Surgery for anal cancer

Surgery used to be the main treatment for anal cancer. For most people with anal cancer, a combination of chemotherapy and radiotherapy, called chemoradiotherapy, is now more likely to be recommended. Chemoradiotherapy is more effective at curing the cancer than surgery and usually means that you don’t need to have a permanent colostomy.

Surgery may sometimes be used if your chemoradiotherapy treatment doesn’t completely get rid of the cancer, or if there are signs that the cancer has returned (recurred). Sometimes it’s used if radiotherapy isn’t appropriate, for example if you’ve had radiotherapy to the area before. Occasionally, it’s used to relieve symptoms before treatment with chemoradiation.

Surgery may also be used to remove small tumours. 

Your doctor will discuss with you whether surgery is needed and if so, the most appropriate type of surgery for your situation.

Types of surgery

Local excision

This may sometimes be used to treat small, early stage cancers in the anal margin.

The operation only removes the area of the anus containing the cancer cells. The anal sphincter isn’t usually affected, so you should still be able to control your bowel in the normal way.

Your doctors may sometimes recommend that you have radiotherapy or chemoradiotherapy after you’ve had surgery.

Abdomino-perineal excision

If the cancer hasn’t gone completely after chemoradiotherapy, or if it comes back after treatment, you may be advised to have an abdomino-perineal (AP) excision. This involves removing the anus, the rectum and part of the large bowel (colon).

After an AP excision, you will usually have two wounds – an abdominal wound where the surgeon has removed the anus and rectum, and a wound where the anus has been surgically closed.

Sometimes the surgeon can do the operation using only four or five small cuts (about 1cm each) in your abdomen. They use specially designed instruments that can be put through these small cuts. This type of surgery is known as laparoscopic or keyhole surgery. There will still be a wound where the anus has been surgically closed.

Because the rectum and anus are removed, you will need a permanent colostomy. This involves diverting the open end of the bowel to the surface of the abdomen (tummy area), to allow bowel motions (stools) to be passed out of the body into a colostomy bag. The opening on the abdominal wall is called a stoma.

We have more information if you need a colostomy.

Surgery to relieve symptoms

Occasionally, you may need surgery to make a temporary colostomy before chemoradiotherapy starts.

A temporary colostomy may be used to help relieve symptoms if:

  • you are having a lot of difficulty opening your bowels
  • the cancer is causing incontinence, a blockage in the bowel or significant pain
  • there is an opening between the bowel and the skin or another organ, such as the bladder or vagina (a fistula).

Sometimes surgery may be done if there is a risk of a fistula forming.

After the treatment is finished, you will be assessed to see if the stoma can be closed to allow you to pass your stools through the back passage again.

Back to Surgery explained

Who might I meet?

A team of specialists will plan your surgery. This will include a surgeon who specialises in your type of cancer.

If you have a stoma

Adjusting to a stoma takes time but most people manage well with support from their stoma care nurse.

Sex life after bowel surgery

Treatments for anal cancer can have some effects on your sex life. Talk to your doctor or specialist nurse for advice.