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Anal cancer

Last reviewed: 4 Sep 2023
Last updated: 17 Aug 2023



History and exam

Key diagnostic factors

  • rectal bleeding
  • rectal pain
  • rectal mass
More key diagnostic factors

Other diagnostic factors

  • anal discharge
  • anal itching
  • fecal 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 tumor
  • 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


locoregional disease

distant metastatic disease



Bruce D. Minsky, MD

Professor and Frank T. McGraw Endowed Chair

Radiation Oncology

MD Anderson Cancer Center




BDM declares that he has no competing interests.

Peer reviewers

Brian Czito, MD

Associate Professor

Department of Radiation Oncology

Duke University Medical Center




BC declares that he has no competing interests.

Lisa Kachnic, MD

Chief and Associate Professor

Department of Radiation Oncology

Boston University Medical Center




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




SC declares that she has no competing interests.

  • Differentials

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  • Guidelines

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

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