When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Anal cancer

Last reviewed: 23 Oct 2024
Last updated: 18 Jul 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • rectal bleeding
  • rectal pain
  • rectal mass
Full details

Other diagnostic factors

  • anal discharge
  • anal itching
  • faecal incontinence
  • anal fistula
  • non-healing ulcer
  • inguinal node mass
  • features of distant metastasis
Full details

Risk factors

  • HPV
  • HIV
  • immunosuppression
  • receptive anal intercourse
  • multiple sexual partners
  • autoimmune disease
  • smoking
  • anal intraepithelial neoplasia
  • anal fistula
Full details

Diagnostic investigations

1st investigations to order

  • anoscopy
  • biopsy of tumour
  • pelvis MRI scan
  • pelvis CT scan
  • abdominal and chest CT scan
Full details

Investigations to consider

  • PET scan
  • inguinal node needle biopsy
  • serum HIV enzyme-linked immunosorbent assay (ELISA)
  • cervical cancer screening
Full details

Treatment algorithm

ACUTE

locoregional disease

distant metastatic disease

Contributors

Authors

Bruce D. Minsky, MD

Professor and Frank T. McGraw Endowed Chair

Radiation Oncology

MD Anderson Cancer Center

Houston

TX

Disclosures

BDM declares that he has no competing interests.

Peer reviewers

Brian Czito, MD

Associate Professor

Department of Radiation Oncology

Duke University Medical Center

Durham

NC

Disclosures

BC declares that he has no competing interests.

Lisa Kachnic, MD

Chief and Associate Professor

Department of Radiation Oncology

Boston University Medical Center

Boston

MA

Disclosures

LK has received funding from the US Department of Defense to perform research on non-anal cancers. LK is the author of a study referenced in this topic.

Sue Clark, MD

Consultant Colorectal Surgeon

Assistant Director

The Polyposis Registry

St Mark's Hospital

Harrow

UK

Disclosures

SC declares that she has no competing interests.

  • Differentials

    • Haemorrhoids
    • Rectal cancer
    • Anal margin cancer
    More Differentials
  • Guidelines

    • NCCN clinical practice guidelines in oncology: cancer in people with HIV
    • NCCN clinical practice guidelines in oncology: anal carcinoma
    More Guidelines
  • Patient information

    Anal tears

    Bowel cancer: what is it?

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer