Chemotherapy for anal cancer

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Chemotherapy uses drugs to destroy cancer cells. These drugs target rapidly dividing cells throughout the whole body. This means that chemotherapy kills cancer cells but it can also damage healthy cells.

With most types of chemotherapy, the drugs travel through the blood to reach and destroy cancer cells all over the body, including cells that may have broken away from the primary tumour. This is described as systemic therapy.

Most people with anal cancer have chemotherapy. If you have chemotherapy, your healthcare team will use what they know about the cancer and about your health to plan the drugs, doses and schedules.

You may have chemotherapy to:

  • treat an anal cancer tumour
  • destroy cancer cells that are left behind after other treatments (called salvage therapy)
  • treat cancer that comes back, or recurs
  • relieve pain or control the symptoms of advanced anal cancer (called palliative chemotherapy)
Chemotherapy is most often given along with radiation therapy during the same time period to treat anal cancer. This is called chemoradiation. Some chemotherapy drugs can help make radiation work better by making cancer cells more sensitive to radiation. Combining chemotherapy and radiation therapy can be more effective than either treatment on its own. Chemoradiation is used to treat early-stage (stages 1, 2 and 3) anal cancer.

Chemotherapy is not often used by itself to treat anal cancer. But you may be given chemotherapy on its own if you have already been treated with radiation therapy for anal cancer.

Chemotherapy drugs used for anal cancer

Anal cancer is usually treated with a combination of chemotherapy drugs. The combination of drugs used will depend on where the cancer is in the body.

The most common chemotherapy combination for anal cancer is fluorouracil (also called 5-fluorouracil or 5-FU) and mitomycin. This combination is used along with radiation therapy as part of chemoradiation.

Other chemotherapy combinations that may also be used are:

  • carboplatin and paclitaxel
  • capecitabine and mitomycin
  • fluorouracil and cisplatin
  • cisplatin, leucovorin and fluorouracil
  • docetaxel, cisplatin and fluorouracil
  • oxaliplatin, leucovorin and fluorouracil

Side effects of chemotherapy

Side effects of chemotherapy will depend mainly on the drug, the dose, how it's given and your overall health. Tell your healthcare team if you have side effects that you think are from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Common side effects of chemotherapy drugs for anal cancer include:

Find out more about chemotherapy

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Expert review and references

  • Shahid Ahmed , MD, FRCPC, PhD, FACP
  • Ahmed S, Eng C, Messick CA. Squamous cell carcinoma of the anal canal. Yalcin S, Phillip PA (eds.). Textbook of Gastrointestinal Oncology. Springer Nature Switzerland; 2019: 10:171–180.
  • Cancer Research UK. Chemotherapy for Anal Cancer. 2019:
  • Czito BG, Ahmed S, Kalady MF, Eng C. Cancer of the anal region. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer; 2019: 64:997–1013.
  • Gondal TA, Chaudhary N, Bajwa H, Rauf A, Duc L, Ahmed S. Anal cancer: the past, present and future. Current Oncology. 2023: 30(3):3232–3250.
  • Gotfrit J, Goodwin R, Asmis T, et al. Eastern Canadian Gastrointestinal Cancer Consensus Conference 2019. Current Oncology. 2021: 28:1988–2006.
  • PDQ Adult Treatment Editorial Board. Anal Cancer Treatment (PDQ®) – Health Professional Version. Bethesda, MD: National Cancer Institute; 2022:
  • National Comprehensive Cancer Network . NCCN Clinical Practice Guidelines in Oncology: Anal Carcinoma Version 1.2022 . 2022.
  • Hosni A, Elamir A. Princess Margaret Cancer Center Clinical Practice Guidelines: Gastrointestinal: Anal. University Health Network; 2019.
  • Rao S, Guren MG, Khan K, et al. Anal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2021: 32(9):1087–1100.

Medical disclaimer

The information that the Canadian Cancer Society provides does not replace your relationship with your doctor. The information is for your general use, so be sure to talk to a qualified healthcare professional before making medical decisions or if you have questions about your health.

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