Anal Cancer Surgery | Treatment, Therapy, and Surgery for Anal Cancer, Including Salvage Surgery

Surgery for anal cancer is a surgical treatment used to treat anal cancer. Anal cancer accounts for well under five percent of all cancers of the bowel.

The average age of affected patients is 70 years. In most cases, the malignant tumor can be completely removed surgically. A complete cure is possible for many patients.

Treatment depends largely on the specific findings. If the tumor is still small and in the early stages, the doctor can usually remove it completely through surgery.

In addition, doctors combine this procedure with chemotherapy and radiation therapy (radiochemotherapy). This combination has proven particularly effective in achieving a lasting cure.

If the cancer is advanced, it is often possible to achieve results that improve the patient’s quality of life. If necessary, doctors may remove a section of the intestine and create a colostomy. However, this is rare and applies only to tumors that have spread extensively.

Surgeries that do not require a stoma are much more common.

Cancer of the anus (anal carcinoma) develops in the skin cells immediately surrounding the anus or in the mucous membrane of the transition zone between the anus and the rectum (the anal canal) @ bilderzwerg /AdobeStock

The primary goal of surgery is to prevent the disease from spreading further and to remove the affected tissue. A malignant tumor must not remain in the body; therefore, doctors should remove it promptly.

Furthermore, the goal is to destroy all tumor cells and preserve natural anal function (bowel movements). The focus is on maintaining the highest possible quality of life.

Typically, the specialists involved discuss the individual treatment plan for each patient during a tumor board meeting. These experts include specialists from the following disciplines:

• Oncology
• Surgery, and
• Radiation Oncology

Surgery is not always necessary immediately upon diagnosis of anal cancer.

In many cases, very good results are achieved with chemoradiotherapy alone, which can even lead to complete tumor regression.

The choice of treatment depends primarily on the tumor size and the stage of the disease. The doctor determines the extent of the disease during an examination.

Radiochemotherapy is the first step in treatment. For over 70 percent of all patients, this treatment alone is sufficient. Only if residual tumor is still detectable afterward will the doctor recommend surgery.

In combined chemotherapy and radiation therapy, the doctor does not limit radiation to the tumor area alone. Additional radiation to the lymph nodes in the pelvis and groin increases the likelihood of eliminating all cancer cells.

Intensity-modulated radiation therapy (IMRT) is particularly useful for radiation treatment. It is better tailored to the tumor than other forms of radiation therapy.

Surgery is intended to remove all tumor tissue. To this end, a rectal resection (removal of the rectum) may also be considered. The doctor uses this procedure when the disease is at a very advanced stage or in the event of a recurrence (return of the disease).

Follow-up examinations after anal cancer surgery are critically important for detecting a recurrence of the disease at an early stage and for promptly initiating further treatment.

During the first 12 months after diagnosis, a follow-up examination should take place every three months. In the second year, these should be conducted every six months, and once a year thereafter.

Follow-up appointments take place on an outpatient basis, and the specific procedures depend on the treatment received. Typically, the doctor first performs a physical examination. This is followed by an abdominal ultrasound. If necessary, the doctor may use additional imaging techniques.

These include:

• X-ray
• CT (computed tomography) and
• colonoscopy

In addition to attending follow-up appointments, patients should also maintain a healthy lifestyle.

This includes:

• A balanced diet rich in vitamins and minerals 
• Sufficient exercise to keep the body healthy
• Good sexual hygiene, as viral infections can increase the risk of cancer

The prognosis (outlook) for the disease is generally good. The statistical data collected on this topic covers a five-year period following diagnosis. According to these figures, approximately 70 to 90 percent of all affected patients are still alive at that point.

As with any surgery, there are complications that are generally manageable. These include, for example:

• Wound healing complications
• Postoperative bleeding, as well as
• infections in and around the anal canal

In the first few weeks after treatment, you may experience pain during bowel movements, constipation, or a sensation of a foreign body. These symptoms will gradually subside over time.

Radiochemotherapy also frequently causes side effects, though these usually disappear after a few weeks. Possible side effects include diarrhea-like symptoms, pain during urination, or inflammation in the anal area.

The inflammation is usually caused by the radiation exposure from intensity-modulated therapy.

Surgery is now performed only if the tumor does not completely regress under chemoradiotherapy @ jaojormami /AdobeStock

Anal cancer is one of the most treatable types of colorectal cancer. If you’re affected, it’s important to seek care from a specialist in colorectal diseases.

Take your time to learn about your treatment options and your diagnosis. Don’t hesitate to ask your doctor questions. The better informed you are, the more confident you’ll feel as your treatment progresses.