Treatments for stage 4 anal cancer

Last medical review:

There is no standard treatment for stage 4 anal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. 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.

Your treatment plan may include one or more of the following treatments.


Chemotherapy uses drugs to destroy cancer cells. You may be offered chemotherapy for stage 4 anal cancer. It may be given alone or as part of chemoradiation.

The chemotherapy drug combinations most often used to treat stage 4 anal cancer are carboplatin and paclitaxel or fluorouracil (also called 5-fluorouracil or 5-FU) and cisplatin. Treatment usually continues as long as the cancer does not grow or spread any further and you can cope with the side effects.

Find out more about chemotherapy for anal cancer.


You may be offered surgery for stage 4 anal cancer if the tumour causes symptoms like pain and bleeding. A wide local excision removes the tumour and a small amount of healthy tissue around it (called the surgical margin).

Find out more about 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
  • 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.
  • MacMillan Cancer Support. Understanding Anal Cancer. 2020:
  • National Comprehensive Cancer Network . NCCN Clinical Practice Guidelines in Oncology: Anal Carcinoma Version 1.2022 . 2022.
  • PDQ Adult Treatment Editorial Board. Anal Cancer Treatment (PDQ®) – Health Professional Version. Bethesda, MD: National Cancer Institute; 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.
  • Stewart DB, Gaertner WB, Glasgow SC, Herzig DO, Feingold D, Steele SR. Clinical practice guidelines for anal squamous cell cancers (revised 2018). Diseases of the Colon and Rectum. 2018: 61(7):775–774.

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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