Anal Cancer: Chemotherapy
What is chemotherapy?
Chemotherapy (chemo) uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells that grow quickly. Some normal cells also grow quickly. Because of this, chemo can also harm those cells. This can cause side effects.
For this treatment, you’ll see a medical oncologist. This is a doctor who specializes in using medicines to treat cancer. For anal cancer, your doctor is likely to give you more than one medicine. This is called combination chemotherapy.
When might chemotherapy be used for anal cancer?
Chemo at the same time as radiation is called chemoradiation. This is often the first treatment for anal cancers that have not spread to other parts of the body. In some cases, it can cure the cancer without surgery. If chemoradiation doesn’t destroy the cancer, you may need more chemo.
Sometimes chemoradiation is given after surgery. This is done to help kill any cancer cells that may be left in your body. This can help lower the chance that the cancer will come back later.
Chemo is used if the anal cancer has spread to distant parts of your body. This can include your lungs or liver. This can help keep the cancer from growing, slow its growth, or ease problems the tumor is causing.
How is chemotherapy given for anal cancer?
You most likely will get chemo by IV (intravenously) into a vein. But some chemo medicines are taken as pills. Chemo is a systemic treatment. This means the medicines travel all through your body in your bloodstream. Most people with anal cancer get chemo in an outpatient part of the hospital or at their healthcare provider’s office. In rare cases, depending on your health or the medicines you get, you may need to stay in the hospital during treatment.
Chemo is given in cycles. This means you’re treated with chemo for a period of time. And then you have a rest period. Each treatment and rest period make up one cycle. You'll likely have more than one cycle of treatment. Your healthcare provider will explain what your treatment plan will be and what you can expect. The length of each treatment period and the number of cycles differ depending on the type of medicines you get. Monthly treatments are common. But sometimes chemo is given more often.
Some of the IV chemo medicines used for anal cancer go into your bloodstream over a short period of time. But some medicines are given as a nonstop infusion over a few days. The medicine is controlled by a small pump that's connected to your IV by a tube that carries the chemo into your blood. If you get chemo this way, you’ll need to have a vein (venous) access device or an indwelling catheter. A catheter is a thin, flexible tube. The catheter is a device that's put through your skin into a large vein. It stays in place between cycles so that you don't have a new IV put in each time you get treatment. It might be in your upper chest or your arm. Your healthcare team will talk with you about if you need one, the type that might be best for you, and the risks and benefits of these devices.
What are common chemotherapy combinations used to treat anal cancer?
These are the main chemo medicine combinations used along with radiation to treat anal cancer:
Some of the medicine combinations used to treat anal cancer that has spread beyond the anus are:
5-FU and cisplatin
Oxaliplatin, Leucovorin, and 5-FU
Carboplatin and paclitaxel
What are common side effects of chemotherapy for anal cancer?
Chemo affects both normal cells and cancer cells. Side effects depend on the type and amount of medicines you take. Ask your healthcare provider which side effects you should watch for. Common side effects can include:
Tiredness and lack of energy (fatigue)
Nausea and vomiting
Loss of appetite
Low blood cell counts
Easy bleeding or bruising
Numbness or tingling in fingers and toes
Most side effects go away or get better between treatments. They will go away over time after treatment ends. You may also be able to help control some of these side effects. Some can even be prevented. Tell your healthcare providers about any side effects you have. They can help you manage your symptoms.
Working with your healthcare provider
It's important to know which medicines you're taking. Write your medicines down. Ask your healthcare team how they work and what side effects they might have.
Talk with your healthcare providers about what signs to look for and when to call them. For example, chemo can make you more likely to get infections. Know what number to call with questions. Is there a different number for evenings and weekends?
It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.