Treatment for Anal Cancer

Fred Hutchinson Cancer Center experts offer comprehensive care for anal cancer, including advanced treatments and new options available only through clinical studies. Although anal cancer is uncommon, we treat it regularly here.

Most patients with anal or colorectal cancer are seen at our Colorectal Cancer Specialty Clinic. At this clinic, all of the specialists who will be involved in your care will meet to design treatment that's tailored to you. You will receive a multidisciplinary treatment plan in a single day — truly one-stop shopping.

Some patients see a single specialist, based on their individual needs. Either way, we see you quickly so you can start your treatment quickly.

A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help. 

Anal Cancer Expertise at Fred Hutch

Everything You Need is Here

We have medical oncologists, radiation oncologists, colorectal surgeons and pathologists who specialize in anal and other gastrointestinal cancers; the most advanced diagnostic, treatment and recovery programs; and extensive support. 

Anal Cancer Treatment Tailored to You

We view treatment as a collaborative effort. Your Fred Hutch physicians will explain all your options and recommend a treatment plan to get you the best results based on the type, stage and location of your cancer and your health, lifestyle and preferences.

Team-Based Approach

Your personal team includes more than your anal cancer physicians. Additional experts who specialize in treating people with cancer will be involved if you need them — experts like a dietitian, pharmacist, social worker or palliative care professional.

Learn more about Supportive Care Services

Innovative Anal Cancer Therapies

Fred Hutch patients have access to advanced therapies being explored in clinical studies for anal cancer conducted here and at UW Medicine

Ongoing Care and Support

During and after treatment, your team continues to provide follow-up care on a schedule tailored to you and helps you return to normal quality of life. The Fred Hutch Survivorship Clinic is also here to help you live your healthiest life as an anal cancer survivor.

Treatment Types

If you have this type of cancer:

Squamous cell carcinoma that started in the outer lining of your anal canal — it’s treated according to the guidelines in this anal cancer section.

Adenocarcinoma that started in the anus — it’s treated like rectal cancer.

Skin cancer that started in the skin around your anus (whether it’s squamous cell carcinoma, basal cell carcinoma or melanoma) — it’s treated like skin cancer in other parts of the body.

Radiation Therapy

Most people with anal cancer have a combination of radiation therapy and chemotherapy, called chemoradiation. This combination may cure anal cancer without the need for surgery. 

For anal cancer, physician most often use intensity-modulated radiation therapy (IMRT). 

  • IMRT uses a computer-controlled linear accelerator that moves around you to deliver X-ray radiation. 

  • It shapes the beams and aims them at the tumor from several angles. 

  • The intensity of the beams can be adjusted to lessen the dose that reaches sensitive normal tissue. 

  • Proton therapy for anal cancer is also an option and might be used in certain situations, such as if your anal cancer recurs after previous radiation therapy or has spread to your liver.

If your treatment involves radiation therapy, your radiation oncologist will explain the type that we recommend for you, determine the dosage and schedule for your treatments and help you prevent or manage any side effects. 

Learn More About Radiation Therapy


For most people, chemoradiation cures anal cancer, meaning there's no evidence of disease. If your cancer is not completely gone after these treatments, surgery remains an option. Your team may recommend surgery if your cancer either doesn’t respond to chemoradiation or comes back after treatment.

Anal cancer surgery for Fred Hutch patients is performed by colorectal surgeons at University of Washington Medical Center who are specially trained to do this operation. 

Abdominoperineal Resection 

The exact procedure you need will depend on many factors. You and your team will discuss your options and decide together what is best for you.

Abdominoperineal resection is a typical procedure for anal cancer in the anal canal (from the anal skin to the rectum) that doesn’t respond to chemoradiation or that recurs. This means removing the anus, rectum, part of the colon and lymph nodes.

After this surgery, stool cannot move out of your body along the normal pathway. Instead, you will need a colostomy. The surgeon creates an opening (stoma) in your abdomen. They bring the open end of your colon through the opening and sew it to the skin. They attach a bag to the skin on the outside to collect waste. 

We help you learn how to care for your colostomy and adjust so you can go on with normal activities comfortably. We have a specially certified wound ostomy nurse who understands the physical and emotional impact of ostomies and can work closely with you, your family and your doctors. Our survivorship clinic also plays an integral part in your ongoing care.

Wide Local Excision

If you have perianal cancer (in the skin around the anus), your surgeon will operate to remove the tumor itself and a margin of healthy tissue around it.

Learn More About Surgery


Your physician will recommend chemotherapy:

  • In combination with radiation therapy if you have localized anal cancer (cancer that hasn’t spread) 

  • By itself if you have metastatic anal cancer (cancer that has spread)

Usually chemotherapy medicines are given by infusion into a vein. Then they enter your bloodstream and travel throughout your body.

Your Fred Hutch team will talk with you about the specific medicines we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and we’ll connect you with medical and support resources throughout Fred Hutch.

Learn More About Chemotherapy

Treating Liver Metastases

Over the past decade, amazing advances have been made in treating anal cancers that have spread to the liver. If you have liver metastases, surgeons and interventional radiologists work together at UW Medicine’s Secondary Liver Tumor Clinic to determine which treatment approaches will work best for you. Treatments may include concurrent liver and anal surgeries or catheter-based therapies, such as transarterial chemoembolization. 

Learn More About Liver Cancer

Proton Therapy

Protons can be controlled with greater precision than X-rays. This means that more energy goes into destroying the tumor and less radiation is delivered to surrounding healthy tissue. For this reason, proton therapy is particularly good for treating tumors near healthy organs, including gastrointestinal tumors.

More About Proton Therapy

Meet the Anal Cancer Care Team