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 life-long changes in how your body works.
If you need surgery, the type of surgery depends on the type and location of the tumor. There are two types of surgery used to treat anal cancer.
If the cancer is small and has not spread, your surgeon may do a local resection. The tumor along with some surrounding healthy tissue is removed. Usually, with this type of surgery, the sphincter muscle is not damaged. This means that you’ll still be able to pass stool in the normal way.
You may need this surgery if the cancer doesn’t respond to the chemoradiation. Or you may need it if the cancer keeps coming back after treatment. For this type of surgery, the surgeon removes your anus and your rectum. This means you’ll no longer be able to pass stool in the same way. A permanent opening is 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 to collect the stool as it passes through the opening in your abdomen.
Risks of anal cancer surgery
All surgery comes with risks. The risks of anal cancer surgery include:
Damage to internal organs
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 build up in your abdomen. This can lead to pain and digestive problems.
Your risks depend on your overall health, what type of surgery you need, and other factors. Talk with your healthcare provider about which risks apply most to you. Keep in mind, though, that healthcare providers can only give you their best estimates. No one can guarantee that you won't have side effects.
Getting ready for your surgery
Your surgeon will talk with you about the surgery option that’s best for you. After you have talked about all the details of the surgery, you’ll sign a consent form. This gives the surgeon permission to perform 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 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 doctor who will give you the general anesthesia. This is the medicine that prevents pain and makes you sleep during surgery. He or she also monitors you during surgery to keep you safe. He or she will ask about your medical history and the other medicines you take.
Before surgery, tell your healthcare team if you’re taking any medicines. This includes over-the-counter medicines, vitamins, herbs, and other supplements. This is to make sure you’re not taking medicines 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 a typical 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.
You’ll have electrocardiogram (EKG) electrodes put on your chest. These are to keep track of your heart rate. You’ll also have a blood pressure cuff on your arm.
You’ll receive anesthesia through an intravenous (IV) tube in your hand or arm.
When you’re asleep, your surgeon will do the surgery.
A soft, flexible tube (urinary catheter) will be put into your bladder during surgery. It may be kept in place for a few days.
After your surgery
You’ll wake up in a recovery room. Your healthcare team will watch you closely. 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. Your pain 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 or turn over often. You need to do this as you heal from surgery.
You may have a urinary catheter for a few days. This a 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. 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 avoid heavy activity for about 6 weeks. Your healthcare team will tell you what kinds of activities are safe for you while you recover.
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
Let your healthcare provider know right away if you have any of these problems after surgery:
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.