Anal Cancer Treatment

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).

Read more About Anal Cancer

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).


Surgery for Anal Margin Cancer

Penn medicine offers patients one of the most advanced colorectal surgery programs in the United States with a nationally recognized record for high-quality patient care and survivorship.

Local resection surgery for anal margin cancer, or cancer that can be seen on the outside of the anus, is generally the first treatment if the cancer is located on the skin surrounding the anus and can be completely removed with surgery. Typically, if the tumor is removed completely, no further treatment is required. Close surveillance and follow-up with the surgeon and medical oncologist are needed to ensure that rare recurrences are detected early.

Local Resection

Local resection is a surgical procedure in which the tumor is cut from the skin around the anus along with some of the surrounding healthy tissue. Local resection may be used if the cancer is small and has not spread. This procedure saves the sphincter muscles and anus so the patient can still control bowel movements. This surgery is used for anal margin cancers.

Radiation Therapy for Anal Canal Cancer

Radiation oncologists at Penn Medicine are recognized for techniques that target radiation precisely to the disease site while sparing nearby tissue.

Proton therapy at Penn Medicine is now being used to treat upper gastrointestinal cancers and recurrent tumors in the digestive tract. Penn Medicine is one of the only facilities in the country treating gastrointestinal cancers in this way.

Radiation therapy uses high-energy radiation to kill cancer cells. A radiation therapy schedule usually consists of a specific number of treatments given over an extended period of time. In many cases, radiation therapy is capable of killing all of the cancer cells.

Radiation therapy for anal cancer is commonly used first in combination with chemotherapy for anal canal cancer, or cancer that is inside the anal canal and cannot be seen. Anal canal cancer is very sensitive to chemotherapy and radiation treatments.

3-D Conformal Radiation Therapy

The imaging technology used by radiation oncologists at Penn Medicine helps shape the radiation treatment beam to the shape of the tumor. Known as conformal radiation therapy, this technology gives doctors more control when treating tumors.

In conformal radiation, a special computer uses CT imaging scans to create 3-D maps of the cancer’s location in the body. The system permits the delivery of radiation from several directions and the beams can then be shaped, or conformed, to match the shape of the cancer. Conformal radiation therapy limits radiation exposure to nearby healthy tissue as well as the tissue in the beam's path.

Intensity-Modulated Radiation Therapy (IMRT)

This advanced type of radiation therapy uses a computer-controlled device, called a linear accelerator, to deliver precise doses of radiation to tumors or specific areas within the tumors. Radiation therapy, including IMRT, stops cancer cells from dividing and growing, thus slowing or stopping tumor growth.

In many cases, radiation therapy is capable of killing all of the cancer cells. Using 3-D computed tomography (CT) images along with computerized dose calculations, IMRT allows for the radiation dose to conform more precisely to the shape of the tumor by controlling — or modulating — the intensity of the radiation beam. The therapy allows higher radiation doses to be delivered to areas within the tumor while minimizing the dose to the surrounding area.

Volumetric-Modulated Arc Therapy (VMAT)

Volumetric modulated arc therapy (VMAT) is a type of specialized intensity-modulated radiation therapy, or IMRT. VMAT delivers radiation by rotating the radiation machine, through one or more arcs while radiation is continuously delivered.

VMAT allows Penn radiation oncologists to treat complex cancers while minimizing exposure to surrounding healthy tissue. VMAT shortens radiation delivery time, and offers patients more comfort because it does not require them to lie completely still for long periods of time.

Penn radiation oncologists use RapidArc™ radiotherapy technology to treat hard to reach tumors.

Proton Therapy

Penn Medicine is the only health care facility in the country that is using proton therapy to treat recurrent gastrointestinal tumors in clinical trials.

Penn Medicine's Roberts Proton Therapy Center is the largest and most advanced facility in the world for this precise form of cancer radiation. Patients have access to one of the most sophisticated weapons against cancer, seamlessly integrated with the full range of oncology services available at Penn Medicine. Proton therapy is external beam radiotherapy in which protons are directed at a tumor.

The radiation dose that is given through protons is very precise, and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation. The result is a better chance for curing cancer with fewer harmful side effects.

Proton therapy, like all forms of radiation therapy, works by aiming the energized particles, in this case protons, onto the target tumor. The particles damage the DNA of cells, ultimately causing their death. Unlike X-rays, protons can be manipulated to release most of their energy only when they reach their target. With more energy reaching the cancerous cells, more damage is administered by each burst of radiation.

Chemotherapy for Anal Canal Cancer

Penn Medicine specializes in a team approach to cancer treatment with interdisciplinary care and innovative approaches that use chemotherapy to target tumors prior to and after surgery.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is usually delivered intravenously through a catheter or orally by pill.

Chemoradiotherapy

Chemoradiotherapy is the practice in which chemotherapy and radiation therapy are used simultaneously. 

Surgery for Anal Canal Cancer

Local resection surgery for anal canal cancer is very rare. If surgery for anal canal cancer is needed, Penn Medicine offers patients one of the most advanced colorectal surgery programs in the United States with a nationally recognized record for high-quality patient care and survivorship.

Local resection surgery removes cancer and surrounding tissues from the anal canal.

Close surveillance and follow-up with the surgeon and medical oncologist is needed to ensure that rare recurrences are detected early. 

Clinical Trials for Anal Cancer

Today, more and more people are surviving cancer. Clinical trials benefit patients by providing access to breakthrough therapies and treatments. These new advances in cancer treatment are occurring every day at Penn Medicine, giving patients hope that even greater discoveries lie ahead. Through clinical trials:

  • Diagnosing cancer has become more precise.
  • Radiation and surgical techniques have advanced.
  • Medications are more successful.
  • Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes.
  • Strategies to address the late effects of cancer and its treatment are improving quality of life.

Penn Medicine is the only health care facility in the country that is using proton therapy to treat recurrent gastrointestinal tumors in clinical trials. Also, radiation oncologists at Penn Medicine will soon use proton therapy to treat gastrointestinal cancers in the upper digestive tract.

Other Treatments for Anal Cancer

In addition to standard treatments and clinical trials, patients at Penn Medicine may wish to add additional therapies and treatments such as massage therapy, acupuncture and art therapy. These therapies do not have curative intent, and are designed to complement standard treatments – not take their place.

Integrative Medicine and Wellness Programs

At Penn Medicine, integrative medicine and wellness services can supplement traditional cancer treatments such as chemotherapy, surgery and radiation therapy. While conventional medicine plays a critical role in eradicating cancer, integrative medicine and wellness programs offer patients and their families ways to enhance the quality of their lives, minimize or reduce the side effects of cancer and cancer treatment, and promote healing and recovery.

The physicians at Penn Medicine are knowledgeable and supportive of complementary cancer treatments. The cancer team works with patients and families to integrate these supportive programs into the overall care plan, while ensuring the safety and health of patients.

The Abramson Cancer Center's range of integrative supportive services is designed to help patients cope with the cancer experience and improve their overall sense of well-being. Services include:

The Abramson Cancer Center at Pennsylvania Hospital at Pennsylvania Hospital offers a variety of supportive care programs for patients and families, from diagnosis through survivorship. These programs are available at no cost to the patients treated at Pennsylvania Hospital, and some are open to patients treated elsewhere. These services include social work counseling, nutrition counseling, psychological counseling and spiritual counseling.

The Cancer Appetite and Rehabilitation Clinic focuses on patients with loss of appetite and weight as well as deconditioning.

The Supportive Care Clinic helps to manage cancer-related symptoms. Integrative support programs include:

Support groups and educational programs are available at Pennsylvania Hospital throughout the year.

Palliative Care

Palliative care provides medical and non-medical interventions to ease the symptoms of cancer and its treatment. Palliative care includes physical, emotional and spiritual care that can enhance the quality of life for cancer patients.

Palliative care can be used to complement traditional cancer therapies, or can be used to improve quality of life when curative therapies are no longer an option to treat symptoms.

Palliative care is an approach to patient care that can be integrated with curative therapies at any point from diagnosis to survivorship or end of life care.

Palliative care services include palliative chemotherapy, radiation therapy and surgery as well as psychological counseling, art therapy and support groups for patients and families. The goals of palliative care are to enhance the quality of life for cancer patients and their families, and provide emotional and spiritual support to enhance personal growth.

Palliative care services are offered at Pennsylvania Hospital, and at the Hospital of the University of Pennsylvania.

Penn Home Care and Hospice Services

Penn Home Care and Hospice Services offers a full range of home health care needs by partnering three top-level home health care services under one roof:

Penn Home Care and Hospice Services provides an array of specialized therapies and medications for patients with cancer and cancer-related conditions

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

Clinical Trials

Clinical trials are studies to find new ways to prevent, detect and treat cancer. The purpose of each clinical trial is to answer a specific question. Our physicians carefully design these studies to find new ways to improve care and quality of life ... more about clinical trials