Anal cancer

Last reviewed: 5 Sep 2022
Last updated: 04 May 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • rectal bleeding
  • rectal pain
  • rectal mass
More key diagnostic factors

Other diagnostic factors

  • anal discharge
  • anal itching
  • faecal incontinence
  • anal fistula
  • non-healing ulcer
  • inguinal node mass
  • features of distant metastasis
Other diagnostic factors

Risk factors

  • HPV
  • HIV
  • immunosuppression
  • receptive anal intercourse
  • multiple sexual partners
  • autoimmune disease
  • smoking
  • anal intraepithelial neoplasia
  • anal fistula
More risk factors

Diagnostic investigations

1st investigations to order

  • anoscopy
  • biopsy of tumour
  • pelvic MRI scan
  • pelvic CT scan
  • abdominal and chest CT scan
More 1st investigations to order

Investigations to consider

  • PET scan
  • inguinal node needle biopsy
  • serum HIV enzyme-linked immunosorbent assay (ELISA)
  • cervical cancer screening
More investigations to consider

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 is a co-chair emeritus of the NCI GI Steering Committee.

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 monograph.

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

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    • Rectal cancer
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  • Guidelines

    • NCCN clinical practice guidelines in oncology: anal carcinoma
    • NCCN clinical practice guidelines in oncology: cancer in people with HIV
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