Surgery for Anal Cancer

Most patients with anal cancer are treated with a combination of radiation therapy and chemotherapy. However, surgery might be used if you have been treated for anal cancer and you still have some cancer left in your body, the cancer has come back after you were treated, or your cancer is at an advanced stage. You might also be treated with surgery if you cannot have chemotherapy or radiation therapy because of your overall health. 

If you need surgery for your anal cancer, your surgeon will do either a local resection or an abdominoperineal resection. 

• Local resection - The surgeon removes only the tumor and a small amount of noncancerous tissue around the tumor. Local resection is used if the cancer is small and has not spread to nearby tissues or lymph nodes. Local resection does not usually affect the muscular ring that opens and closes the anus (sphincter). This means that after the operation, your bowels should be able to move the same way they did before the procedure. Most small tumors that start in the lower part of the anus (anal margin) and have not spread beyond the anus can be treated with local resection. 

• Abdominoperineal resection (APR or AP resection) - In this more extensive operation, the surgeon cuts into the abdomen and the space between the anus and the external genitals (perineum) and takes out the anus, rectum, and part of the colon. The surgeon may also take out some of the lymph nodes (small bean-shaped organs that help fight infection) during this operation, which is called lymph node dissection. Lymp node dissection can also be done after APR. Although this surgery used to be the main treatment for anal cancer, many doctors today use a combination of radiation therapy and chemotherapy instead because it is equally effective and does not damage the anal sphincter. 

• Colostomy (ostomy) - APR damages the anal sphincter. You will need a permanent opening (stoma) in the abdomen so that feces can leave your body. Your surgeon will sew the end of the intestine to this opening. Feces will pass through the colostomy into a disposable collection bag attached to your body.

This content has been reviewed and approved by Myo Thant, MD.