Supportive care for anal cancer

Supportive care helps with the physical, practical, emotional and spiritual challenges of cancer. This important part of cancer care focuses on improving the quality of life of people with cancer and their loved ones, especially after treatment has ended.

Adjusting to life after treatment is different for everyone. Your recovery will depend on many different factors, such as where the cancer was in your body, the stage of the cancer, the organs and tissues removed during surgery, the type of treatment and side effects.

If you have been treated for anal cancer, you may have the following concerns.

Diarrhea is a common problem for people treated for anal cancer. This is because the digestive system is very sensitive to treatments like radiation therapy and chemotherapy. An abdominoperineal resection may also cause diarrhea.

Diarrhea usually goes away after treatment is finished, but sometimes it can last several months or years after treatment.

Making changes to your diet can help manage diarrhea. You can try limiting certain foods and drinks, such as greasy foods, high-fibre foods, coffee, tea and alcohol. Ask your doctor for a referral to a dietitian if you have questions or concerns about your diet. Your healthcare team may also recommend medicines to help manage diarrhea.

In addition to diarrhea, some people may not be able to control their bowel movements (called incontinence). This often happens if treatment damages the muscles of the anal sphincter. Tell your healthcare team if you have incontinence. Special pads or undergarments can help protect your skin and avoid odour. In some cases, you may have surgery to repair the anal sphincter. If the anal sphincter can’t be fixed, you may need a colostomy.

Find out more about diarrhea.

Some treatments for anal cancer can cause sexual problems or make having sex difficult. For example, it is common to lose interest in sex around the time of diagnosis and during treatment. Some people may not be able to have anal sex because of cancer or its treatments.

Radiation therapy or an abdominoperineal resection may lead to erectile dysfunction, which means not be able to have or keep an erection. These treatments can also lead to ejaculation problems, including dry orgasm (no semen is ejaculated). Find out more about managing these types of sexual problems.

Radiation therapy may cause the vagina to become irritated and dry, which can make sex painful or uncomfortable. Having vaginal sex can also be painful if scar tissue or adhesions develop in the abdomen from an abdominoperineal resection. Find out more about managing these types of sexual problems.

Talk to your healthcare team if you are having problems with sex. They can suggest ways to help you manage these problems, such as medicines or special devices. Some people find that counselling helps them cope with the effects that anal cancer and its treatments have on their sexual relationships.

A colostomy creates an artificial opening (called a stoma) from the colon to the outside of the body through the abdominal wall. A colostomy bag is attached to the stoma to collect food waste from the colon.

If you have an abdominoperineal resection, you will need a permanent colostomy. This surgery removes the muscles of the anal sphincter, and without them you cannot have a bowel movement (poop).

Specially trained healthcare professionals called enterostomal therapists will help you adapt to having a colostomy. They will teach you how to live with a colostomy and care for the stoma. Local or national ostomy groups and associations can also give you support and information.

Find out more about colostomy.

To make the decisions that are right for you, ask your healthcare team questions about supportive care.

Stigma has a serious effect on people with anal cancer.

People may end up with a poorer prognosis because they avoid seeing a healthcare professional about their symptoms. People may ignore symptoms of anal cancer because they are too embarrassed to report them to their doctor, or they may avoid talking to healthcare professionals about sexual behaviours that increase the risk of anal cancer. This avoidance can lead to later diagnosis. Earlier diagnosis generally leads to easier and more effective treatment and better outcomes.

People with anal cancer report very high levels of cancer-related stress. This includes anxiety, depression, guilt, embarrassment and feeling isolated from other people. They also report pain, sexual problems and financial concerns.

They blame themselves. Self-stigma, or self-blame, is when you start to believe the stigma that others have about you. People with anal cancer feel self-stigma because of the negative ideas that surround anal cancer. If you feel ashamed or you worry that you might be rejected or blamed for your diagnosis, you might not want to tell anyone that you have anal cancer or you may be less likely to seek help when you need it.

These feelings of self-stigma in people with anal cancer can lead to:

• delaying diagnosis and treatment, or not having treatment

• withdrawing from friends and family
• increased feelings of guilt, anxiety, shame, depression and anger
• stress in relationships
• poor quality of life

Having any type of cancer is hard, but the stigma of anal cancer makes the experience even harder. These ideas can help you break down the stigma.

Learn about the disease. Find out more about the ​ risks ​ and ​ treatments for anal cancer ​.

Share your story to teach other people. ​ You can help reduce anal cancer stigma by letting people know that anal cancer can affect anyone. It affects you. But it's also OK to not want to talk about it all the time and to choose who you tell.

Remember no one deserves any kind of cancer, including anal cancer. ​ Cancer is a disease, not a punishment. Anyone can be diagnosed with anal cancer. If you're diagnosed with it, you deserve to be treated with understanding, compassion and support.​

Recognize and be honest about your feelings. You may find it hard to talk about anal cancer, stigma and your feelings. But being honest can help improve communication and make your relationships stronger. Learn more about ​ coping with your emotions ​.

Find a support group. You may be able to find an anal cancer support group in your area or join a general cancer support group. Look online to find others living with anal cancer. These groups can help you talk about your feelings and frustrations.

Ask your healthcare team for a referral to a professional counsellor. A counsellor can listen to your fears or concerns, and offer ways to help you cope.