Surgery is not commonly needed to treat anal cancer but it is possible depending on the type and location of the tumor. Here, we take a look at what surgery for anal cancer consists of, when it is used and the main side effects.
When is surgery used to treat anal cancer?
Although anal cancer is primarily treated with chemotherapy and radiation protocols, there may be times when surgery is used.
Although uncommon, surgery can be used for early-stage anal cancer when the tumor is extremely small and localized. Your provider may refer to this type of cancer as “superficially invasive”. During surgery, the area in which cancer is present is excised (removed). This operation is called a local resection. If tests after the surgery show that there is no evidence of disease, the individual will be observed by their doctors. If the tests after surgery show that anal cancer is still present, the patient will undergo further treatment, which may include another excision or chemotherapy and radiation.
Types of surgery for anal cancer
A local resection only removes the tumor and a small area of normal, healthy tissue around it. The anal sphincter is not usually affected as this surgery is mostly reserved for smaller tumors on the outside of the anus.
Bowel function tends to remain the same after a local resection, although tell your doctor if you are experiencing pain or difficulty. You may also find that you experience some difficulty urinating after this procedure. If this occurs along with any other side effects, speak to your doctor.
An ostomy is a surgically created opening in the abdominal wall that is used to remove bodily waste, i.e. stool (poop). There are different types of ostomies. For anal cancer, the most common ostomy is colostomy.
Ostomies for anal cancer can be temporary or permanent depending on the extent of injury to the anus and rectum during treatment. Some thrivers may only need an ostomy during chemoradiation to help them avoid pain when using the bathroom, and get it reversed after healing. Other ostomies are permanent because of the treatment or physical circumstances prior to treatment. Individuals who undergo an Abdominoperineal Resection (or APR—see below) must have permanent colostomies.
Please see our Radiation for Anal Cancer page for more information about why a provider may recommend an ostomy.
Seeing a Wound Ostomy and Continence Nurse (in the UK these are called Stoma Nurses) can provide you expert care and advice on living with an ostomy—both for dietary needs and more generally. These nurses may be commonly referred to as a WOCN, although there are different certifications for different skill levels. If you are in the US, locate your closest certified nurse. If you are in the UK, be sure to speak to your care team and ask for referrals to a specialist nurse who can help you manage your ostomy.
An ostomy can be a frightening or distressing prospect, but many people adapt well over time. Remember that ostomies are used for many other conditions, not just anal cancer, so you are absolutely not alone in this! The American Cancer Society has a comprehensive guide to what to expect when you first get a colostomy, and how to manage and care for it in the long term. The United Ostomy Associations of America, Inc. (UOAA) also provides a wealth of information on their website. In the UK, the Colostomy Association is the leading source of information and help for individuals with ostomies.
Abdominoperineal Resection (APR)
An APR is a very extensive operation. It generally occurs after chemoradiation is unsuccessful in treating the primary tumor, but cancer has not metastasized to other locations in the body. APR involves removing the anus and rectum, and sometimes some of the nearby groin lymph nodes as well. To help remove stool from the body, the end of the colon is attached to a new opening in the abdomen called an ostomy. A small bag for collecting stool is attached to this opening—this is how the individual removes their bodily waste after they’ve had their anus and rectum removed. For more information about ostomy side effects and management, see the ostomy section above.
Preparing for surgery
Your medical team will discuss with you how to best prepare for surgery. General advice for surgery usually includes the following:
- Stop food and drinks for a certain period before the time of surgery
- Bathe or clean, and possibly shave the area to be operated on
- Undergo pre-surgery procedures: these may include blood tests, X-rays, electrocardiograms, etc.
- You may be asked to take an enema the evening before surgery, to empty the bowels.
- On the day of the surgery, do not wear:
- Nail polish
- Leave jewellery and other valuables at home
- Tell the medical staff about dentures or other prosthetic devices you may use
Patients are also advised to bring the following:
- Loose-fitting clothes
- Social Security card number
- Insurance information
- Medicare or Medicaid card
Possible side effects of surgery for anal cancer
After an APR, internal scar tissue may develop, which can cause organs and tissues to stick together. This can be painful and cause digestive issues such as bloating, cramping, nausea, vomiting and changes in bowel movements and regularity. Discuss any side effects you experience after surgery with your medical team.
Sex life and sexual performance
There do not appear to be documented sexual side effects of local resection in either men or women, but please speak with your care team to confirm this. Be sure to ask if there is anything you should know about your sexual function before undergoing any type of surgery.
Men undergoing an APR may experience erectile dysfunction, and/or a lessening in their ability to achieve orgasm. Pleasure during orgasm may also become less intense. Finally, the nerves that control ejaculation can become damaged, which may lead to orgasms without semen, or ‘dry’ orgasms.
In women, an APR does not damage the nerves that control genital feeling and orgasm. Some women do notice vaginal dryness, especially if their ovaries have also been removed. Certain sexual positions may be painful or uncomfortable as the vagina becomes scarred to the tailbone. A couple may need to work together to find the most comfortable and enjoyable sexual positions.
Finally, the presence of an ostomy bag can have effects on body image and self-confidence in both men and women. The American Cancer Society provides some useful tips about managing the presence of an ostomy during sex. The UOAA also provides comprehensive advice about managing intimacy and ostomies for both men and women, as does the Colostomy Association in the UK.
Speak to your surgical team about ways to minimize your sexual side effects. They may also be able to recommend sexual therapy or counseling, which can help thrivers manage sexual changes after surgery.
Dietary changes & bowel issues
Any needed changes to your diet will depend on what sort of surgery you have had. If your anus and rectum have been removed, you will need to adjust your regular diet. A regular, balanced diet is recommended for individuals with colostomies, just as it is for anyone without them!
If part of your bowel has been removed, your stools may become more watery as your body isn’t as able to absorb as much water. Many thrivers have found that sanitary pads or adult diapers are very useful during this time—they can help manage accidents as well as provide peace of mind.
Foods that cause gas may be problematic if you have a colostomy. It will probably take a little experimentation to discover what works with your system and what does not. Remember that sometimes the issue is not with the food itself, but with the way it has been prepared (such as with added fat, for example). Gas-causing foods typically include:
- High-fiber fruit and vegetables, particularly raw.
- Onions and cabbage.
- Carbonated drinks, including beer.
- Rich/fatty food.
If you are having issues, your doctor can direct you to a dietician to provide further help and guidance around diet. Keeping a food diary before your visit, including how certain foods make you feel or digestive issues and their timing, can help maximize your time with them. You may notice a pattern emerge around certain foods. Making adjustments to your diet canhelp you feel better.
There are no foods that are truly off-limits. It’s important for you to focus on what works best for your body, and what makes you feel good or bad. Also, it’s common to find that a food that works well for you initially can cause problems further down the road, or vice versa. If something is causing you trouble, try going without it for a few months and then trying again later if you’re up for it.
The UOAA and Colostomy Association both provide helpful guides about healthy eating for those with ostomies.
Nausea and vomiting are common in the first few weeks after surgery. You may not feel like eating solid food but remember it’s very important to stay hydrated with plenty of liquids. Keep liquids nearby so you can take frequent sips.
If begin vomiting, stop foods and drinks for about an hour and then try to start having some liquids again. Make sure to speak to your medical team if the nausea and/or vomiting become too severe. You may need to be seen by a doctor or even get an IV drip to rehydrate your body.
As with any surgery you may be at risk of infection afterwards. You’ll be given antibiotics to reduce this risk but tell your medical team if you have symptoms of infection. Those include:
- a high temperature
- feeling hot and cold (chills)
- feeling generally unwell or sick
- swelling or redness around your wound
Connect with a Peer
Looking for someone to talk to about your anal cancer diagnosis? We are here to help. The Peer to Peer Support Program is a free service provided by the Anal Cancer Foundation that matches anal cancer thrivers (our word for survivors) and caregivers with thriver volunteers and caregiver volunteers.