Anal cancer is fairly rare – much less common than cancer of the colon or rectum. The American Cancer Society estimates for anal cancer in the United States for 2018 are:

• About 8,580 new cases (5,620 in women and 2,960 in men)
• About 1,160 deaths (680 in women and 480 in men)

The number of new anal cancer cases has been rising for many years. Anal cancer is rare in people younger than 35 and is found mainly in older adults, with an average age being in the early 60s.

The risk of being diagnosed with anal cancer during one’s lifetime is about 1 in 500. The risk is slightly higher in women than in men. The risk is also higher in people with certain risk factors for anal cancer.

Treatment for anal cancer is often very effective, and many patients with this cancer can be cured. But anal cancer can be a serious condition. For information on survival, see Survival Rates by Stage of Anal Cancer.

Visit the American Cancer Society’s Cancer Statistics Center for more key statistics

Important research into anal cancer is now under way in many hospitals, medical centers, and other institutions around the world. Each year, scientists use clinical trials to find out more about what causes this disease, how to prevent it, and how to better treat it.

Looking at changes in anal cancer cells

We know that human papillomavirus (HPV) is a major cause of anal cancer. Researchers are now looking at how HPV affects molecules inside anal cells to cause them to become cancer. Improved understanding of the molecular changes inside anal cancer cells may lead to ways to prevent it and is also expected to help scientists find treatments using drugs that target these changes. Targeted drugs are different from standard chemotherapy drugs. They sometimes work when chemo drugs don’t, and they often have different (and less severe) side effects.

Screening for anal cancer

Ongoing research is being done on the value of screening tests for anal cancer, especially in people with major risk factors, such as HIV infection. (Screening is checking for a disease in people who don't have symptoms of it.) The test studied most is anal cytology, sometimes called the anal Pap test. This test may help find anal cancer when it's small, before it's causing symptoms and when it's easier to treat. Studies are also looking at whether the anal Pap test can help find  anal pre-cancer (called anal intraepithelial neoplasia, or AIN), so it can be treated before cancer even develops. 

Treatment

Better treatments for anal cancer with fewer side effects and long-term changes in body function are areas of active research. For instance, photodynamic therapy is being looked at to see if it can help treat small tumors and pre-cancer changes. Drugs like 5-FU and imiquimod cream are also being used. These treatments are focused on the changed cells in the anus. They don't harm healthy cells in the anus or the rest of the body.

Immunotherapy is treatment that boosts the body’s immune response against cancer cells. Different kinds of immunotherapy are being study for use against anal cancer. Pembrolizumab (Keytruda^®) is one example that's already used to treat other types of cancer. It's now being studied for use in treating anal cancers that have spread to other parts of the body and don't respond to other forms of treatment.

Radiation therapy is a common treatment for anal cancer. Doctors are looking at ways to give external radiation more accurately and effectively to decrease the effects on normal healthy tissues. Other research is being done to learn about the possible benefits of combining external radiation and internal radiation therapy to treat anal cancer.

Combining chemotherapy and radiation is another area of interest. Giving these treatments together might allow people to get lower doses of each one, which could lessen side effects. Different drug combinations, with different forms of radiation are being tested in clinical trials.

HPV vaccines are used today to prevent HPV infection, but they don't help treat HPV infections. Doctors are looking at whether these vaccines might be used to help treat high-grade pre-cancers and keep them from becoming cancer. Researchers are also working on new vaccines to treat women and men who already have HPV infections and HPV-related cancers like anal cancer or cervical cancer. These vaccines may help the immune system attack pre-cancers and even cancers that contain HPV.

Some people at high risk for anal cancer are diagnosed by screening tests, such as the digital rectal exam and/or anal Pap test (described in Can Anal Cancer Be Found Early?). Sometimes a doctor will find anal cancer during a routine physical exam or during a minor procedure, such as removing a hemorrhoid. Treating cancers found this way is often very effective because the tumors are found early in the course of the disease. (This means they're small and haven't spread.) But most often anal cancers are found because of signs or symptoms a person is having.

If anal cancer is suspected, exams and tests will be needed to confirm the diagnosis. If cancer is found, more tests will be done to help determine the extent (stage) of the cancer.

Medical history and physical exam

If you have symptoms that might be caused by anal cancer, the doctor will ask about your medical history to check for possible risk factors and learn more about your symptoms.

Your doctor will also examine you to look for signs of anal cancer or other health problems. For women, this will include a pelvic exam and Pap test. A digital rectal exam will probably be done, too. (This is when the doctor puts a gloved, lubricated finger into your anus and rectum to feel for lumps or other changes).

If problems or changes are found, your doctor might do other exams or tests to help find the cause. If you're being seen by your primary care doctor, you might be referred to a specialist such as a colorectal surgeon, also called a proctologist (a doctor specializing in diseases of the colon, rectum, and anus), for more tests and, if needed, treatment.

Endoscopy

Endoscopy uses a thin tube with a lens or tiny video camera on the end to look inside part of the body. Many types of endoscopy can be used to look for the cause of anal symptoms. They can also be used to get tissue samples from inside the anal canal (described below under Biopsy). Drugs may be used to make you sleepy during these tests.

Anoscopy

For anoscopy the doctor uses a short, hollow tube called an anoscope. It's 3 to 4 inches long and about 1 inch in diameter and may have a light on the end of it. The doctor coats the anoscope with a lubricant and then gently pushes it into the anus and rectum. By shining a light into this tube, the doctor has a clear view of the lining of the lower rectum and anus. This exam usually doesn't hurt.

Rigid proctosigmoidoscopy

The rigid proctosigmoidoscope is a lot like an anoscope, except that it's longer (about 10 inches long). It lets the doctor see the rectum and the lower part of the sigmoid colon. You might need to take laxatives or have an enema before this test to make sure your bowels are empty.

Biopsy

If a change or growth is seen during an endoscopic exam, your doctor will need to take out a piece of it to see if it's cancer. This is called a biopsy. If the growth is in the anal canal, this can often be done through the scope itself. Drugs may be used to numb the area before the biopsy is taken. Then, a small piece of the tissue is cut out and sent to a lab. If the tumor is very small, your doctor might try to remove the entire tumor during the biopsy.

A doctor called a pathologist will look at the tissue sample under a microscope. If cancer is present, the pathologist will send back a report describing the cell type and extent of the cancer.

Anal cancer sometimes spreads to nearby lymph nodes (bean-sized collections of immune system cells). Swollen lymph nodes in the groin can be a sign that cancer has spread. Lymph nodes may also become swollen from an infection. Biopsies may be needed to check for cancer spread to nearby lymph nodes.

There are many different ways to do a biopsy. A type called fine-needle aspiration (FNA) is often used to check lymph nodes that might have cancer in them. To do this, a small sample of fluid and tissue is taken out of the lymph node using a thin, hollow needle. A pathologist checks this fluid for cancer cells. If cancer is found in a lymph node, surgery may be done to remove the lymph nodes in that area.

Imaging tests

Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests might be done for a number of reasons both before and after a diagnosis of anal cancer, including:

• To help find cancer
• To learn how far cancer has spread
• To help see if treatment is working
• To look for signs of cancer coming back after treatment

Some of these imaging tests are used more often than others.

Ultrasound

Ultrasound uses sound waves to make pictures of internal organs or masses. This test can be used to see how deep the cancer has grown into the tissues near the anus.

For most ultrasound exams a wand-like transducer is moved around on the skin. But for anal cancer, the transducer is put right into the rectum. This is called a transrectal or endorectal ultrasound. The test can be uncomfortable, but it usually doesn't hurt.

Computed tomography (CT) scan

CT scans use x-rays to make detailed cross-sectional images of your body. This is a common test for people with anal cancer. It can be used to help tell if the cancer has spread into the lymph nodes or to other parts of the body, such as the liver, lungs, or other organs.

Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these into an image of a slice of your body.

CT-guided needle biopsy: CT scans can also be used to guide a biopsy needle right into a change that could be cancer. To do this, you stay on the CT scanning table while the doctor moves a biopsy needle through your skin and toward the tumor. CT scans are repeated until the needle is in the tumor. A biopsy sample is then taken out and sent to a lab to be looked at under a microscope.

Magnetic resonance imaging (MRI)

MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed by the body and then released in a specific pattern formed by the type of tissue and by certain diseases. A computer translates the pattern into detailed images of parts of the body.

This test is sometimes used to see if nearby lymph nodes are enlarged, which might be a sign the cancer has spread there.

Chest x-ray

A regular x-ray might be done to find out if the cancer has spread to the lungs. It isn’t needed if a CT scan of the chest is done.

Positron emission tomography (PET) scan

For a PET scan, a form of radioactive sugar (known as fluorodeoxyglucose or FDG) is injected into your blood. Cancer cells are very active, so they absorb large amounts of the radioactive sugar. After about an hour, you'll be moved onto a table in the PET scanner. A special camera creates pictures of areas where the radioactivity has collected. The picture is not finely detailed like a CT or MRI scan, but it provides helpful information about your whole body.

Often a PET scan is done in a machine that can do a CT scan at the same time (a PET/CT scan). It lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed image of that area on the CT scan.

The type of treatment your cancer care team will recommend depends on the type of anal cancer, where it is, and how far it has spread (the stage).

Most experts agree that treatment in a clinical trial should be considered for anal cancer that has spread beyond the anus or if standard treatment isn't working. This way you can get the best treatment available now and may also get the treatments that are thought to be even better.

Anal tumors affecting the anal margin or the perianal skin (and not the anal canal) are sometimes treated differently from anal canal cancers.

Stage 0

At this stage, the cancer is still only in the inner lining of the anus and has not grown into deeper layers. Anal cancers are seldom found at this early stage.

Stage 0 tumors can often be removed completely by surgery (local resection). The goal is to take out all of the cancer as well as edge (margin) of healthy cells around it. Radiation therapy and chemotherapy (chemo) are rarely needed.

Stages I and II

These cancers have grown into the anal wall but have not grown into nearby organs or spread to the lymph nodes.

Surgery (local resection) can be used to remove some small tumors (usually less than 1 centimeter or ½ inch) that do not involve the sphincter. In some cases, this may be followed with chemo and radiation therapy.

The standard treatment for anal cancers that can’t be removed without harming the anal sphincter is radiation therapy combined with chemo (called chemoradiation). In chemoradiation, the 2 treatments are given over the same time period. The chemo is usually 5-FU with mitomycin C. The mitomycin is given as a short intravenous (IV) injection, usually at the start of radiation treatment and then again near the end, at around 4 to 6 weeks. The 5-FU is often given by a long IV infusion over 4 to 5 days and repeated in 4 to 6 weeks. In some cases, your doctor may suggest internal radiation along with the external beam radiation.

If the cancer hasn’t gone away completely after chemoradiation is done, more treatment might be needed. But it's important to know that it may take months to see the full effects of chemoradiation. Because of this, doctors may watch any remaining cancer for up to 6 months. It may continue to shrink and even go away without more treatment.

If more treatment is needed, sometimes chemo (with or without extra radiation) may be given to try to shrink any remaining cancer. The drugs most often used are 5-FU plus cisplatin. Another option is surgery to remove the remaining cancer. This is most often a major operation called an abdominoperineal resection (APR), but sometimes only a local resection is needed.

Stages IIIA and IIIB

These cancers have grown into nearby organs or spread to nearby lymph nodes, but they have not spread to distant parts of the body.

In most cases, the first treatment will be radiation therapy combined with chemo (chemoradiation). In chemoradiation, both treatments are given over the same time period. The chemo is usually 5-FU with mitomycin C. The mitomycin is given as a short intravenous (IV) injection, usually at the start of radiation treatment and then again near the end, at around 4 to 6 weeks. The 5-FU is often given by a long IV infusion over 4 to 5 days and repeated in 4 to 6 weeks. In some cases, your doctor may suggest internal radiation along with the external beam radiation.

If some cancer remains after the chemoradiation, it may be watched closely for up to 6 months because it can take months to see the full effects of treatment. If the cancer grows, more treatment is needed. More chemo may be given. The drugs most often used are 5-FU plus cisplatin. Sometimes more radiation is given as well. (This is called a radiation boost.) Another option is surgery to remove the cancer. This is most often a major operation called an abdominoperineal resection (APR), but sometimes only a local resection is needed. If the cancer has spread to nearby lymph nodes, they may be removed with surgery or treated with radiation therapy.

Stage IIIB anal cancer can be hard to treat, so people with this stage might be helped by taking part in a clinical trial.

Stage IV

In this stage, the cancer has spread to distant organs or tissues. Most often, anal cancer first spreads to the lungs, liver, brain, or bones, but it can spread anywhere.

Treatment is very unlikely to cure these cancers. Treatment is aimed at controlling the disease for as long as possible and relieving symptoms as much as possible. Chemotherapy, sometimes along with radiation, is usually the standard treatment. The drugs most often used are 5-FU and cisplatin. Surgery might also be an option in some cases, but before having any surgery it’s important that you understand its goal (to prolong life, relieve symptoms, etc.) and the possible risks and side effects.

Because these cancers can be hard to treat, you might also want to think about taking part in a clinical trial of newer treatments.

Recurrent anal cancer

Cancer is called recurrent when it comes back after treatment. Recurrence can be local (in or near the same place it started) or distant (spread to organs like the lungs or bone).

If cancer returns in the anus or nearby lymph nodes after treatment, treatment depends on what treatment you had the first time. For example, if you had surgery alone, you may get radiation therapy and chemo (chemoradiation). If you first had chemoradiation, then you might be treated with surgery and/or chemo. Treating recurrent anal cancer often requires a major surgery called an abdominoperineal resection (APR).

For some people, the cancer will come back in distant sites or organs in the body. The most common sites are the liver and lungs. The main treatment for this is usually chemo. Most often 5-FU and cisplatin are used. Chemo might not cure the cancer, but it can often help control it and reduce any symptoms it's causing. In rare cases, surgery or radiation therapy might be options to help treat these cancers. But as with chemo, they are unlikely to cure these cancers, so be sure you understand the goal of any treatments offered.

Clinical trials of newer treatments might also be useful for people with recurrent anal cancer.

Treating HIV-infected patients

Most people with HIV infection can be given the same treatment as others with anal cancer, and they can have a good outcome. People with advanced HIV disease and weakened immune systems might need to have less intensive chemotherapy.

Anal melanoma

Melanoma doesn’t respond well to chemotherapy or radiation, so surgery to remove the cancer is the main treatment when possible. Early stage anal melanomas are treated with surgery to remove the tumor and a rim of surrounding normal tissue (local excision). If the tumor is large or has grown into deeper tissues (such as the sphincter muscle) a bigger operation, such as an abdominoperineal resection (APR) may be needed.

If the melanoma has spread to other organs, it's treated like skin melanoma that has spread, often with immunotherapy or targeted therapy drugs. For more information about the treatment of advanced melanoma, see Melanoma Skin Cancer.

In most cases, surgery is not the first treatment used for anal cancer. For people who do need 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 margin (edge) of the normal tissue around the tumor. It's most often used to treat cancers of the anal margin if the tumor is small and has not spread to nearby tissues or lymph nodes.

In most cases, local resection saves the sphincter (SFINK-ter) muscles that keep stool from coming out until they relax during a bowel movement. This allows a person to move their bowels normally after the surgery.

Abdominoperineal resection

An abdominoperineal resection (or APR) is a major operation. The surgeon makes one incision (cut) 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, though this (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 for stool leave the body. To do this, 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.

In the past, 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.

Possible risks and side effects of surgery

Potential 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.

APR tends to cause more side effects, many of which are long-lasting changes. For instance, after an APR, you might develop scar tissue (called adhesions) in your belly that can cause organs or tissues to stick together. This mght cause pain or problems with food moving through the intestines, which can lead to digestive problems. 

People also need a permanent colostomy after an APR. This can take some time to get used to and may mean some lifestyle changes.

For men, an APR may cause erection problems, trouble having an 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).

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 at Sex and the Man With Cancer and Sex and the Woman With Cancer.

For more general information about cancer surgery, see Cancer Surgery.

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking or diet, can be changed. Others, like a person’s age or family history, can’t.

Several factors can affect your risk of anal cancer. But having a risk factor, or even several risk factors, does not mean that you will get cancer. Many people with risk factors never develop anal cancer, while others with this disease may have few or no known risk factors.

Human papillomavirus (HPV) infection

Most squamous cell anal cancers are linked to infection with the human papillomavirus (HPV), the same virus that causes cervical cancer, as well as many other kinds of cancer. In fact, women with a history of cervical cancer (or pre-cancer) have an increased risk of anal cancer.

HPV is a group of more than 150 related viruses. They are called papillomaviruses because some of them cause papillomas, which are more commonly known as warts. There are many subtypes of HPV, but the one most likely to cause anal cancer is HPV-16. Other subtypes of HPV can cause warts in the genital and anal areas, but not cancer. The 2 types of HPV that cause most cases of anal and genital warts are HPV-6 and HPV-11. While anal warts themselves are unlikely to develop into anal cancer, people who have had anal warts are more likely to get anal cancer. This is because people who are infected with HPV subtypes that cause anal and genital warts are also more likely to be infected HPV subtypes that cause anal cancer.

HPV is passed from one person to another during skin-to-skin contact with an infected area of the body. HPV can be spread during sexual activity – including vaginal, anal, and oral sex – but sex doesn’t have to occur for the infection to spread. All that's needed is for there to be skin-to-skin contact with an area of the body infected with HPV. The virus can be spread through genital-to-genital contact, or even hand-to-genital contact. An HPV infection can also spread from one part of the body to another. For example, an HPV infection might start in the genitals and then spread to the anus.

It can be very hard to avoid being exposed to HPV. It might be possible to prevent genital HPV infection by not allowing others to have contact with your anal or genital area, but even then there could be other ways to become infected that aren’t yet clear.

Infection with HPV is common, and in most cases the body can clear the infection on its own. But in some people the infection doesn’t go away and becomes chronic. Chronic infection, especially with high-risk HPV types, can cause certain cancers over time, including anal cancer.

For more information, see HPV and HPV Vaccines.

Having certain other cancers

Women who have had cancer of the cervix, vagina, or vulva are at increased risk of anal cancer. This is probably because these cancers are also caused by infection with HPV.

In men, it would seem likely that having had penile cancer, which is also linked to HPV infection, would increase the risk of anal cancer, but this link has not been shown in studies.

HIV infection

People infected with the human immunodeficiency virus (HIV), the virus that causes AIDS, are much more likely to get anal cancer than those not infected with this virus. For more information about HIV and AIDS, see HIV Infection, AIDS, and Cancer.

Sexual activity

Having multiple sex partners increases the risk of infection with HIV and HPV. It also increases the risk of anal cancer.

Receptive anal sex also increases the risk of anal cancer in both men and women. Because of this, men who have sex with men have a high risk of this cancer.

Smoking

Smoking increases the risk of anal cancer. Current smokers are several times more likely to have cancer of the anus compared with people who do not smoke. Quitting smoking seems to reduce the risk. People who used to smoke but have quit are only slightly more likely to develop this cancer compared with people who never smoked.

Lowered immunity

Higher rates of anal cancer occur among people with reduced immunity, such as people with AIDS or people who have had an organ transplant and must take medicines that suppress their immune system.

Gender and race/ethnicity

Anal cancer is more common in women than men overall, but this varies in racial/ethnic groups and can vary with age. For instance, in African Americans younger than age 60, it's more common in men than in women, but after age 60 it's more common in women.

Many anal cancers can be found early in the course of the disease. Early anal cancers often have signs and symptoms that lead people to see a doctor. Unfortunately, some anal cancers may not cause symptoms until they reach an advanced stage. Other anal cancers can cause symptoms like those of diseases other than cancer. This may delay their diagnosis.

Anal cancers develop in a part of the digestive tract that your doctor can easily see and reach. A digital rectal exam (DRE) can find some cases of anal cancer early. In this exam, the doctor inserts a gloved, lubricated finger into the anus to feel for unusual lumps or growths. This test is sometimes used to look for prostate cancer in men (because the prostate gland can be felt through the rectum). The rectal exam is also done routinely as part of a pelvic exam on women.

The odds that anal cancer can be found early depend on the location and type of the cancer. Cancers that begin higher up in the anal canal are less likely to cause symptoms and be found early. Anal melanomas tend to spread earlier than other cancers, making it harder to diagnose them early.

Screening in people at high risk

Looking for a disease like cancer in someone with no symptoms is called screening. The goal of screening is to find cancer at an early stage, when treatment is likely to be most helpful. Anal cancer is not common in the United States, so screening the general public for anal cancer is not widely recommended at this time.

Still, some people at increased risk for anal intraepithelial neoplasia (AIN, a potentially pre-cancerous condition) and anal cancer might benefit from screening. This includes men who have sex with men (regardless of HIV status), women who have had cervical cancer or vulvar cancer, anyone who is HIV-positive, and anyone who has received an organ transplant. Some experts also recommend screening for anyone with a history of anal warts.

For these people, some experts recommend screening with regular DREs and anal cytology testing (also known as an anal Pap test or anal Pap smear because it is much like a Pap test for cervical cancer). For an anal Pap test, the anal lining is swabbed, and cells that come off on the swab are looked at under the microscope.

The anal Pap test has not been studied enough to know how often it should be done, or if it actually reduces the risk of anal cancer by catching AIN early. Some experts recommend that the test be done every year in men who have sex with men who are HIV-positive, and every 2 to 3 years if the men are HIV-negative. But there is no widespread agreement on the best screening schedule, or even exactly which groups of people can benefit from screening.

Patients with positive results on an anal Pap test should be referred for a biopsy. If AIN is found on the biopsy, it might need to be treated (especially if it is high-grade).

For many people with anal cancer, treatment can remove or destroy the cancer. The end of treatment can be both stressful and exciting. You may be relieved to finish treatment, but it’s hard not to worry about cancer coming back. This is very common if you’ve had cancer.

For other people, the cancer might never go away completely. Some people may need to get treatments to try and help keep the cancer in check. Learning to live with cancer that doesn't go away can be difficult and very stressful. 

Life after cancer means returning to some familiar things and also making some new choices.

Follow-up care

When treatment ends, your doctors will still want to watch you closely. It's very important to go to all of your follow-up appointments. During these visits, your doctors will ask questions about any problems you may have and will do a physical exam, which will include a rectal exam, an exam of the anus, and an exam to see if any nearby lymph nodes are enlarged. Blood tests and imaging tests such as CT scans may also be ordered.

Almost any cancer treatment can have side effects. Some may last for a few weeks to months, but others can last the rest of your life. This is the time for you to talk to your cancer care team about any changes or problems you notice and any questions or concerns you have.

Follow-up doctor visits after treatment may be as often as every 3 months for at least 2 years, and then maybe less often as time goes on. 

Close follow-up is very important in the first several months after treatment with chemoradiation, especially if not all of the cancer is gone. Some tumors continue to shrink after treatment, so the doctor will want to watch the cancer closely during this time to see if more treatment might still be needed.

For patients with colostomies

Most people treated for anal cancer don’t need extensive surgery (known as an abdominoperineal resection, or APR). But if you do have an APR, you will need to have a permanent colostomy.

If you have a colostomy, follow-up is important. You might feel worried or isolated from normal activities. A wound, ostomy, continence nurse (WOCN) or enterostomal therapist (a health care professional trained to help people with their colostomies) can teach you how to care for your colostomy. You can also ask the American Cancer Society about programs offering information and support in your area. See our colostomy information to learn more.

Ask your doctor for a survivorship care plan

Talk with your doctor about developing a survivorship care plan for you. This plan might include: 

• A suggested schedule for follow-up exams and tests
• A schedule for other tests you might need in the future, such as early detection (screening) tests for other types of cancer, or tests to look for long-term health effects from your cancer or its treatment
• A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
• Diet and physical activity suggestions
• Reminders to keep your appointments with your primary care provider (PCP), who will monitor your general health care 

Keeping health insurance and copies of your medical records

Even after treatment, it’s very important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.

At some point after your cancer treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history. It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment. Learn more in Keeping Copies of Important Medical Records.

Can I lower my risk of the anal cancer progressing or coming back?

If you have (or have had) anal cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. Unfortunately, it’s not yet clear if there are things you can do that will help.

Adopting healthy behaviors such as not smoking, eating well, getting regular physical activity, and staying at a healthy weight might help, but no one knows for sure. However, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of anal cancer or other cancers.

About dietary supplements

So far, no dietary supplements (including vitamins, minerals, and herbal products) have been shown to clearly help lower the risk of anal cancer progressing or coming back. This doesn’t mean that no supplements will help, but it’s important to know that none have been proven to do so.

Dietary supplements are not regulated like medicines in the United States – they do not have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do. If you’re thinking about taking any type of nutritional supplement, talk to your health care team. They can help you decide which ones you can use safely while avoiding those that might be harmful.

If the cancer comes back

If the cancer does recur at some point, your treatment options will depend on where the cancer is located, what treatments you’ve had before, and your health. For more information on how recurrent cancer is treated, see Treatment of Anal Cancer, by Stage.

For more general information on recurrence, you may also want to see Understanding Recurrence.

Could I get a second cancer after treatment?

People who’ve had anal cancer can still get other cancers. In fact, anal cancer survivors are at higher risk for getting some other types of cancer. Learn more in Second Cancers After Anal Cancer.

Getting emotional support

Some amount of feeling depressed, anxious, or worried is normal when cancer is a part of your life. Some people are affected more than others. But everyone can benefit from help and support from other people, whether friends and family, religious groups, support groups, professional counselors, or others. Learn more in Life After Cancer.