About Anal Cancer

About Anal Cancer

At Penn Medicine's Abramson Cancer Center, patients with anal cancer receive their care from a multidisciplinary team of nationally recognized experts in the diagnosis, treatment and research of gastrointestinal cancer.

The anus is at the end of the digestive tract below the rectum. The anal canal is a three- to four-centimeter long structure between the anal sphincter, a muscle that controls bowel continence, and the anal margin, the area of skin just outside of the digestive tract. The anus is the opening of the rectum to the outside of the body.

There are two types of anal cancer:

  • Anal margin: Visible on the skin outside of the anus
  • Anal canal: Cannot be seen on the outside of the anus

Anal cancer is not very common and accounts for only 1 to 2 percent of all gastrointestinal cancers.

Penn Medicine's multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials. This multidisciplinary approach has a dual goal of anal conservation and cure of disease.

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).


Anal Cancer Risk and Prevention

Risk factors can increase the chance of getting cancer. There are different kinds of risk factors. Some risk factors for cancer, like age and family history, cannot be prevented.

Patients who feel they are at risk may benefit from consulting with a risk assessment specialist within Penn Medicine's GI genetics program at the Abramson Cancer Center.

Anal Cancer Risk Factors

Risk factors affect the chance of getting anal cancer. Having a risk factor, or even several, does not always mean that someone will get cancer.

  • Being infected with HPV. Anal cancer is also associated with the human papilloma virus (HPV). This virus causes warts also called condyloma in and around the anus, and on the cervix in women. HPV is also associated with an increased risk for cervical cancer.
  • Age. Anal cancer is most often diagnosed in people over 50 years old, but young people with HIV are a large affected group.
  • Anal intercourse. People who participate in unprotected anal sex are at an increased risk.
  • Having many sexual partners. People who have many sexual partners who engage in anal intercourse are at an increased risk for anal cancer.
  • Immunosuppression. People with weakened immune systems, such as those who take certain drugs or have HIV, are at an increased risk.
  • Chronic local inflammation. People with long-standing fistulas, open wounds, redness, swelling or soreness around the anus may be at an increased risk.
  • Smoking. Smoking has been linked to an increased risk of developing anal cancer.

Anal Cancer Prevention

While cancer cannot be totally prevented, a person's risk for anal cancer may decrease significantly with preventative measures.

Types of Anal Cancer

  • Anal margin
  • Anal canal

Anal Margin Cancer

Cancer of the anal margin is cancer that is found just outside of the anus – on the skin. This type of cancer is usually treated in the same way skin cancer is treated – with surgery, excising the lesion, but not the anus itself.

Cancer of the anal margin should not be confused with melanoma of the anus.

Anal Canal Cancer

Cancer in the anal canal cannot be detected by sight. Anal canal cancer is usually detected with a digital rectal exam or a proctoscopy.

Anal Cancer Symptoms

Many cases of anal cancer can be found early because the cancer forms in an area that physicians can see and reach easily. This is why it is important to have regular check-ups.

Anal cancer can be mistaken for hemorrhoids because some symptoms are similar.

Some symptoms of anal cancer include:

  • Bleeding from the rectum or anus
  • A lump or mass at the anal opening
  • Pain or pressure in the area of the anus
  • Itching in the anus or discharge
  • Change in bowel movements, or straining during a bowel movement
  • Narrowing of the stools
  • Mucous or pus discharge from the anus
  • Swollen lymph nodes in the groin or anus

Staging Anal Cancer

Staging systems provide doctors with a common language for describing tumors. After cancer is first diagnosed, a series of tests are used to investigate the extent of the cancer and to see whether it has spread to other parts of the body from where it started. Staging is a way of recording the size and growth of a cancer, and determining the plan for treatment. By understanding the stage of their cancer, patients can make informed decisions about their treatment.

Staging anal cancer attempts to discover the following:

  • The size of the tumor
  • Whether the cancer has spread to nearby tissues
  • Whether the cancer has spread to other parts of the body

Anal Cancer Treatment at Penn

After being diagnosed with anal cancer, patients at the Abramson Cancer Center may be evaluated through the Gastrointestinal Cancer Evaluation Center (GICEC). The center provides patients with expert support and evaluation to discuss treatment options and individualized treatment plans.

Patients with anal cancer are treated by a multidisciplinary team of cancer specialists who see more patients with gastrointestinal (GI) cancers in one year than many doctors see in their careers.

The physicians of Penn Medicine's GI cancer program are nationally recognized for their expertise in the diagnosis and treatment of cancer. Patients with anal cancer are treated by Penn surgeons in the Division of Colon and Rectal Surgery.

Penn's GI cancer treatment team includes:

  • Nationally recognized medical experts with years of experience in diagnosing and treating GI cancer.
  • Nurses with advanced training and experience in caring for patients with GI cancer.
  • Oncology Navigation Specialists to help patients navigate the health system.
  • Registered dietitians to provide nutrition counseling.
  • Cancer counselors to provide individual or family counseling for issues many cancer patients face.
  • Rehabilitation therapists who specialize in the diagnosis and treatment of physical effects from cancer and its treatment.

Penn's GI cancer program is also supported by a robust research program with immediate translation from bench to bedside.

Patients at Penn Medicine can benefit from participating in clinical trials. Patients interested in learning more about clinical trials should speak with a member of their treatment team.

Diagnosing Anal Cancer

An accurate cancer diagnosis from trusted cancer specialists is the first step in getting personalized treatment options to treat anal cancer.

Patients who choose Penn's Abramson Cancer Center, benefit from a multidisciplinary team of cancer specialists including medical oncologists, gastroenterologists, radiologists, pathologists and surgeons who work together to provide a diagnosis and treatment plan designed specifically for each patient with anal cancer.

Cancer specialists at Penn Medicine are highly experienced in using the most advanced techniques for diagnosing anal cancer.

Navigating a cancer diagnosis and treatment options can be difficult. Patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse who can help them make an appointment with the right person. Penn Medicine’s contact center has experienced cancer nurses available and ready to guide patients in finding the cancer specialist right for them.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more Diagnosing Anal Cancer

Anal Cancer Treatment

Following the diagnosis and staging of anal cancer, cancer specialists at Penn Medicine’s Abramson Cancer Center develop a personalized treatment plan.

Anal margin cancer, otherwise known as “perianal cancer” is treated with surgery to remove the growth.

Anal canal cancer is usually treated with a combination of chemotherapy and radiation.  Surgery is rarely needed in cases of anal canal cancer. 

In all cases of anal cancer, Penn cancer specialists are committed to doing everything they can to conserve the anus and anal tissue.

Penn’s treatment options for anal margin cancer include:

  • Surgery
    • Local resection

Penn’s treatment options for anal canal cancer include:

  • Radiation therapy
    • 3-D conformal radiation
    • Intensity-modulated radiation therapy (IMRT)
    • Volumetric-modulated arc therapy (VMAT)
    • Proton therapy
  • Chemotherapy and biologic therapies
  • Surgery
    • Local resection

Other possible treatment options for anal margin and canal cancer include:

  • Clinical trials
  • Other treatments
    • Integrative medicine and wellness
    • Palliative care
    • Penn Home Care and Hospice

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more Anal Cancer Treatment

Anal Cancer Survivorship

Survivorship programs at Penn Medicine are a distinct phase of anal cancer care and are designed to help patients transition from their cancer treatment routine to a post-cancer care lifestyle. There are more than 12 million cancer survivors living and thriving today as a result of advances in cancer treatment. However, cancer treatments can result in physical, emotional and financial complications long after the therapy is complete.

Read more Anal Cancer Survivorship


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Clinical Trials

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