatment results. But not everyone’s goals or priorities are the same. We listen to what matters most to you. Our experts work with you on a care plan that’s best for you.
There are many options for anal cancer treatment. You may feel overwhelmed as you explore them.
This guide will help you better understand your options and get ready to talk with your doctors. You’ll have the information you need to make the best decisions for your care together.
Your care team includes doctors, nurses, and other experts in anal cancer. MSK’s anal cancer experts will make a treatment plan just for you.
Your anal cancer treatment plan will target the type and stage of anal cancer you have. It will be based on the latest research and therapies. During your treatment, you may have a few therapies for the best possible results.
How is anal cancer treated?
Your MSK care team will talk with you about the best therapies for you. You may have 1 treatment, or a few treatments together.
Treatment for anal cancer can include:
- Radiation therapy
- Systemic therapy
- Surgery
Systemic therapies
Chemotherapy, targeted therapy, and immunotherapy are called systemic therapies. Treatments are given by pill or liquid, intravenous (IV) infusion, or injection (shot). They spread throughout the body to treat cancer.
Surgery
Some people with anal cancer have surgery to remove the cancer. The type of surgery depends on the type of anal cancer, its location, and its stage.
How does MSK care for people with anal cancer?
We care for every person with anal cancer with kindness, warmth, and respect.
Your care team includes doctors, nurses, and other experts who focus on anal cancer. Together they use the latest science and research to create your care plan. It will focus on what matters most to you, and the treatment best for your type and stage of anal cancer.
At MSK, we take care of the person, not just the cancer. We offer support and resources to help you and your caregivers, during and after treatment.
Your care plan may include nutrition advice, physical therapy, exercise, and mental health support. Our rehabilitation experts help you manage the side effects of anal cancer and its treatment.
Molecular test development manager Tessara Baldi is an expert in processing test samples.
You’ll get the best possible cancer care at MSK. Your care team has experts in treating the type of anal cancer you have. We offer:
- The latest anal cancer treatments. The best treatment for cancer that has not spread is radiation therapy. It often is given along with chemotherapy, called chemoradiation. The chemotherapy helps the radiation work better to kill the cancer.
- Rehabilitation (rehab) experts, who help your body heal and stay healthy after your treatment is done.
- Integrative medicine (also called complementary, holistic, or natural medicine) to care for side effects of treatment, such as nerve pain. Our integrative medicine experts also can help with general wellness during and after treatment. They can offer advice about herbs and supplements.
THE MSK DIFFERENCE
MSK's Center for Young Onset Colorectal and Gastrointestinal Cancer is the first program of its kind. Our treatment experts work together to care for the needs of young adults with these cancers. We also offer mental health counseling, fertility and sexual health medicine, nutrition and more.
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MSK’s anal cancer experts will work with you to choose a treatment that’s best for you.
Types of anal cancer treatment
At MSK, all members of your care team will review your case. They’ll talk with you about which treatments are best for you.
Your care team may offer you a few treatment options. They’re based on your symptoms, any other health issues, and the anal cancer’s:
- Type
- Stage
- Location
We assess all these things and then find the best treatment choice for you.
We have treatments for early-stage 1 or 2 anal cancers. We also offer treatments for later-stage or advanced anal cancers. These are stage 3 anal cancer treatments or stage 4 (metastatic) anal cancer treatments.
Radiation oncologist Dr. Christopher Crane is with a patient in MSK’s linear accelerator treatment suite.
Radiation therapy for anal cancer
Radiation therapy is the most common treatment for anal cancer. Radiation therapy uses very precise high-energy X-rays to kill cancer cells.
Radiation oncologists are cancer doctors with special training in using radiation to treat cancer. MSK’s radiation experts do everything possible to limit healthy tissue’s exposure to radiation. They use the most precise methods to deliver powerful doses of radiation right to the tumor.
Sometimes we can use methods that lower the number of treatments you’ll need. This can raise the chances of controlling and curing the cancer.
Radiation therapy aims to control or kill off cancer cells with as few side effects as possible.
Your doctor may recommend chemotherapy as part of your radiation therapy. When you have chemotherapy and radiation at the same time, it’s called chemoradiation. It may help the tumor respond better to treatment.
You may have radiation therapy after surgery, to kill the rest of the cancer cells.
There are 2 basic types of radiation therapy:
- External radiation therapy is delivered outside your body. This kind of therapy uses high-energy rays to harm cancer cells so they can no longer grow. External beam radiation therapy (EBRT) is the most common type of radiation therapy for anal cancer. It uses a treatment machine called a linear accelerator to aim beams of radiation right at the tumor
- Internal radiation therapy is when we put something, such as radioactive seeds, inside your body very close to the tumor. This is called brachytherapy (BRAY-kee-THAYR-uh-pee).
Intensity-modulated radiation therapy for anal cancer
Intensity-modulated radiation therapy (IMRT) is the most common radiation therapy treatment for anal cancer. MSK radiation therapy experts are highly trained in this type of treatment. Their skill helps give you the best chance for a good result while lowering the risk of side effects.
IMRT lets us change the radiation beams’ power during treatment using a special computer program. It lets us make a dose plan that can deliver high doses of radiation more precisely to the tumor area.
IMRT can have fewer side effects for some people because it’s so accurate.
You’ll have a CT scan before IMRT to make a 3D map of the tumor. Most treatment sessions take 10 to 30 minutes. You’ll have them 5 days a week for a few weeks.
The total number of treatments depends on things like the tumor’s size and location. You also may have chemotherapy to make radiation work better.
Stereotactic body radiotherapy (SBRT) for anal cancer
Stereotactic body radiotherapy (SBRT) could be a treatment option for anal cancer that came back only in 1 place. SBRT delivers more precise, higher doses of radiation than standard therapy.
SBRT lets you get back to your daily life faster because of the shorter treatment schedule. You may have fewer skin reactions and side effects. At MSK, our SBRT treatment is called MSK Precise.®
SBRT often takes 1 to 5 treatments. Each SBRT session takes about 30 to 60 minutes.
You’ll have an imaging scan before each treatment. This makes sure the radiation goes exactly to the tumor while keeping nearby tissue safe.
Brachytherapy
Brachytherapy (BRAY-kee-THAYR-uh-pee) is internal radiation therapy.
It’s not often used to treat anal cancer. It’s added to IMRT when standard treatment with chemoradiation does not work well.
At the hospital, you’ll have anesthesia (medicine to make you sleep). You may be able to go home the same day, depending on the type of brachytherapy you have.
Brachytherapy seals radioactive material inside a thin tube, placed close to or inside the tumor. The radiation does not travel far from the radioactive material. Brachytherapy lets the tumor get a high radiation dose while nearby healthy tissue gets little or none.
It's a myth people can only get great care in New York City. We treat patients on Long Island with the very same treatments we offer in the city, like liver pump treatments, immunotherapies, clinical trials.
Side effects of radiation therapy for anal cancer
Radiation treatments are very precise and cause little harm to healthy tissues. This treatment does not cause hair loss. Many people report few lasting side effects.
In general, you can keep doing your daily activities or keep working through treatment.
Some people do have short-term side effects during or shortly after anal cancer radiation therapy. You may get side effects from radiation right away, such as:
- Diarrhea and pain while going to the bathroom
- Burns or rashes on the skin at the treatment site
- Fatigue (feeling very tired)
- Nausea (feeling like throwing up)
- Irritated vagina
Your care team will talk with you about when side effects are likely to start. They can prescribe medicine for pain to keep you as comfortable as possible.
Most side effects go away when treatment ends. You can have other side effects that last longer. MSK experts have methods and support programs to help with long-term side effects from radiation therapy.
What are the long-term side effects of anal cancer radiation therapy?
Side effects can start months or years after radiation treatment ends. These are called long-term or late effects. Late effects of anal cancer radiation are not common, but they can include:
Some cancer treatments can cause fertility problems that affect your ability to have a biological child. Fertility problems from cancer treatment can be temporary or permanent.
Radiation therapy and surgery are anal cancer treatments that can affect the fertility of both males and females. Read Common Questions About Fertility After Cancer Treatment to learn more.
MSK’s fertility nurse specialists can talk with you about options for growing your family. Our experts may talk with you about egg and embryo freezing and sperm banking.
Radiation for anal cancer can harm the vagina. You can have discomfort and pain.
MSK has a program to help you keep your vaginal and sexual health before, during, and after treatment. Your care team can offer special tools during radiation that can help protect your vagina.
Radiation to the anus can harm tissue in your bowel (small and large intestines). Over time, scar tissue can form. This scar tissue can affect the muscles that control the anus.
You may not have the same control over your bowels (poop). Your care team can offer treatments to help you adapt to changes in how your bowels work.
Cancer and its treatment can harm the muscular floor of the pelvis. This can cause:
- Pain in your lower back.
- Incontinence (in-KON-tih-nents), when you cannot control the flow of urine (pee) or stool (poop).
- Problems that make it hard to enjoy sex.
Our rehabilitation experts can make a treatment plan for you. Physical therapy can help with muscle strength and coordination.
How MSK helps you cope with anal cancer radiation therapy side effects
We manage side effects to help your fast recovery from anal cancer radiation therapy.
Our Integrative Medicine and Wellness Service offers acupuncture, meditation, massage therapy, yoga, and exercise. Integrative medicine is also called complementary, natural, or holistic therapies. Without using prescription drugs, integrative therapies can help improve and control side effects of cancer treatment.
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What questions should I ask my radiation oncologist?
Before your appointment, it’s helpful to write down questions you want to ask. Here are some examples. Write down the answers during your appointment so you can review them later.
- How will radiation to my anus make me feel?
- What kind of radiation therapy will I get?
- How many radiation treatments will I get?
- What side effects should I expect during my radiation therapy?
- Will these side effects go away after I finish my radiation therapy?
- What kind of late side effects should I expect after my radiation therapy?
Anal cancer chemotherapy and other systemic therapies
Systemic therapies are drugs that travel through the body to kill cancer cells. These therapies for anal cancer largely include chemotherapy, immunotherapy, and targeted therapy.
You may have neoadjuvant (NEE-oh-A-joo-vant) therapy. This is treatment you get before anal cancer surgery. Neoadjuvant therapy shrinks tumors so they’re easier to remove during surgery.
You may have adjuvant (A-joo-vant) therapy, which is treatment you get after anal cancer surgery or radiation therapy. It’s used to kill any cancer cells that may be left in your anus or the rest of your body. Adjuvant therapy can lower the risk of anal cancer coming back or spreading.
Our medical oncologists will talk with you about your condition. They may not recommend chemotherapy. It may not be right for you if there are major side effects, but the benefits are not clear.
Here are systemic therapies for anal cancer:
- Chemotherapy
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Chemotherapy (chemo) is a treatment that uses medicine to stop or slow cancer cells from growing. Chemo puts medicines that target cancer cells into your vein. Most chemo medicines for anal cancer can go through a standard intravenous (IV) drip. The medicine travels in your bloodstream to kill cancer cells in the body.
There are a few kinds of chemo medicines we use for anal cancer. Your care team will talk with you about the best options.
- Immunotherapy
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Immunotherapy can treat anal cancer that has metastasized (spread) or that got worse after chemo.
Immunotherapy is a cancer treatment that boosts your immune system’s natural ability to fight cancer. Your immune system will then attack cancer cells, much the same way it attacks bacteria or viruses.
Immunotherapy medicine most often is given through an IV into your vein.
We’ll test your anal cancer cells for a protein called PD-L1. This test tells us if immunotherapy drugs may help you.
Checkpoint inhibitors such as nivolumab (Opdivo®) and pembrolizumab (Keytruda®) target PD-L1 to treat anal cancer.
- Targeted therapy
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Targeted therapies are cancer treatments that target a tumor’s gene changes (mutations or variants). It’s a personal treatment plan just for the type of cancer you have. These medicines often are given by mouth in pill form, or through an IV into your vein.
Targeted therapy is rarely used for anal cancer. It may help people with advanced anal cancer that has not responded to treatment.
MSK uses a testing tool developed at MSK called MSK-IMPACT®. It tests for changes in more than 500 genes. Your MSK doctor may talk with you about having your tumor analyzed.
Types of anal cancer surgery
For some people with anal cancer, surgery is the best option. This treatment option is based on the tumor’s size and location.
If you or someone you care about has anal cancer, we want to help you understand options for surgery. This information can help you get ready for the decisions you and your doctors will make together.
Surgeons may be able to use minimally invasive methods that do less harm to the body and improve recovery. Surgery may sometimes be used along with other therapies.
MSK’s anal cancer surgeons are very experienced at removing a tumor without harming nearby organs. They’re experts in:
- All stages and types of anal cancer.
- Treating anal cancer that has recurred (come back).
- Treating anal cancer that did not respond to other treatments.
The 2 main types of anal cancer surgery are:
- Local resection
- Abdominoperineal resection
Local transanal resection or excision surgery
A local resection is also known as a transanal excision (TAE). TAE surgery is for early-stage anal cancer. This surgery removes small tumors in the anal margin (outer layer of the anus) that have not spread. Your surgeon removes the tumor and a little tissue around it to get all the cancer cells.
Most people have normal bowel action (being able to poop) after a local resection. You will not need a colostomy bag.
In rare cases, it can cause problems with how well you can control your bowel. Your care team can offer special tools or treatments to get you back to normal as soon as possible.
Abdominoperineal resection for anal cancer
Chemoradiation is now the main treatment for anal cancer. In the past, it was abdominoperineal resection (ab-DAH-mih-noh-PAYR-ih-NEE-ul ree-SEK-shun).
APR surgery removes the anus, rectum, sphincter muscles, and part of the sigmoid colon (lower colon). APR treats anal cancer that did not respond to radiation or chemotherapy, or that came back after treatment.
APR surgery in general takes about 2 to 3 hours. You’ll be in the hospital for a few days. It takes about 3 to 6 weeks to recover from APR surgery.
APR can be done by open or minimally invasive methods.
Open surgery is when your surgeon makes 1 long incision (cut) on your abdomen (belly).
Minimally invasive surgery is when your surgeon makes a few small incisions.
This surgery removes your rectum and anus. You’ll need a new place for your stool (poop) to leave your body. You’ll have a permanent colostomy during APR surgery. You’ll need to have a colostomy pouch (bag).
Our care goes beyond your treatment
At MSK, we support you every step of the way.
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Bring these questions to your next appointment
When you learn you have anal cancer, you’ll probably have many questions for your cancer doctor at your first visit. Talking about treatment options with your doctors can help you feel confident when making decisions about your care.
- What type of anal cancer do I have, and what stage is it?
- Did I have all the scans I need to learn the stage?
- What genetic testing do you offer for anal cancer?
- What are the best treatment options for the type and stage of anal cancer I have?
- When can I start treatment?
- Can I get anal cancer treatment at MSK close to my home?
- What are the risks and side effects of anal cancer treatment?
- Do I need surgery?
- Are there new anal cancer drugs I can try?
- Do you have a clinical trial that’s right for me?
THE MSK DIFFERENCE
Many people prefer to get cancer treatment closer to home. MSK provides excellent anal cancer care on Long Island and in locations in Westchester County, New Jersey, and New York City. You can meet with your surgeon and have chemotherapy, radiation therapy, and genetic testing.
The MSK anal cancer team
At MSK, your care is always a team effort. Our care teams combine the skill and experience of many kinds of anal cancer experts. They work together to give you the best cancer treatment.
Radiation oncologist Dr. John Cuaron and nurses Kristina Boyce and Jacquelyn Kochan at MSK in Commack, LI.
THE MSK DIFFERENCE
MSK has Magnet® designation for our nurses’ excellent patient care, strong leadership, and a culture that values constant improvement. Only about 1 out of every 10 hospitals in the country have Magnet status. It’s one of the highest honors a hospital can earn for nursing excellence.
What types of MSK experts care for and treat people with anal cancer?
Your care team has special training in how to diagnose and treat anal cancer. Their goal is to support you during and after treatment for anal cancer.
We take care of the person, not just the cancer. Our social workers are here to help you and your family with the emotional, social, and physical effects of cancer.
Your care team has doctors, nurses, and other healthcare providers who are experts in anal cancer. They include:
- Surgeons
- Medical oncologists (cancer doctors)
- Radiation oncologists (doctors who use radiation to treat cancer)
- Radiologists (doctors who are experts in imaging)
Your team meets with a panel of experts who review and talk about your diagnosis. They discuss new ideas and the latest research. This expert panel then works together to choose your treatment plan.
Your MSK anal cancer care team may include these experts:
- Colorectal surgeon
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A colorectal surgeon is a doctor with special training in surgery on the colon and rectum.
- Gastrointestinal medical oncologist
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A gastrointestinal (GAS-troh-in-TES-tih-nul) medical oncologist is a cancer doctor with special training in gastrointestinal (GI) cancers. This includes anal cancers.
- Radiation oncologist
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A radiation oncologist is a cancer doctor with special training in using radiation therapy (RT) to treat cancer.
- Radiologist
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A radiologist is a doctor with special training in using imaging to diagnose and treat disease. Imaging includes X-rays, computed tomography (CT), and magnetic resonance imaging (MRI).
- Advanced practice provider
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An advanced practice provider is a healthcare provider with special training who works alone or with your doctor to care for you. Examples are nurse practitioners (NPs) and physician assistants (PAs).
- Social worker
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A social worker is a healthcare provider with special training in helping people cope with problems in their lives. They support you emotionally, socially, and physically by providing counseling and practical assistance.
- Pathologist
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A pathologist is a doctor who uses a microscope to make a diagnosis from cell and tissue samples. They analyze the samples to learn more about a health issue, such as cancer.
With MSK’s level of expertise, people who come to us can be assured they will get care that’s second to none.
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Our Care Advisors will match you with the right anal cancer experts for you.
Anal cancer support services and programs
Social worker Hadley Maya (right) is an expert in supporting young people who are treated at MSK for colorectal cancer.
How does MSK support people with anal cancer?
Cancer treatment affects your body and emotions. The experience is not the same for everyone. We will support you during your treatment.
But you’re also a person with a life beyond cancer. We want to help you get back to it. That’s why we have many programs and services to support you and your loved ones.
You can connect with other people going through cancer treatment in our virtual support groups, led by a social worker.
Or you may need help with side effects of treatment. We have experts with special training in treating pain.
Your caregivers are a very important part of your care team. They need support, too. We have a Caregivers Clinic to help your loved ones cope with cancer.
Podcast
Alternative Cancer Treatments Science vs. Hype
MSK experts talk about Integrative Medicine and Wellness and MSK’s many services, such as our About Herbs resource, Meditation Library, At-Home program, yoga, acupuncture, and mindfulness. Integrative medicine uses traditional cancer treatments along with holistic therapy.
Ways we support you
Our Integrative Medicine and Wellness Service offers complementary, holistic, and natural therapies. This includes acupuncture, meditation, massage therapy, yoga, and exercise.
You may want support to cope with side effects of anal cancer treatment. These may include pain, fatigue (feeling very tired), nerve problems, nausea, insomnia, and stress.
Without using prescription drugs, integrative therapies can help improve and control side effects of cancer treatment.
Integrative medicine services are available in New York City, New Jersey, Westchester, and on Long Island. We also offer virtual classes and workshops.
Pain management is an important part of cancer care. MSK was the first cancer center in the country to have a service just for treating pain in people with cancer.
Our pain experts will help relieve or manage pain after surgery. They can help while you’re still in the hospital, and after you’re home.
We have experts who manage the symptoms and side effects of cancer treatment, such as nausea during chemotherapy.
We offer counseling and support to help you manage anxiety, depression, anger, or loneliness. There are individual and group counseling sessions, both in person and through telemedicine visits. Counseling is open to you and your family, separately or together.
We also run support groups and programs if you want to talk with other people going through a similar experience. Our social workers can offer information about how to talk about your diagnosis with family members, work colleagues, and friends.
Cancer treatment can affect your digestion (how your body breaks down the food you eat). It can change your taste, how you eat, and how hungry you are.
Our clinical dietitian nutritionists can help with:
- Planning healthy meals at home.
- Advice about special diets.
- Dealing with food allergies.
- Managing symptoms such as weight loss or gain, and loss of appetite (not feeling hungry).
- Eating healthy to help with recovery.
Cancer affects your sex life in both physical and emotional ways. It’s normal to think about how cancer treatment may affect your sex life.
Our sexual health programs can help. They have experts in the physical symptoms and emotional challenges that may affect your sex life. We can talk with you about physical changes that affect intimacy.
MSK has experts with special training in female sexual health and fertility. Perhaps you’re trying to have a child or think you may want to start a family someday. We can help you understand your options for having children.
THE MSK DIFFERENCE
MSK is a place where people of all genders and sexual orientations feel welcome and treated with respect. Our LGBTQI+ Cancer Care Program gives you the support you need during cancer care. It’s for LGBTQI+ people getting screened or treated at MSK, or in our survivorship program.
MSK’s treatment locations
We believe anal cancer care should be as convenient as possible. We have treatment locations near you in New York City, Westchester, on Long Island, and in New Jersey.
At our locations, you can meet with your care team and get your anal cancer treatment. You may be able to have chemotherapy or radiation therapy, or join a clinical trial.
MSK brings its expert care closer to you so you can get back home to what matters most.
Expert cancer care where you need it
Many of MSK’s anal cancer treatments and services are available at locations across New York and New Jersey.
We’ll guide you about where you can go for check-ups, procedures, or treatments, based on your diagnosis and treatments.