Treatments for recurrent anal cancer

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The following are treatment options for recurrent anal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. Treatment options depend on if the cancer comes back in or near the anus (called local recurrence) or if it recurs in another part of the body farther from the anus (called distant metastasis).

Local recurrence

The treatment options for a local recurrence of anal cancer depend on what was used to treat the original tumour.

Chemoradiation is usually given if surgery was the only treatment used to remove the original tumour. This treatment gives chemotherapy during the same time period as radiation therapy. Chemotherapy uses drugs to destroy cancer cells, and radiation therapy uses high-energy rays or particles to destroy cancer cells. Chemoradiation is usually given as daily treatments of external beam radiation therapy for 5 to 6 weeks. The drugs most commonly given during this time period are fluorouracil (also called 5-fluorouracil or 5-FU) and mitomycin. Sometimes capecitabine is used instead of fluorouracil.

Surgery can be done to remove a local recurrence if chemoradiation was used to treat the original tumour. An abdominoperineal resection removes the rectum, anal sphincter, anus and muscles around the anus. A wide local excision to remove the tumour and a small amount of tissue around it (called the surgical margin) may be done if there is a local recurrence of perianal skin cancer.

Chemotherapy alone can be given if chemoradiation was used to treat the original tumour and surgery can’t be done to remove the recurrence. The chemotherapy drug combinations used most often are carboplatin and paclitaxel or fluorouracil and cisplatin.

Radiation therapy may be given alone if it wasn't used before to treat the original tumour.

Find out more about surgery for anal cancer, chemotherapy for anal cancer or radiation therapy for anal cancer.

Distant metastasis

There is no standard treatment for distant metastasis. The goal of treatment is to control the disease, relieve symptoms (called palliative therapy) and help you live as long as possible with a good quality of life.

Chemotherapy may be given alone or as part of chemoradiation. The chemotherapy drug combinations used most often are carboplatin and paclitaxel or fluorouracil and cisplatin. Treatment is usually continued as long as the cancer doesn’t grow or spread any further and you can cope with the side effects.

Radiation therapy may be used to manage symptoms like pain and bleeding caused by an anal tumour.

A wide local excision may be done to remove an anal tumour that causes symptoms like pain and bleeding.

Find out more about chemotherapy for anal cancer, radiation therapy for anal cancer and surgery for anal cancer.

Clinical trials

Talk to your doctor about clinical trials open to people with anal cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

If you can't have or don't want cancer treatment

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don't work anymore, they're not likely to improve your condition or they may cause side effects that are hard to cope with. There may be other reasons why you can't have or don't want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

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.
  • 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.
  • 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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