My anal cancer treatment journey
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April 29, 2026
Anal Cancer Treatment
Anal cancer is a rare disease. Most doctors encounter only a few cases during their career.
As a top-ranked cancer center, UT MD Anderson doctors have extensive experience treating anal cancer. Patients get care from a medical oncologist, radiation oncologist and surgeon. They work together as a team to plan the best treatment plan for each patient.
Our anal cancer treatments
Anal cancer often can be treated successfully with chemotherapy combined with radiation therapy. If the cancer does not respond to this treatment or returns after treatment, doctors may recommend surgery.
The team of specialists focusing on your care will discuss with you the best options to treat it. This depends on several factors, including:
- The stage of anal cancer
- Location of the tumor in the anus
- If the cancer has just been diagnosed or if it has returned after being treated
- Your age and general health
Surgery
Anal cancer surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure. UT MD Anderson surgeons perform a large number of surgeries for anal cancer each year, using the most advanced techniques.
Patients who undergo certain surgeries will not be able to have normal bowel movements. In these cases, the surgeon creates an opening in the abdomen. Waste is then diverted into an external bag. This procedure is called a colostomy. For anal cancer patients, this is a permanent change. Learn more about living with a colostomy.
If surgery is needed to treat anal cancer, your surgeon may use one of the following procedures.
Wide local excision
Wide local excisions are an option for people who have a tumor outside the anal canal but near the anus. The procedure is often used to cure the disease.
In a local resection, the tumor and some healthy tissue around it are surgically removed. The patient does not get a colostomy.
Local resection is an outpatient surgery and typically lasts under two hours. Patients are under general anesthesia during the procedure.
Patients should start walking as soon as possible after the procedure. This movement can speed up their recovery. Sitting upright may be difficult, especially for the first few days after surgery.
Patients can resume daily tasks as soon as they feel able. Patients who work desk jobs can return to work whenever they feel ready. If the patient’s job requires physical labor, the wound needs about two weeks to heal before they can return to work.
Abdominoperineal resection (APR)
APR is used when the tumor does not respond to chemoradiation or responds then returns.
During the procedure, the surgeon makes one incision in the abdomen and one in the buttocks. The surgeon then removes the anus, rectum and part of the colon. A reconstructive surgeon then rebuilds the pelvic floor, which holds the organs of the abdomen in place.
Patients who undergo an APR also receive a permanent colostomy during the procedure.
APR is a major surgery that requires four to seven nights in the hospital. It is performed under general anesthesia and usually takes seven to 12 hours.
Following surgery, patients should start walking after their anesthesia wears off. Moving will speed up their recovery and help restart the gastrointestinal tract. They should begin routine tasks, like cooking and cleaning, as soon as they feel able.
For the first five days after surgery, patients are only able to sit for short amounts of time. Their sitting time then increases daily. There are no sitting restrictions by about two weeks after surgery.
Full recovery takes two to three months.
Exenteration
Exenterations are typically performed when anal cancer has spread into nearby organs but not to distant parts of the body. This is an extensive procedure that very few patients need.
Several organs are removed during an exenteration for anal cancer, including:
- For men, the anus, rectum, sigmoid colon, prostate and bladder
- For women, the anus, rectum and sigmoid colon. Other structures that may be removed are the back wall of the vagina, the bladder and the uterus.
After an exenteration, all patients get a colostomy bag. If the bladder was removed, the patients also get a urostomy bag to collect urine.
Exenteration is an extensive procedure that often takes 10-14 hours. Patients usually spend about seven nights in the hospital. Patients who are traveling for surgery must stay nearby for another two to three weeks for follow-up care.
Following surgery, patients should begin walking as soon as they feel able. Walking the day of surgery is encouraged, and the day after is expected. This movement should shorten their recovery time, help reduce pain and help restart the gastrointestinal tract.
Patients can begin routine tasks, like cooking and cleaning, as soon as they feel able, though they often need a few days of recovery time first. Most patients who work a desk job return to work three to four weeks after surgery. Patients who do physical labor often need two to three months of recovery time before going back to work.
Chemotherapy
Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing.
Getting chemotherapy
If the disease has not spread, patients with anal cancer get two different chemotherapy drugs. These are given in combination with radiation therapy.
One is delivered through IV infusions. Patients typically get one infusion a week for five to six weeks. Infusions usually last around two hours.
The other drug is delivered through a pump attached to either a port or a central venous catheter. The pump fits in a fanny pack and delivers a steady dose of chemotherapy five days a week.
If the disease has spread, these chemotherapy drugs may be given in combination with immune checkpoint inhibitors.
Chemotherapy side effects
Side effects of chemotherapy include fatigue, nausea, vomiting and hair loss. Many patients experience side effects throughout their chemotherapy treatment.
Patients with these side effects should talk to their care team about ways to limit their impact.
Learn more about the side effects of chemotherapy.
Immune checkpoint inhibitors
Immune checkpoint inhibitors are a type of immunotherapy. They stop the immune system from turning off while it fights cancer.
Immunotherapy is used to treat anal cancer only when the disease has spread, or metastasized, to other parts of the body. It is typically given in combination with chemotherapy.
Learn more about immune checkpoint inhibitors.
Getting immune checkpoint inhibitors
Immunotherapy for anal cancer is delivered through an IV infusion. Patients get one infusion every four weeks for one year. Each infusion lasts around two hours.
Immune checkpoint inhibitor side effects
Side effects of immune checkpoint inhibitors include fatigue; skin changes like itchiness and rash; and bowel problems including constipation and diarrhea.
Read about immune checkpoint inhibitor side effects.
Radiation Therapy
Radiation therapy uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques. Doctors use these to accurately target a tumor while minimizing damage to healthy tissue.
For anal cancer, radiation therapy is typically given along with chemotherapy as part of a plan to cure the disease. It can also be used on its own to help relieve disease symptoms.
Anal cancer patients typically get intensity modulated radiation therapy (IMRT). One type of IMRT is volumetric modulated radiation therapy, or VMAT.
Learn more about radiation therapy.
Getting IMRT/VMAT
This treatment starts with a radiation simulation. Simulations are scheduled at least a week before the first radiation therapy session. They help doctors develop the patient's exact treatment plan.
Simulations begin with an imaging exam such as a CT scan and/or an MRI. The patient's body is then positioned so radiation can be delivered to the tumor while limiting the impact to healthy tissue. The care team then makes a special body mold that will hold the patient in that exact position during each treatment. The care team also will use marks or small tattoos on the patient’s skin to record the treatment position.
If the treatment is designed to cure the cancer, patients get radiation therapy Monday through Friday for five to six weeks. Each session lasts less than 30 minutes total.
If radiation is being used to relieve symptoms (called palliative care), patients get one to three weeks of radiation.
Radiation therapy side effects
The short-term side effects of radiation include:
- Fatigue
- Skin changes including redness, irritation and pain
- Bowel changes including urgent and difficult to control bowel movements, diarrhea and painful bowel movements.
- Changes in urinary habits, including frequency, urgency and a burning sensation during urination
- For female patients, vaginal irritation and discharge.
Long-term side effects
Radiation therapy can cause long-term side effects, including:
- Bowel changes such as chronic diarrhea, urgency, potential incontinence or constipation and difficulty passing stool
- Rectal changes such as pain, bleeding and narrowing
- Bladder changes such as frequent or painful urination or potential incontinence
- Weakened pelvic bones that can lead to increased risk of insufficiency fractures
- Changing color or texture of skin in the perianal and groin areas
- Chronic fatigue
- Infertility and premature menopause
- Sexual dysfunction including vaginal dryness, vaginal narrowing and painful intercourse for females and erectile dysfunction, decreased or absent ejaculate and potential reduction in sperm production males.
Many of these side effects can be treated or managed through medications or other treatments. Talk to your care team about any side effects you experience.
Learn more about anal cancer:
What is a total pelvic exenteration?
“Exenteration” refers to a complex surgery in which organs, bones and other structures are removed from the pelvis in order to treat cancer. A pelvic exenteration might involve the bladder, rectum, anus and/or sacrum (tailbone), as well as the prostate gland in men and the vagina and/or uterus in women.??
While this procedure may sound fairly extreme, it is often the best — and only potentially curative — option for some types of cancer. It also provides the best possible chance of long-term cancer control.?
But which cancers does a pelvic exenteration typically treat? What makes you a good candidate for one? How will it affect your sex life and bathroom habits? And, what else should you know about this life-changing operation? Read on for answers.?
Which cancers is a total pelvic exenteration used most frequently to treat?
A total pelvic exenteration (TPE) is most commonly used for locally advanced rectal cancer?or another type of cancer that involves the rectum. This is because of the way cancer grows and spreads in the rectum. But TPE is also used to treat:?
In fact, pelvic exenteration was originally designed to treat recurrent cervical cancer. It originated as an operation for this gynecologic cancer because the cervix is located in the center of the pelvis. In the days before HPV vaccinations prevented most cervical cancers and radiation therapy was used to treat it, cervical cancer often grew into the structures around it. This procedure was seen as a way of clearing it out.?
Are there different types of exenterations?
An exenteration used to treat rectal cancer usually involves the removal of the rectum, plus something else. That could be the bladder, the bone behind the rectum (the sacrum), or any of the other structures surrounding it that are not normally removed during rectal surgery. Generally speaking, though, there are three types of exenterations:
Anterior exenteration
In a male, this entails removing the bladder and the prostate, but leaving the rectum intact. In a female, this involves removing the bladder, uterus and possibly the vagina, but leaving the rectum intact.??
Posterior exenteration
This involves the removal of the rectum and sacrum, as well as the uterus (if present) and possibly part of the vagina in a female.?
Total pelvic exenteration
In a male, this involves removal of the rectum, bladder and prostate. In a female, this normally entails the removal of the rectum, bladder and uterus (if present) and can also include the vagina.?
Which patients make the best candidates for an exenteration?
Ideally, we want you to be at your very fittest before an exenteration. That way, you’ll have some strength in reserve if any complications arise. So, any therapies we might recommend before that are all part of a plan to get your body prepared for surgery, not to help you avoid it.??
Your best chance for a cure is when we can do a TPE early as a planned part of your treatment, rather than waiting to do it as a last resort when systemic treatments are no longer working. But a TPE is a long and very complex operation, and the recovery can be prolonged. Not all patients will be able to undergo it. So, the first thing we ask is, “Do you have a cancer that’s resectable?” That is: “Can your tumor be removed with surgery? Then, your surgeon will determine if you are fit enough to undergo it.??
Unfortunately, a lot of patients are told elsewhere that this type of surgery is impossible, even when their cancer is not metastatic and is still potentially curable. They only come to MD Anderson after other treatments have failed. Other patients are so leery of the procedure itself that they’ll try almost anything to avoid it.?
The trouble is that while chemotherapy and radiation therapy can sometimes slow a cancer’s growth, the problems caused by a locally advanced tumor in the pelvis often become worse. These can include severe pain, obstructions, infections, blood supply problems, and nerve damage. All of those may end up becoming much bigger issues than they would’ve been if someone had gotten the surgery earlier.?