Anal cancer is a cancer that develops in the cells and tissue of the skin lining on either the inside or outside of the anus.
The anus is an opening to the outside of the body where stool exits the body. It is below the rectum and is the last part of the gastrointestinal tract.
Some confuse anal cancer with rectal cancer due to its proximity, but the two diseases and treatments of the diseases are different. Colorectal cancer, for example, is primarily adenocarcinoma, and anal cancer is usually squamous cell carcinoma (SCC).
Signs and Symptoms of Anal cancer
Understanding the symptoms of anal cancer is crucial for early detection and treatment. Symptoms may vary depending on the stage of the disease, with early-stage symptoms often being less noticeable.
Early Symptoms
In the initial stages, symptoms may be mild and could easily be mistaken for less serious conditions, such as hemorrhoids or minor infections. Common early symptoms include:
- Itching or irritation around the anus.
- Small amounts of bleeding during bowel movements.
- Unusual lumps or growths near the anus.
- Persistent discomfort or mild pain in the anal area.
- These symptoms might come and go, so it’s important to consult a healthcare provider if they persist.
Late-Stage Symptoms
As the cancer progresses, symptoms typically become more severe and noticeable. Late-stage symptoms may include:
- Persistent and significant pain in the anal or rectal region.
- Larger, noticeable lumps or masses around the anus.
- Difficulty controlling bowel movements (incontinence).
- A sensation of fullness or blockage in the rectum.
- Swelling in the groin area, which could indicate lymph node involvement.
If you experience any of these symptoms, especially in combination, seek medical advice as soon as you can.
I thought I had a hemorrhoid. I remember driving to my sister’s house over Thanksgiving and trying to sit on one side because it felt like something was there. A week later, I had my annual OBG appointment and she performed a rectal exam. She assured me that it was NOT a hemorrhoid and that I should get it checked immediately.
I noticed that I was bleeding from my rectum in December 2010. I didn’t think much of it in the beginning. Assuming it was a case of hemorrhoids, I decided not to go to see the GP. The bleeding persisted and I noticed some changes in my bowel habits so eventually, after much persuasion from my family, I went to see my GP. I really believed that I was wasting the GP’s time, so was very taken aback when she said “I can feel an abnormality in your rectum, I need to refer you for further investigation”.
Looking for someone to talk to about your anal cancer diagnosis? We are here to help.
Anal Cancer Staging
Staging is used by doctors to describe how far a cancer has spread. Treatment options and outlook depend on a cancer’s stage.
There are four stages of anal cancer according to the National Cancer Institute:
- Stage I: Cancer exists and the tumour is 2 centimetres (cm) or smaller.
- Stage II: The tumour is larger than 2cm.
- Stage IIIA: The tumour is of any size and has spread to the lymph nodes near the rectum or to nearby organs such as the vagina, bladder or urethra.
- Stage IIIB: The tumour is of any size and may have spread to the lymph nodes in the rectum, pelvis, and/or groin, and possibly to nearby organs.
- Stage IV: The tumour is of any size and may have spread to the lymph nodes or nearby organs and has also spread to distant parts of the body.
Read more about anal cancer staging.
Anal Cancer Types
There are three types of anal cancer. Treatment options vary depending on the type of anal cancer.
Squamous cell carcinoma (SCC)
Squamous cell carcinoma (SCC) starts in the outer lining of the anus. Approximately 90% of anal cancers are squamous cell carcinoma and result from HPV most of the time
Basal cell carcinoma
Basal cell carcinoma is a skin cancer that occurs in the area around the anus. They account for only a very small number of anal cancers and are considered a type of squamous cell carcinoma.
Adenocarcinoma
Adenocarcinoma is either in the lining of the anus near the rectum or in the anal glands that produce mucous.
Malignant melanoma
Malignant melanoma occurs in the cells of the skin of the anal lining responsible for pigment and makes up ≤2% of anal cancers. Malignant melanoma may also be called skin cancer.
Causes and Risk Factors for anal cancer
Anal cancer and precancer have several causes and risk factors.
Approximately 10,540 people will be diagnosed with anal cancer in the US and about 1,500 in the UK annually.
In almost all cases, anal cancer is caused by HPV, a virus that nearly every person has at some point in their life. The other risk factors on this page – immunosuppression, sexual activity, tobacco use, and older age – all may increase the chance that an HPV infection becomes cancerous. However, there are people who don’t have these additional vulnerabilities who also develop anal cancer.
HUMAN PAPILLOMAVIRUS (HPV)
Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and UK. HPV is a skin virus that can lead to anal, cervical, vulvar, vaginal, penile and head and neck cancers. It is transmitted through skin-to-skin contact. The virus enters the DNA of the cell and causes changes that limit the body’s ability to destroy the cell even though it is infected with a virus. The impact is that the cell replicates abnormally. This may lead to groups of cellular changes that can become precancer or cancerous over time.
Nearly all adults will have HPV at some point in their lifetime. Frequently HPV goes away on its own, although for some it can remain dormant in the body for decades, causing cancers to surface later in life. A small percentage of HPV infections develop into cancer. It is important to note that our immune system finds HPV the vast majority of the time, with 90% of HPV resolving within two years. There are over 100 strains of the virus, some cause cancer and some cause warts. Most people don’t even know they’ve had it. Vaccines now exist to prevent HPV and the cancers it causes and are routinely recommended for children to prevent infection.
There are certain HPV-related conditions that make it more likely that you will develop anal cancer:
- History of anal warts or anal precancer: men and women with anal warts or anal precancer are at increased risk of developing anal cancer because this history indicates an HPV infection. If the infection is persistent with recurrent lesions, it can lead to changes in the anal cells, which may eventually become cancer if left untreated.
- History of other HPV-related cancer:women with a history of cervical, vulvar or vaginal cancer are at risk of developing anal cancer because these cancers are also caused by HPV, and the immune system has demonstrated difficulty in fighting the virus.
Find out more about HPV and preventing the infection with vaccination.
IMMUNOSUPPRESSION
Having a weakened immune system can make the body more susceptible to developing an infection. This is also true for HPV, which can more easily develop into a persistent infection in these individuals. Individuals at increased risk of developing anal cancer include:
- HIV-positive men and women.
- Individuals with autoimmune disorders.
- Transplant recipients and other individuals on immunosuppressive drugs.
I contacted a leading doctor in the anal cancer field, who graciously spoke with me on the phone and explained his work with HPV and anal cancer. He said I likely had HPV since the ‘70’s, that had remained dormant for years, and that in the presence of severe immune suppression, probably had become carcinogenic.
SEXUAL ACTIVITY
Any sexual contact, including manual stimulation, has the ability to expose you to HPV. It’s important to reiterate that nearly all adults will have HPV at some point in their lifetime.
While increasing exposure will increase your chance of contracting HPV, even a person with only one lifetime partner can be infected with HPV. Having multiple sex partners can increase your chance of developing anal cancer because it can increase your chance of being exposed to a carcinogenic strain of HPV.
People who engage in anal sex are at a higher risk of developing anal cancer because they are at a higher risk of skin-to-skin contact in the anal region and contracting an anal HPV infection. Because HPV is a skin virus that is transmitted very easily, anal intimacy is not necessary to contract anal HPV or to develop anal cancer.
In addition, men who are uncircumcised are at a higher risk of developing a persistent HPV infection.
Condom use is always recommended to prevent contracting an STD. However, condom use is not completely effective at preventing HPV transmission.
SMOKING
Smoking increases your chances of developing anal cancer as the carcinogens (cancer-causing chemicals) in tobacco can affect the entire body. There is evidence that smoking may decrease the immune system’s ability to fight HPV infection. Studies have also shown that current smokers are at a higher risk of developing anal cancer than former smokers and those who have never smoked at all.
For help quitting smoking:
US – For help quitting visit the CDC website on smoking cessation
UK – For help quitting visit the NHS website on smoking cessation
OLDER AGE
Most cases of anal cancer are diagnosed when an individual is older than 50 years old. This is because HPV takes time to alter the cells to develop into cancer. However, there are cases of people in their 20s and 30s developing anal cancer.
If you think you are at risk of anal cancer, or are concerned you may have symptoms, see a provider to answer your questions.
Anal Cancer Diagnosis
If you have symptoms or signs, the following tests may be used to diagnose anal cancer:
Digital Anal Rectal Examination ‘DARE’
A doctor places his or her fingers inside the anal canal to feel for abnormalities. The purpose of this test is to look for abnormal masses or growths, so if you think you may have precancer, request this additional testing.
Blood test
This is to check your level of red blood cells. The tests also check how well your liver and kidneys are working.
Your GP can refer you to a hospital specialist. This is usually either a surgeon or a specialist in bowel conditions (gastroenterologist). Tests at the hospital could include:
Anal Pap test/biopsy
Similar to a routine cervical pap test and involves sampling cells inside the anus to detect changes and abnormalities.
Anoscopy: a tube called an anoscope is placed inside the anus and a strong light illuminates the tissue.
High-resolution anoscopy or HRA
a more advanced ansocope with a high-resolution magnifying glass is used to examine and evaluate the tissue in the anus. This is the most precise examination for anal cancer and precancer.
If your biopsy results show anal cancer, it is likely you will have imaging tests in order to learn more information about the tumour, its size, and location. These tests could include:
CT Scan
A CT scan is a test that takes detailed cross-sectional pictures of the inside of your body. It can help detect if the cancer has spread (metastasised)
MRI
Magnetic resonance imaging (MRI) is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body. It’s sometimes used to detect if nearby lymph nodes are enlarged, or if there are abnormalities in the liver, brain, or spinal cord. This could indicate cancer spread.
Fine needle aspiration (FNA) of the lymph nodes
Fine-needle aspiration is a minimally invasive way to obtain a cell sample to confirm if the cancer has spread there.
PET-CT scan
Positron emission tomography (PET) scans produce detailed 3-dimensional images of the inside of the body. They may be combined with a CT scan to produce more detailed images.
PET/CT scans can be used:
- To determine location of cancer spread, if it is suspected.
- In staging anal cancer when you are initially diagnosed.
ANAL CANCER TREATMENT
Treatment options for anal cancer vary depending on stage and type. The three treatment options for anal cancer include chemotherapy, radiation and surgery.
chemotherapy
Chemotherapies are a class of drugs that kill cancer cells and prevent them from multiplying.
Learn more about chemotherapy treatment for anal cancer.
radiation
Radiation for anal cancer involves using an external beam of radiation that is directed towards the location of the cancer to shrink tumours and kill cancer cells.
Learn more about radiation treatment for anal cancer.
surgery
Surgery can be used for early-stage anal cancer when the tumor is extremely small and localised.
Learn more about surgery for anal cancer.
Nigro Protocol
Nigro Protocol consists of radiation therapy combined with 5-FU and mitomycin-C. It is the standard first step of treatment for most people diagnosed with anal cancer in stages I through III
Learn more about the nigro protocol.
Anal Cancer Prevention
Anal cancer is not completely preventable but the following measures can affect your risk including:
- HPV infection
- HIV
- Certain studies indicate that the risk of anal cancer is higher for women who have had cervical, vaginal or vulval cancer.
- Age/Gender
- Smoking
Learn more about anal cancer risk factors & prevention.
Anal Cancer Screening
Routine screening guidelines for anal cancer or precancer have yet to be universally adopted because there have not yet been enough studies for the government and medical communities to recommend routine screening
If you think you may have AIN or are at risk, it is suggested that you have a clinician screen you.
Screening involves visual inspection. However, appropriate and accurate screening should also include additional methods, as a visual check alone can fail to diagnose AIN that is inside the anal canal and any subtle changes. Additional screening options include:
- Digital ano-rectal exams or ‘DARE’
- An anal pap test
- Anoscopy
- High-resolution anoscopy or HRA: a more advanced ansocope with a high-resolution magnifying glass is used
Learn more about anal cancer pre-cancer and screening.
Prognosis for Anal Cancer
The prognosis for anal cancer varies depending on several factors, including the stage at which it is diagnosed, the individual’s overall health, and the treatment approach used. With advancements in medical care, the outlook for anal cancer has improved significantly, especially when detected early.
Factors Influencing Prognosis
- Stage at Diagnosis: Early-stage anal cancer (Stage I or II) typically has a more favorable prognosis, with higher survival rates, as the cancer is localized and easier to treat effectively. Advanced stages (Stage III or IV), where the cancer has spread to nearby lymph nodes or distant organs, can be more challenging to treat but may still respond well to newer therapies.
- Type of Cancer: Squamous cell carcinoma, the most common type of anal cancer, often responds well to treatment, particularly chemoradiation.
- Treatment Response: The success of initial treatments such as chemotherapy, radiation, or surgery plays a crucial role in determining long-term outcomes.
Survival Rates
Survival rates are often used to estimate prognosis. According to recent data:
- Localized anal cancer has a five-year survival rate of about 85%, meaning the majority of individuals live at least five years after diagnosis.
- Cancer that has spread regionally, such as to nearby lymph nodes, has a five-year survival rate of approximately 60-65%.
- Distant metastases, or cancer that has spread to other parts of the body, have a lower survival rate, around 30%.
- It’s important to note that these figures are general estimates and do not account for individual variations in health, response to treatment, or access to care.
Advances in Treatment
The emergence of immunotherapy and targeted therapies has brought hope for patients with advanced or recurrent anal cancer. These innovative treatments can significantly improve outcomes for individuals who may not respond well to traditional methods.
The Importance of Early Detection
Early detection remains one of the most important factors in improving prognosis. Regular check-ups, prompt attention to symptoms, and open communication with healthcare providers can lead to earlier diagnoses and better outcomes.
Anal Precancer
Anal precancer is a growth and/or changes in the skin cells in the anal region. The existence of a ‘precancerous’ condition is not a cancer diagnosis, which is very important to remember. Precancerous conditions are very important precursors to cancer, however, and must be monitored, and treated if appropriate, to reduce the risk of them developing into cancer.
Learn more about anal precancer.
AFTERCARE
Utilize yearly examinations, annual check-ups, or other medical visits as occasions to talk to your provider about screening, and as opportunities for them to screen for anal cancer. Individuals with anal cancer risk factors should discuss screening with their providers. See our screening section for more information on options. If you think something is wrong, and you feel your doctor is not appropriately addressing your concerns, seek a second opinion.
Some doctors may misdiagnose anal cancer for hemorrhoids. If your hemorrhoids persist and do not disappear after treatment, speak to your doctor about a more detailed examination or ask for a referral to a specialist.
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FAQs
How do I find a provider who screens for anal precancer?
Finding a provider who knows how to screen for anal precancer is a great step to learning more about your anal health. Locate a provider near you.
What is HPV and what role does it play in anal cancer?
HPV (Human Papillomavirus) is a skin virus that is transmitted through intimate contact. HPV can be either low-risk or high-risk. High-risk strains may result in 6 different HPV-related cancers including anal cancer. Learn more about HPV and HPV-related cancers.
Can anal cancer be cured?
Yes, anal cancer can be treated and, in many cases, cured. The chances of successful treatment depend on various factors such as the stage of the cancer, the overall health of the patient, and the specific treatment approach used. Treatment for anal cancer often involves a combination of therapies, which may include surgery, radiation therapy, and chemotherapy.
Surgery: In the early stages of anal cancer, surgery can be an effective option. The surgeon may remove the tumor and nearby lymph nodes to ensure that the cancer has not spread.
Radiation Therapy: This involves using high-energy rays to target and kill cancer cells. It’s often used alongside surgery or as the primary treatment for more advanced cases.
Chemotherapy: Chemotherapy involves using drugs to kill or control cancer cells. It can be used in combination with radiation therapy or surgery.
Targeted Therapy: This is a more recent approach that targets specific molecules involved in the growth and spread of cancer cells. It’s not always used for anal cancer but may be considered in certain cases.
The prognosis for anal cancer has improved over the years, especially with advances in treatment options. Early detection and timely treatment are crucial factors for successful outcomes. Regular screenings and check-ups can help catch anal cancer at an earlier stage, when it’s more treatable.
It’s important to note that like any cancer, the success of treatment and the possibility of cure can vary depending on the individual case. It’s recommended to work closely with a medical team to determine the best treatment plan based on the specific circumstances.
What does anal cancer look like?
What does anal cancer look like?
Anal cancer can appear in different ways, and its appearance can vary depending on the stage of the cancer and other factors. It’s important to note that I’m not a medical professional, but I can provide you with some general information about the possible appearances of anal cancer:
Early Stages: In the early stages, anal cancer might not cause noticeable symptoms. However, as the cancer progresses, you might observe changes such as:
Anal Bleeding: This is a common symptom of anal cancer. Blood might be visible on toilet paper or in the toilet bowl after a bowel movement.
Pain or Discomfort: Some individuals might experience pain, itching, or discomfort in the anal area.
Changes in Bowel Habits: You might notice changes in your bowel habits, such as diarrhea, constipation, or a feeling of incomplete bowel movements.
Visible Lesions: As anal cancer advances, it can lead to the formation of visible lesions around the anal area. These can vary in appearance but might include:
Raised Bumps or Growths: These could be pink or reddish and might resemble small, raised bumps or lumps.
Ulcerations: Cancerous ulcers might appear as open sores that don’t heal or that keep recurring. They can be painful and might bleed.
Discoloration: The affected area might appear darker or redder than the surrounding skin.
Lumps or Masses: In some cases, you might feel a lump or mass around the anus or in the anal canal. This could be a sign of a more advanced stage of anal cancer.
Remember, these symptoms and visual cues can also be indicative of other conditions, such as hemorrhoids or infections. If you notice any changes in your anal area, it’s important to consult a healthcare professional for an accurate diagnosis. Early detection and treatment can significantly improve the outcomes for anal cancer. If you’re concerned about any symptoms, it’s recommended to seek medical advice promptly.
How do you know if you have anal cancer?
If you suspect you might have anal cancer or are experiencing concerning symptoms, it’s important to consult a healthcare professional for proper evaluation and diagnosis. Here are some steps to consider:
Recognize Symptoms: Be aware of potential symptoms associated with anal cancer, such as anal bleeding, pain or discomfort in the anal area, changes in bowel habits, the presence of lumps or masses, and persistent itching. While these symptoms can indicate various conditions, they should be discussed with a doctor.
Medical Evaluation: If you’re experiencing any concerning symptoms, it’s recommended to schedule an appointment with a healthcare provider. They will ask you about your symptoms, medical history, and conduct a physical examination.
Screening and Testing: Depending on your symptoms and medical history, your doctor might recommend certain tests to evaluate your condition. These could include:
Digital Rectal Exam: This involves the doctor using a gloved finger to examine the rectum and anus for abnormalities.
Anoscopy: A procedure in which a thin, flexible tube with a light and camera (anoscope) is inserted into the anus to examine the anal canal.
Biopsy: If suspicious areas are found during an examination, a biopsy might be performed. A small tissue sample is taken from the suspicious area and examined under a microscope to determine if cancer is present.
Imaging Tests: In some cases, imaging tests like CT scans, MRI, or PET scans might be recommended to determine the extent of the cancer and if it has spread to other areas.
Consult a Specialist: If anal cancer is suspected or diagnosed, you may be referred to a specialist, such as a colorectal surgeon or an oncologist, who can provide specialized care and treatment recommendations.
Remember that many symptoms associated with anal cancer can also be caused by other conditions, such as hemorrhoids or infections. Only a healthcare professional can provide an accurate diagnosis. If you have concerns about your health, it’s best to seek medical attention to receive proper guidance and care. Early detection and treatment can lead to better outcomes for anal cancer and other medical conditions.
Is anal cancer rare?
Anal cancer is considered relatively rare compared to some other types of cancer, but its incidence has been increasing over the past few decades. It is still an important health concern that requires attention and awareness. The exact prevalence and incidence of anal cancer can vary by region and population. Here are a few key points to consider:
Incidence: The incidence of anal cancer is relatively low compared to more common cancers like breast, lung, or colon cancer. However, its occurrence has been rising, particularly among certain populations, including men who have sex with men and individuals with weakened immune systems.
Risk Factors: Several risk factors contribute to the development of anal cancer. These include infection with high-risk strains of human papillomavirus (HPV), a history of receptive anal intercourse, smoking, a weakened immune system (such as due to HIV infection), and certain pre-existing conditions like anal intraepithelial neoplasia (AIN).
Screening and Prevention: Routine screening for anal cancer is not as established as screenings for some other cancers. However, some healthcare providers might recommend anal cancer screening for high-risk individuals, especially those with a history of HPV infection, HIV, or other risk factors. HPV vaccination can also help prevent some of the HPV-related cancers, including anal cancer.
Importance of Awareness: Due to the potential for increased risk among specific populations, raising awareness about anal cancer, its risk factors, and the importance of early detection is crucial. Recognizing symptoms and seeking medical attention if concerning symptoms arise can lead to earlier diagnosis and better outcomes.
Treatment and Prognosis: As mentioned earlier, anal cancer is treatable, especially when detected in its early stages. Advances in treatment options have improved survival rates and quality of life for individuals with anal cancer.
While anal cancer may be less common than some other cancers, it’s important for individuals to be aware of potential risk factors, symptoms, and the importance of regular healthcare check-ups. If you have concerns about your health or potential risk factors, it’s advisable to discuss them with a healthcare professional.
How common is anal cancer?
In the United States, an estimated 11,270 people will be diagnosed with anal cancer in 2026, according to the National Cancer Institute. It accounts for about 0.5% of new cancer diagnoses.
In US data from 2019 to 2023, the median age at diagnosis was 65, meaning about half were younger and half were older. Diagnoses were most common between ages 65 and 74. Anal cancer can also affect younger adults. It is more common in women than men in the US, and rates vary by country and population.
Here are some general points to consider regarding the prevalence of anal cancer:
Global Incidence: The global incidence of anal cancer is estimated to be around 1 to 2 cases per 100,000 people per year. This makes it one of the less common cancers.
Population Variation: The incidence of anal cancer can vary significantly among different populations. Certain groups, such as men who have sex with men (MSM) and individuals with compromised immune systems (such as those with HIV/AIDS), have a higher risk of developing anal cancer.
HPV-Related Cases: A significant portion of anal cancers are caused by high-risk strains of the human papillomavirus (HPV), the same virus responsible for many cases of cervical cancer. The prevalence of HPV-related anal cancers has contributed to the increased attention and awareness around the disease.
Gender Distribution: Anal cancer can affect both men and women, but some studies suggest that it is slightly more common in women.
Age Distribution: Anal cancer can occur at any age, but it is most commonly diagnosed in people between the ages of 50 and 60.
Geographic Variation: The incidence of anal cancer can also vary by geographic region. Developed countries with better access to healthcare and screening may have higher reported rates.
Please note that these statistics are based on information available up to September 2021, and the situation may have evolved since then. If you’re looking for the most current and accurate information about the prevalence of anal cancer, I recommend consulting reputable health organizations or medical databases. If you have concerns about your health or potential risk factors, it’s advisable to discuss them with a healthcare professional.
Does anal cancer itch?
Yes, itching around the anal area can be a symptom of anal cancer, although it’s important to note that itching can also be caused by various other conditions, such as hemorrhoids, anal fissures, infections, or skin conditions. If you’re experiencing persistent itching around the anal region, it’s recommended to consult a healthcare professional for proper evaluation and diagnosis.
Anal cancer can cause irritation and discomfort in the anal area, which might manifest as itching. However, itching alone is not a definitive sign of anal cancer and can have multiple potential causes. Other accompanying symptoms, such as bleeding, pain, changes in bowel habits, or the presence of lumps or masses, should also be taken into consideration when determining the cause of the itching.
Because anal itching can be caused by different factors, seeking medical advice is crucial to determine the underlying cause and receive appropriate treatment. If you’re concerned about any symptoms or changes in your health, it’s best to consult a healthcare provider for accurate diagnosis and guidance.
My loved one has been diagnosed with anal cancer. How do I help?
Going through an anal cancer diagnosis with a loved one can be very difficult and you may not know where to start. We have a wide range of support resources for caregivers to help you during this time.
How do I find support?
It may be difficult to locate the necessary information and resources needed to go through an anal cancer diagnosis and treatment. Anal Cancer Foundation provides resources like our Peer to Peer Support Program and links to other helpful programs to help you navigate your diagnosis and treatments.
More links and information on anal cancer
- For the Newly Diagnosed
- Living with the Side Effects of Anal Cancer Treatment
- Recurrent and Advanced Anal Cancer
- Questions to Ask Your Doctor
- Facing an Anal Cancer Diagnosis
- Anal Precancer
- Prevention
The information is presented as downloadable documents that you may add to your library of resources.
Anal Cancer: The Facts
Information on anal cancer, testing, and treatment.
Anal Cancer: Questions to Ask Your Doctor
Knowing the right questions to ask your doctor after a diagnosis can be tricky. The questions outlined in this document will help you develop a list of your own questions to better inform your anal cancer experience.
We’re here to empower thrivers and the anal cancer community. But we can’t do it without your support.
Anal cancer is a cancer that develops in the cells and tissue of the skin lining on either the inside or outside of the anus.
The anus is an opening to the outside of the body where stool exits the body. It is below the rectum and is the last part of the gastrointestinal tract.
Some confuse anal cancer with rectal cancer due to its proximity, but the two diseases and treatments of the diseases are different. Colorectal cancer, for example, is primarily adenocarcinoma, and anal cancer is usually squamous cell carcinoma (SCC).
Signs and Symptoms of Anal cancer
Understanding the symptoms of anal cancer is crucial for early detection and treatment. Symptoms may vary depending on the stage of the disease, with early-stage symptoms often being less noticeable.
Early Symptoms
In the initial stages, symptoms may be mild and could easily be mistaken for less serious conditions, such as hemorrhoids or minor infections. Common early symptoms include:
- Itching or irritation around the anus.
- Small amounts of bleeding during bowel movements.
- Unusual lumps or growths near the anus.
- Persistent discomfort or mild pain in the anal area.
- These symptoms might come and go, so it’s important to consult a healthcare provider if they persist.
Late-Stage Symptoms
As the cancer progresses, symptoms typically become more severe and noticeable. Late-stage symptoms may include:
- Persistent and significant pain in the anal or rectal region.
- Larger, noticeable lumps or masses around the anus.
- Difficulty controlling bowel movements (incontinence).
- A sensation of fullness or blockage in the rectum.
- Swelling in the groin area, which could indicate lymph node involvement.
If you experience any of these symptoms, especially in combination, seek medical advice as soon as you can.
Looking for someone to talk to about your anal cancer diagnosis? We are here to help.
Anal Cancer Staging
Staging is used by doctors to describe how far a cancer has spread. Treatment options and outlook depend on a cancer’s stage.
There are four stages of anal cancer according to the National Cancer Institute:
- Stage I: Cancer exists and the tumour is 2 centimetres (cm) or smaller.
- Stage II: The tumour is larger than 2cm.
- Stage IIIA: The tumour is of any size and has spread to the lymph nodes near the rectum or to nearby organs such as the vagina, bladder or urethra.
- Stage IIIB: The tumour is of any size and may have spread to the lymph nodes in the rectum, pelvis, and/or groin, and possibly to nearby organs.
- Stage IV: The tumour is of any size and may have spread to the lymph nodes or nearby organs and has also spread to distant parts of the body.
Read more about anal cancer staging.
Anal Cancer Types
There are three types of anal cancer. Treatment options vary depending on the type of anal cancer.
Squamous cell carcinoma (SCC)
Squamous cell carcinoma (SCC) starts in the outer lining of the anus. Approximately 90% of anal cancers are squamous cell carcinoma and result from HPV most of the time
Basal cell carcinoma
Basal cell carcinoma is a skin cancer that occurs in the area around the anus. They account for only a very small number of anal cancers and are considered a type of squamous cell carcinoma.
Adenocarcinoma
Adenocarcinoma is either in the lining of the anus near the rectum or in the anal glands that produce mucous.
Malignant melanoma
Malignant melanoma occurs in the cells of the skin of the anal lining responsible for pigment and makes up ≤2% of anal cancers. Malignant melanoma may also be called skin cancer.
Causes and Risk Factors for anal cancer
Anal cancer and precancer have several causes and risk factors.
Approximately 10,540 people will be diagnosed with anal cancer in the US and about 1,500 in the UK annually.
In almost all cases, anal cancer is caused by HPV, a virus that nearly every person has at some point in their life. The other risk factors on this page – immunosuppression, sexual activity, tobacco use, and older age – all may increase the chance that an HPV infection becomes cancerous. However, there are people who don’t have these additional vulnerabilities who also develop anal cancer.
HUMAN PAPILLOMAVIRUS (HPV)
Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and UK. HPV is a skin virus that can lead to anal, cervical, vulvar, vaginal, penile and head and neck cancers. It is transmitted through skin-to-skin contact. The virus enters the DNA of the cell and causes changes that limit the body’s ability to destroy the cell even though it is infected with a virus. The impact is that the cell replicates abnormally. This may lead to groups of cellular changes that can become precancer or cancerous over time.
Nearly all adults will have HPV at some point in their lifetime. Frequently HPV goes away on its own, although for some it can remain dormant in the body for decades, causing cancers to surface later in life. A small percentage of HPV infections develop into cancer. It is important to note that our immune system finds HPV the vast majority of the time, with 90% of HPV resolving within two years. There are over 100 strains of the virus, some cause cancer and some cause warts. Most people don’t even know they’ve had it. Vaccines now exist to prevent HPV and the cancers it causes and are routinely recommended for children to prevent infection.
There are certain HPV-related conditions that make it more likely that you will develop anal cancer:
- History of anal warts or anal precancer: men and women with anal warts or anal precancer are at increased risk of developing anal cancer because this history indicates an HPV infection. If the infection is persistent with recurrent lesions, it can lead to changes in the anal cells, which may eventually become cancer if left untreated.
- History of other HPV-related cancer:women with a history of cervical, vulvar or vaginal cancer are at risk of developing anal cancer because these cancers are also caused by HPV, and the immune system has demonstrated difficulty in fighting the virus.
Find out more about HPV and preventing the infection with vaccination.
IMMUNOSUPPRESSION
Having a weakened immune system can make the body more susceptible to developing an infection. This is also true for HPV, which can more easily develop into a persistent infection in these individuals. Individuals at increased risk of developing anal cancer include:
- HIV-positive men and women.
- Individuals with autoimmune disorders.
- Transplant recipients and other individuals on immunosuppressive drugs.
I contacted a leading doctor in the anal cancer field, who graciously spoke with me on the phone and explained his work with HPV and anal cancer. He said I likely had HPV since the ‘70’s, that had remained dormant for years, and that in the presence of severe immune suppression, probably had become carcinogenic.
SEXUAL ACTIVITY
Any sexual contact, including manual stimulation, has the ability to expose you to HPV. It’s important to reiterate that nearly all adults will have HPV at some point in their lifetime.
While increasing exposure will increase your chance of contracting HPV, even a person with only one lifetime partner can be infected with HPV. Having multiple sex partners can increase your chance of developing anal cancer because it can increase your chance of being exposed to a carcinogenic strain of HPV.
People who engage in anal sex are at a higher risk of developing anal cancer because they are at a higher risk of skin-to-skin contact in the anal region and contracting an anal HPV infection. Because HPV is a skin virus that is transmitted very easily, anal intimacy is not necessary to contract anal HPV or to develop anal cancer.
In addition, men who are uncircumcised are at a higher risk of developing a persistent HPV infection.
Condom use is always recommended to prevent contracting an STD. However, condom use is not completely effective at preventing HPV transmission.
SMOKING
Smoking increases your chances of developing anal cancer as the carcinogens (cancer-causing chemicals) in tobacco can affect the entire body. There is evidence that smoking may decrease the immune system’s ability to fight HPV infection. Studies have also shown that current smokers are at a higher risk of developing anal cancer than former smokers and those who have never smoked at all.
For help quitting smoking:
US – For help quitting visit the CDC website on smoking cessation
UK – For help quitting visit the NHS website on smoking cessation
OLDER AGE
Most cases of anal cancer are diagnosed when an individual is older than 50 years old. This is because HPV takes time to alter the cells to develop into cancer. However, there are cases of people in their 20s and 30s developing anal cancer.
If you think you are at risk of anal cancer, or are concerned you may have symptoms, see a provider to answer your questions.
Anal Cancer Diagnosis
If you have symptoms or signs, the following tests may be used to diagnose anal cancer:
Digital Anal Rectal Examination ‘DARE’
A doctor places his or her fingers inside the anal canal to feel for abnormalities. The purpose of this test is to look for abnormal masses or growths, so if you think you may have precancer, request this additional testing.
Blood test
This is to check your level of red blood cells. The tests also check how well your liver and kidneys are working.
Your GP can refer you to a hospital specialist. This is usually either a surgeon or a specialist in bowel conditions (gastroenterologist). Tests at the hospital could include:
Anal Pap test/biopsy
Similar to a routine cervical pap test and involves sampling cells inside the anus to detect changes and abnormalities.
Anoscopy: a tube called an anoscope is placed inside the anus and a strong light illuminates the tissue.
High-resolution anoscopy or HRA
a more advanced ansocope with a high-resolution magnifying glass is used to examine and evaluate the tissue in the anus. This is the most precise examination for anal cancer and precancer.
If your biopsy results show anal cancer, it is likely you will have imaging tests in order to learn more information about the tumour, its size, and location. These tests could include:
CT Scan
A CT scan is a test that takes detailed cross-sectional pictures of the inside of your body. It can help detect if the cancer has spread (metastasised)
MRI
Magnetic resonance imaging (MRI) is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body. It’s sometimes used to detect if nearby lymph nodes are enlarged, or if there are abnormalities in the liver, brain, or spinal cord. This could indicate cancer spread.
Fine needle aspiration (FNA) of the lymph nodes
Fine-needle aspiration is a minimally invasive way to obtain a cell sample to confirm if the cancer has spread there.
PET-CT scan
Positron emission tomography (PET) scans produce detailed 3-dimensional images of the inside of the body. They may be combined with a CT scan to produce more detailed images.
PET/CT scans can be used:
- To determine location of cancer spread, if it is suspected.
- In staging anal cancer when you are initially diagnosed.
ANAL CANCER TREATMENT
Treatment options for anal cancer vary depending on stage and type. The three treatment options for anal cancer include chemotherapy, radiation and surgery.
chemotherapy
Chemotherapies are a class of drugs that kill cancer cells and prevent them from multiplying.
Learn more about chemotherapy treatment for anal cancer.
radiation
Radiation for anal cancer involves using an external beam of radiation that is directed towards the location of the cancer to shrink tumours and kill cancer cells.
Learn more about radiation treatment for anal cancer.
surgery
Surgery can be used for early-stage anal cancer when the tumor is extremely small and localised.
Learn more about surgery for anal cancer.
Nigro Protocol
Nigro Protocol consists of radiation therapy combined with 5-FU and mitomycin-C. It is the standard first step of treatment for most people diagnosed with anal cancer in stages I through III
Learn more about the nigro protocol.
Anal Cancer Prevention
Anal cancer is not completely preventable but the following measures can affect your risk including:
- HPV infection
- HIV
- Certain studies indicate that the risk of anal cancer is higher for women who have had cervical, vaginal or vulval cancer.
- Age/Gender
- Smoking
Learn more about anal cancer risk factors & prevention.
Anal Cancer Screening
Routine screening guidelines for anal cancer or precancer have yet to be universally adopted because there have not yet been enough studies for the government and medical communities to recommend routine screening
If you think you may have AIN or are at risk, it is suggested that you have a clinician screen you.
Screening involves visual inspection. However, appropriate and accurate screening should also include additional methods, as a visual check alone can fail to diagnose AIN that is inside the anal canal and any subtle changes. Additional screening options include:
- Digital ano-rectal exams or ‘DARE’
- An anal pap test
- Anoscopy
- High-resolution anoscopy or HRA: a more advanced ansocope with a high-resolution magnifying glass is used
Learn more about anal cancer pre-cancer and screening.
Prognosis for Anal Cancer
The prognosis for anal cancer varies depending on several factors, including the stage at which it is diagnosed, the individual’s overall health, and the treatment approach used. With advancements in medical care, the outlook for anal cancer has improved significantly, especially when detected early.
Factors Influencing Prognosis
- Stage at Diagnosis: Early-stage anal cancer (Stage I or II) typically has a more favorable prognosis, with higher survival rates, as the cancer is localized and easier to treat effectively. Advanced stages (Stage III or IV), where the cancer has spread to nearby lymph nodes or distant organs, can be more challenging to treat but may still respond well to newer therapies.
- Type of Cancer: Squamous cell carcinoma, the most common type of anal cancer, often responds well to treatment, particularly chemoradiation.
- Treatment Response: The success of initial treatments such as chemotherapy, radiation, or surgery plays a crucial role in determining long-term outcomes.
Survival Rates
Survival rates are often used to estimate prognosis. According to recent data:
- Localized anal cancer has a five-year survival rate of about 85%, meaning the majority of individuals live at least five years after diagnosis.
- Cancer that has spread regionally, such as to nearby lymph nodes, has a five-year survival rate of approximately 60-65%.
- Distant metastases, or cancer that has spread to other parts of the body, have a lower survival rate, around 30%.
- It’s important to note that these figures are general estimates and do not account for individual variations in health, response to treatment, or access to care.
Advances in Treatment
The emergence of immunotherapy and targeted therapies has brought hope for patients with advanced or recurrent anal cancer. These innovative treatments can significantly improve outcomes for individuals who may not respond well to traditional methods.
The Importance of Early Detection
Early detection remains one of the most important factors in improving prognosis. Regular check-ups, prompt attention to symptoms, and open communication with healthcare providers can lead to earlier diagnoses and better outcomes.
Anal Precancer
Anal precancer is a growth and/or changes in the skin cells in the anal region. The existence of a ‘precancerous’ condition is not a cancer diagnosis, which is very important to remember. Precancerous conditions are very important precursors to cancer, however, and must be monitored, and treated if appropriate, to reduce the risk of them developing into cancer.
Learn more about anal precancer.
AFTERCARE
Utilize yearly examinations, annual check-ups, or other medical visits as occasions to talk to your provider about screening, and as opportunities for them to screen for anal cancer. Individuals with anal cancer risk factors should discuss screening with their providers. See our screening section for more information on options. If you think something is wrong, and you feel your doctor is not appropriately addressing your concerns, seek a second opinion.
Some doctors may misdiagnose anal cancer for hemorrhoids. If your hemorrhoids persist and do not disappear after treatment, speak to your doctor about a more detailed examination or ask for a referral to a specialist.
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FAQs
How do I find a provider who screens for anal precancer?
Finding a provider who knows how to screen for anal precancer is a great step to learning more about your anal health. Locate a provider near you.
What is HPV and what role does it play in anal cancer?
HPV (Human Papillomavirus) is a skin virus that is transmitted through intimate contact. HPV can be either low-risk or high-risk. High-risk strains may result in 6 different HPV-related cancers including anal cancer. Learn more about HPV and HPV-related cancers.
Can anal cancer be cured?
Yes, anal cancer can be treated and, in many cases, cured. The chances of successful treatment depend on various factors such as the stage of the cancer, the overall health of the patient, and the specific treatment approach used. Treatment for anal cancer often involves a combination of therapies, which may include surgery, radiation therapy, and chemotherapy.
Surgery: In the early stages of anal cancer, surgery can be an effective option. The surgeon may remove the tumor and nearby lymph nodes to ensure that the cancer has not spread.
Radiation Therapy: This involves using high-energy rays to target and kill cancer cells. It’s often used alongside surgery or as the primary treatment for more advanced cases.
Chemotherapy: Chemotherapy involves using drugs to kill or control cancer cells. It can be used in combination with radiation therapy or surgery.
Targeted Therapy: This is a more recent approach that targets specific molecules involved in the growth and spread of cancer cells. It’s not always used for anal cancer but may be considered in certain cases.
The prognosis for anal cancer has improved over the years, especially with advances in treatment options. Early detection and timely treatment are crucial factors for successful outcomes. Regular screenings and check-ups can help catch anal cancer at an earlier stage, when it’s more treatable.
It’s important to note that like any cancer, the success of treatment and the possibility of cure can vary depending on the individual case. It’s recommended to work closely with a medical team to determine the best treatment plan based on the specific circumstances.
What does anal cancer look like?
What does anal cancer look like?
Anal cancer can appear in different ways, and its appearance can vary depending on the stage of the cancer and other factors. It’s important to note that I’m not a medical professional, but I can provide you with some general information about the possible appearances of anal cancer:
Early Stages: In the early stages, anal cancer might not cause noticeable symptoms. However, as the cancer progresses, you might observe changes such as:
Anal Bleeding: This is a common symptom of anal cancer. Blood might be visible on toilet paper or in the toilet bowl after a bowel movement.
Pain or Discomfort: Some individuals might experience pain, itching, or discomfort in the anal area.
Changes in Bowel Habits: You might notice changes in your bowel habits, such as diarrhea, constipation, or a feeling of incomplete bowel movements.
Visible Lesions: As anal cancer advances, it can lead to the formation of visible lesions around the anal area. These can vary in appearance but might include:
Raised Bumps or Growths: These could be pink or reddish and might resemble small, raised bumps or lumps.
Ulcerations: Cancerous ulcers might appear as open sores that don’t heal or that keep recurring. They can be painful and might bleed.
Discoloration: The affected area might appear darker or redder than the surrounding skin.
Lumps or Masses: In some cases, you might feel a lump or mass around the anus or in the anal canal. This could be a sign of a more advanced stage of anal cancer.
Remember, these symptoms and visual cues can also be indicative of other conditions, such as hemorrhoids or infections. If you notice any changes in your anal area, it’s important to consult a healthcare professional for an accurate diagnosis. Early detection and treatment can significantly improve the outcomes for anal cancer. If you’re concerned about any symptoms, it’s recommended to seek medical advice promptly.
How do you know if you have anal cancer?
If you suspect you might have anal cancer or are experiencing concerning symptoms, it’s important to consult a healthcare professional for proper evaluation and diagnosis. Here are some steps to consider:
Recognize Symptoms: Be aware of potential symptoms associated with anal cancer, such as anal bleeding, pain or discomfort in the anal area, changes in bowel habits, the presence of lumps or masses, and persistent itching. While these symptoms can indicate various conditions, they should be discussed with a doctor.
Medical Evaluation: If you’re experiencing any concerning symptoms, it’s recommended to schedule an appointment with a healthcare provider. They will ask you about your symptoms, medical history, and conduct a physical examination.
Screening and Testing: Depending on your symptoms and medical history, your doctor might recommend certain tests to evaluate your condition. These could include:
Digital Rectal Exam: This involves the doctor using a gloved finger to examine the rectum and anus for abnormalities.
Anoscopy: A procedure in which a thin, flexible tube with a light and camera (anoscope) is inserted into the anus to examine the anal canal.
Biopsy: If suspicious areas are found during an examination, a biopsy might be performed. A small tissue sample is taken from the suspicious area and examined under a microscope to determine if cancer is present.
Imaging Tests: In some cases, imaging tests like CT scans, MRI, or PET scans might be recommended to determine the extent of the cancer and if it has spread to other areas.
Consult a Specialist: If anal cancer is suspected or diagnosed, you may be referred to a specialist, such as a colorectal surgeon or an oncologist, who can provide specialized care and treatment recommendations.
Remember that many symptoms associated with anal cancer can also be caused by other conditions, such as hemorrhoids or infections. Only a healthcare professional can provide an accurate diagnosis. If you have concerns about your health, it’s best to seek medical attention to receive proper guidance and care. Early detection and treatment can lead to better outcomes for anal cancer and other medical conditions.
Is anal cancer rare?
Anal cancer is considered relatively rare compared to some other types of cancer, but its incidence has been increasing over the past few decades. It is still an important health concern that requires attention and awareness. The exact prevalence and incidence of anal cancer can vary by region and population. Here are a few key points to consider:
Incidence: The incidence of anal cancer is relatively low compared to more common cancers like breast, lung, or colon cancer. However, its occurrence has been rising, particularly among certain populations, including men who have sex with men and individuals with weakened immune systems.
Risk Factors: Several risk factors contribute to the development of anal cancer. These include infection with high-risk strains of human papillomavirus (HPV), a history of receptive anal intercourse, smoking, a weakened immune system (such as due to HIV infection), and certain pre-existing conditions like anal intraepithelial neoplasia (AIN).
Screening and Prevention: Routine screening for anal cancer is not as established as screenings for some other cancers. However, some healthcare providers might recommend anal cancer screening for high-risk individuals, especially those with a history of HPV infection, HIV, or other risk factors. HPV vaccination can also help prevent some of the HPV-related cancers, including anal cancer.
Importance of Awareness: Due to the potential for increased risk among specific populations, raising awareness about anal cancer, its risk factors, and the importance of early detection is crucial. Recognizing symptoms and seeking medical attention if concerning symptoms arise can lead to earlier diagnosis and better outcomes.
Treatment and Prognosis: As mentioned earlier, anal cancer is treatable, especially when detected in its early stages. Advances in treatment options have improved survival rates and quality of life for individuals with anal cancer.
While anal cancer may be less common than some other cancers, it’s important for individuals to be aware of potential risk factors, symptoms, and the importance of regular healthcare check-ups. If you have concerns about your health or potential risk factors, it’s advisable to discuss them with a healthcare professional.
How common is anal cancer?
In the United States, an estimated 11,270 people will be diagnosed with anal cancer in 2026, according to the National Cancer Institute. It accounts for about 0.5% of new cancer diagnoses.
In US data from 2019 to 2023, the median age at diagnosis was 65, meaning about half were younger and half were older. Diagnoses were most common between ages 65 and 74. Anal cancer can also affect younger adults. It is more common in women than men in the US, and rates vary by country and population.
Here are some general points to consider regarding the prevalence of anal cancer:
Global Incidence: The global incidence of anal cancer is estimated to be around 1 to 2 cases per 100,000 people per year. This makes it one of the less common cancers.
Population Variation: The incidence of anal cancer can vary significantly among different populations. Certain groups, such as men who have sex with men (MSM) and individuals with compromised immune systems (such as those with HIV/AIDS), have a higher risk of developing anal cancer.
HPV-Related Cases: A significant portion of anal cancers are caused by high-risk strains of the human papillomavirus (HPV), the same virus responsible for many cases of cervical cancer. The prevalence of HPV-related anal cancers has contributed to the increased attention and awareness around the disease.
Gender Distribution: Anal cancer can affect both men and women, but some studies suggest that it is slightly more common in women.
Age Distribution: Anal cancer can occur at any age, but it is most commonly diagnosed in people between the ages of 50 and 60.
Geographic Variation: The incidence of anal cancer can also vary by geographic region. Developed countries with better access to healthcare and screening may have higher reported rates.
Please note that these statistics are based on information available up to September 2021, and the situation may have evolved since then. If you’re looking for the most current and accurate information about the prevalence of anal cancer, I recommend consulting reputable health organizations or medical databases. If you have concerns about your health or potential risk factors, it’s advisable to discuss them with a healthcare professional.
Does anal cancer itch?
Yes, itching around the anal area can be a symptom of anal cancer, although it’s important to note that itching can also be caused by various other conditions, such as hemorrhoids, anal fissures, infections, or skin conditions. If you’re experiencing persistent itching around the anal region, it’s recommended to consult a healthcare professional for proper evaluation and diagnosis.
Anal cancer can cause irritation and discomfort in the anal area, which might manifest as itching. However, itching alone is not a definitive sign of anal cancer and can have multiple potential causes. Other accompanying symptoms, such as bleeding, pain, changes in bowel habits, or the presence of lumps or masses, should also be taken into consideration when determining the cause of the itching.
Because anal itching can be caused by different factors, seeking medical advice is crucial to determine the underlying cause and receive appropriate treatment. If you’re concerned about any symptoms or changes in your health, it’s best to consult a healthcare provider for accurate diagnosis and guidance.
My loved one has been diagnosed with anal cancer. How do I help?
Going through an anal cancer diagnosis with a loved one can be very difficult and you may not know where to start. We have a wide range of support resources for caregivers to help you during this time.
How do I find support?
It may be difficult to locate the necessary information and resources needed to go through an anal cancer diagnosis and treatment. Anal Cancer Foundation provides resources like our Peer to Peer Support Program and links to other helpful programs to help you navigate your diagnosis and treatments.
More links and information on anal cancer
- For the Newly Diagnosed
- Living with the Side Effects of Anal Cancer Treatment
- Recurrent and Advanced Anal Cancer
- Questions to Ask Your Doctor
- Facing an Anal Cancer Diagnosis
- Anal Precancer
- Prevention
The information is presented as downloadable documents that you may add to your library of resources.
Anal Cancer: The Facts
Information on anal cancer, testing, and treatment.
Anal Cancer: Questions to Ask Your Doctor
Knowing the right questions to ask your doctor after a diagnosis can be tricky. The questions outlined in this document will help you develop a list of your own questions to better inform your anal cancer experience.
We’re here to empower thrivers and the anal cancer community. But we can’t do it without your support.
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