Surgery for anal cancer
Surgery is not usually the first option for most people with anal cancer. In people who do need surgery, the type of operation depends on the type and location of the tumor.
A local resection is an operation that removes only the tumor, plus a small margin of the normal tissue around the tumor. It is used most often to treat cancers of the anal margin if the cancer is small and has not spread to nearby tissues or lymph nodes.
In most cases, local resection preserves the sphincter (the muscular ring that opens and closes the anus). This allows a person to move their bowels normally after the surgery.
An abdominoperineal resection (APR) is an extensive operation. The surgeon makes one incision in the abdomen (belly), and another around the anus to remove the anus and the rectum. The surgeon may also take out some of the nearby groin lymph nodes during this operation, although this step (called a lymph node dissection) can also be done later.
The anus (and the anal sphincter) is removed, so a new opening needs to be made to let stool leave the body. The end of the colon is attached to a small opening in the abdomen, which is called a colostomy, or an ostomy. A bag to collect the feces is attached to the body over the opening.
An APR was often done in the past for cancers of the anal canal, but it can almost always be avoided as the first treatment by using radiation therapy and chemotherapy instead. APR is now more often used as an option if other treatments don’t get rid of the cancer or if the cancer comes back after treatment.
Possible risks and side effects of surgery
Potential side effects of surgery depend on several factors, including the extent of the operation and the person’s health before surgery. Most people will have at least some pain after the operation, but it usually can be controlled with medicines if needed. Other problems can include reactions to anesthesia, damage to nearby organs during the operation, bleeding, blood clots in the legs, and skin infections at the incision sites.
After an APR, you might develop scar tissue (called adhesions) in the abdomen that can cause organs or tissues to stick together. This can sometimes cause pain or problems with food moving through the intestines, which can lead to digestive problems. If you have cramping, bloating, changes in bowel habits, or nausea and vomiting, be sure to tell your doctor.
People need a permanent colostomy after an APR. This can take some time to get used to and may require some lifestyle adjustments. If you have a colostomy, you’ll need help learning how to manage it. A specially trained wound, ostomy, continence nurse (WOCN) or enterostomal therapist will usually see you in the hospital before your surgery to discuss the ostomy and to mark a site for the opening. They can help you after the operation as well. For more information, see our document Colostomy: A Guide.
If you are a man, an APR may stop your erections or ability to reach orgasm, or your pleasure at orgasm may become less intense. An APR can also damage the nerves that control ejaculation, leading to “dry” orgasms (orgasms without semen).
If you are a woman, APR usually does not cause a loss of sexual function, but abdominal adhesions (scar tissue) may sometimes cause pain during sex.
A colostomy can have an impact on body image and sexual comfort level in both men and women. While it may require some adjustments, it shouldn’t prevent you from having an enjoyable sex life.
For more general information about surgery for cancer treatment, see Understanding Cancer Surgery: A Guide for Patients and Families.
Last Medical Review: 04/09/2014
Last Revised: 01/06/2015