Anal Cancer: Surgery

How might surgery be used to treat anal cancer?

Surgery is not a common treatment for anal cancer. This is because chemotherapy and radiation work very well in treating this cancer. The combination, called chemoradiation, also has fewer side effects than surgery. Some types of surgery for anal cancer cause lifelong changes in how your body works.

If you need surgery, the type of surgery depends on the type of tumor and where it is. There are two main types of surgery used to treat anal cancer.

Local resection

This might be done if the cancer is small and has not spread beyond your anus. The tumor, along with an edge (margin) of healthy tissue around it, is removed. Usually, with this surgery, the sphincter muscle is not damaged. This means you’ll still be able to pass stool in the normal way.

Abdominoperineal resection

This surgery may be done if the cancer doesn’t respond to chemoradiation treatment. It might also be needed if the cancer keeps coming back after treatment. For this type of surgery, your anus and rectum are removed. This means you’ll no longer be able to pass stool in the same way.

Your colon (large intestine) is attached to an opening (stoma) made on your abdomen (belly). This is where stool comes out of your body after surgery. It's called a colostomy. A plastic bag sticks to your skin around the colostomy. It collects stool as it passes through the stoma. Your healthcare team will teach you how to care for your colostomy.

Risks of anal cancer surgery

All surgery comes with risks. The risks of anal cancer surgery include:

• Reactions to anesthesia

• Heavy bleeding

• Infection

• Damage to internal organs

• Blood clots

• Bulging of organs under the incision on your abdomen (a hernia)

• Erection and orgasm problems in men (This is due to nerve damage.)

• Scar tissue forming in your abdomen, which can lead to pain and digestive problems

Your risks depend on your overall health, the type of surgery done, and other factors. Talk with your healthcare provider about which risks apply most to you and what can be done to help reduce your risks.

Getting ready for your surgery

Your surgeon will talk with you about the type of surgery that’s best for you. After you've talked about the details of the surgery, you’ll sign a consent form. This gives the surgeon permission to do the surgery. You may want to bring a family member or close friend with you to this appointment. Write down questions you want to ask about your surgery. Make sure to ask about:

• Insurance coverage and how much you might have to pay

• What tests need to be done before surgery

• What kind of prep you'll need to do before surgery (You may need to use laxatives or enemas to empty your bowels.)

• What type of surgery you’ll have

• What will be done during surgery

• The risks and side effects of the surgery

• Whether you’ll have a colostomy after surgery

• When you can return to your normal activities

You’ll also talk with an anesthesiologist. This is the healthcare provider who will give you medicines to make you sleep and not feel pain (general anesthesia) during surgery. They also keep track of you during surgery to keep you safe. The anesthesiologist will ask about your medical history, family history, and what medicines you take.

Before surgery, tell your healthcare team if you’re taking any medicines. This includes medicines that don't need a prescription, vitamins, herbs, minerals, and other supplements. It also includes marijuana or street drugs. This is to make sure you’re not taking anything that could affect the surgery.

What to expect during surgery

On the day of surgery, your healthcare team will take you into the operating room. Your healthcare team will include the anesthesiologist, the surgeon, and nurses.

During surgery:

• You’ll be moved onto the operating table.

• You may need to wear special stockings on your legs. These are to help prevent blood clots.

• Your healthcare team will keep track of your vital signs. Electrocardiogram (EKG) electrodes will be put on your chest. These are used to keep track of your heart rate. You’ll also have a blood pressure cuff on your arm.

• The anesthesia will be given through an intravenous (IV) tube put in your hand or arm.

• When you’re asleep, your surgeon will do the surgery.

• A soft, flexible tube (called a urinary catheter) will be put into your bladder during surgery. It may be kept in place for a few days as you heal.

After your surgery

You’ll wake up in a recovery room. You'll be watched closely as you wake up to be sure you're recovering from the anesthesia. You’ll be given pain medicine. Depending on the type of surgery, you might need to stay in the hospital for one or more nights.

For the first few days after surgery, you’re likely to have pain. It can be controlled with medicine. Talk with your healthcare provider or nurse about your options for pain relief. Some people don’t want to take pain medicine, but doing so can help your healing. If you don’t control pain well, for instance, you may not want to cough, take deep breaths, turn over often, or get out of bed. You need to do these things as you recover.

You may have a urinary catheter for a few days. This a soft tube put into your bladder so that your urine goes into a bag outside your body.

You may have bowel problems. Talk with your healthcare provider, nurse, or a dietitian about what you can do to help reduce the chance of this.

You may feel tired or weak for a while. This is normal. The amount of time it takes to heal from surgery is different for each person.

If you get a colostomy, you’ll need supplies to care for it. You’ll be taught how to manage the colostomy and how to get supplies before you go home.

Recovering at home

When you get home, you may get back to light activity. But you should stay away from heavy activity for about 6 weeks. Your healthcare team will tell you what kinds of activities are safe for you while you recover.

Follow-up care

You may need radiation treatment or chemotherapy after surgery. Your healthcare provider will talk with you about this type of treatment, when it should start, and what you'll need to do.

When to call your healthcare provider

Talk to your healthcare provider about problems you should watch for. Call right away if you have any of the following:

• Fever of 100.4°F (38°C) or higher, or as advised by your healthcare provider

• Chills

• Cough or shortness of breath

• Rapid, irregular heartbeat; new chest pain

• Signs of infection around the incision, such as redness, drainage, warmth, and pain

• Drainage from the incision site

• Incision opens up or the edges pull apart

• Any unusual bleeding or bleeding that soaks the bandage

• Trouble passing urine or changes in how your urine looks or smells

• Pain, redness, swelling, or warmth in an arm or leg

• Colostomy problems

• Changes in your stool (constipation or diarrhea)

Know what problems to watch for and when you need to call your healthcare provider. Be sure you know what number to call if you have problems. Ask if there’s a special number to call on evenings, weekends, and holidays.