Surgery for Anal Cancer

In most cases, surgery is not the first treatment used for anal cancer. For people who can have surgery, the type of operation depends on the type and location of the tumor.

Local resection

A local resection is an operation that removes only the tumor, plus a small amount of normal tissue around the tumor. It's most often used to treat perianal (anal margin) cancer if the tumor is small and has not spread to nearby tissues or lymph nodes.

In most cases, local resection saves the sphincter muscles. This allows a person to move their bowels normally after the surgery.

Abdominoperineal resection

In the past, an abdominoperineal resection (APR) was a common treatment for anal cancer, but doctors have found that it can almost always be avoided by using radiation therapy and chemotherapy instead. Today, APR is used only if other treatments don’t work or if the cancer comes back after treatment.

An APR is a major operation. The surgeon makes one incision (cut) in the abdomen (belly), and another around the anus to remove the anus, the rectum, and the sigmoid colon. The surgeon may also take out some of the nearby lymph nodes in the groin area (called a lymph node dissection).

When the anus (and the anal sphincter) is removed,  a new opening needs to be made for stool to leave the body. The end of the colon is attached to a small hole (called a stoma) made on the abdomen. A bag to collect stool sticks to the body over the opening. This is called a colostomy.

Possible risks and side effects of surgery

Side effects of surgery depend on many things, 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. Other problems can include reactions to anesthesia, damage to nearby organs, bleeding, blood clots in the legs, and infection.

Abdominoperineal resection tends to cause more side effects, many of which are long-lasting.

• After an APR, you might develop scar tissue (called adhesions) in your belly that can cause organs or tissues to stick together.
• Adhesions might cause pain or problems with food moving through the bowels, leading to digestive problems.
• People will need a permanent colostomy after an APR. This can take some time to get used to and may mean some lifestyle changes.
• An APR can sometimes damage the ureters or urethra (tubes that collect your urine), making it difficult to urinate. This might mean more surgery. 
• For men, an APR may cause erection problems, trouble having an orgasm, or less intense orgasms. An APR can also damage the nerves that control ejaculation, leading to “dry” orgasms (orgasms without semen).
• APR usually does not cause a loss of sexual function for women, but abdominal adhesions (scar tissue) may sometimes cause pain during sex.

More information on dealing with the sexual impact of cancer and its treatment can be found in Sexual Side Effects.