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Anal Cancer

Anal cancer is a disease in which malignant (cancer) cells form in the tissues of the anus.
The anus is the end of the large intestine, below the rectum, through which stool (solid waste) leaves the body. The anus is formed partly from the outer, skin layers of the body and partly from the intestine. Two ring-like muscles, called sphincter muscles, open and close the anal opening to let stool pass out of the body. The anal canal, the part of the anus between the rectum and the anal opening, is about 1½ inches long.

Anatomy of the lower digestive system, showing the colon and other organs.

The skin around the outside of the anus is called the perianal area. Tumors in this area are skin tumors, not analcancer.

Being infected with the human papillomavirus (HPV) can affect the risk of developing anal cancer.

Stages of Anal Cancer

  • Stage 0 : - anal cancer is very early cancer. The cancer is found only in the top layer of anal tissue.
  • Stage I : - The cancer has spread beyond the top layer of anal tissue, is smaller than 2 centimeters in diameter. It has not spread to the muscle tissue of the sphincter.
  • Stage II : - Cancer has spread beyond the top layer of anal tissue and is larger than 2 centimeters in diameter, but has not spread to nearby organs or lymph nodes (small, bean-shaped structures found throughout the body that produce and store infection-fighting cells).
  • Stage IIIA : - Cancer has spread to the lymph nodes around the rectum or to nearby organs such as the vagina or bladder.
  • Stage IIIB : - Cancer has spread to the lymph nodes in the middle of the abdomen or in the groin, or the cancer has spread to both nearby organs and the lymph nodes around the rectum.
  • Stage IV : - Cancer has spread to distant lymph nodes within the abdomen or to organs in other parts of the body.
  • Recurrent : - Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the anus or in another part of the body.

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Types of anal cancer

Squamous cell cancer

About 9 out of 10 (90%) anal cancers are squamous cell cancers, sometimes called epidermoid cancers.

There are 3 types of squamous cell anal cancer
  • Large cell keratinising
  • Large cell non keratinising (also called transitional)
  • Basaloid
Non keratinising and basaloid cancers are sometimes grouped together as ‘cloacogenic’ anal cancer. A keratinising cancer has keratin (the protein that forms your hair and nails) in the cancer cells. This type of anal cancer starts in the transitional zone of the anal canal, where the squamous cells meet the glandular cells. All the squamous cell types of anal cancer are treated in the same way.

Non epidermoid cancer

The other 1 out of 10 anal cancers (10%) are adenocarcinoma, small cell cancers, ' undifferentiated' cancers (known as basaloid cancers) and melanomas. This group is known as non-epidermoid cancers. They behave differently to squamous cell anal cancers, so the treatment is different.

Cancers that start at the anal margin, usually look more like normal cells (they are ' well differentiated'). Anal margin tumours are more common in men than women. Cancers that start higher up in the anal canal are more common in women.


This is a rare type of anal cancer that affects the glandular cells that produce mucus in the anal canal. Only 5% of anal cancers are this type. This type of anal cancer is treated in the same way as rectal cancer.

Basal cell carcinoma

This is a type of skin cancer and it develops in the area around the anus. You can find information about treatment of basal cell cancers in the skin cancer section of CancerHelp UK.

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This is another type of skin cancer. These cancers develop from the cells that produce melanin, the pigment or colour for the skin. Treatment is the same as for other melanomas.

Risk Factors and Prevention

A risk factor is anything that increases a person’s chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health-care choices.

The following factors may raise a person’s risk of developing anal cancer : -

Human papillomavirus (HPV) infection. Research indicates that infection with this virus is a risk factor for anal cancer. HPV is most commonly passed from person to person during sexual activity. There are different types, or strains, of HPV, and some strains are more strongly associated with certain types of cancer. Learn more about HPV and cancer.

Age. Most people diagnosed with anal cancer are between age 50 and 80.

Frequent anal irritation. Frequent anal redness, swelling, and soreness may increase the risk of developing anal cancer.

Anal fistula. An anal fistula is an abnormal tunnel between the anal canal and the outer skin of the anus that often drains pus or liquid, which can soil or stain clothing. An anal fistula may irritate the outer tissues or cause discomfort. An anal fistula may increase the risk of developing anal cancer.

Cigarette smoking. Cigarettes can cause harm throughout the body, because chemicals from cigarettes can enter the bloodstream and affect nearly every organ and tissue in the body. Smokers are about eight times more likely to develop anal cancer than nonsmokers.

Lowered immunity. People with diseases or conditions affecting the immune system, such as HIV or organ transplantation, and people who take immunosuppressive drugs that make the immune system less able to fight disease, are more likely to develop anal cancer.

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Even though some people who have no risk factors develop anal cancer, there are ways to prevent or reduce your risk of developing anal cancer.
  • Avoid anal sexual intercourse, which carries an increased risk of HPV and HIV infection.
  • Limit the number of sex partners, because having many partners increases the risk of HPV and HIV infection.
  • Use a condom. However, even though condoms can protect against HIV, they cannot fully protect against HPV.
  • Stop smoking.
Anal cancer screening. Anal cytology is a test being developed that doctors can use for people who don’t have symptoms of anal cancer but do have a high risk of contracting a sexually transmitted disease (STD) such as HPV and HIV. The test is similar to a Pap test, which looks for cervical cancer, except this test looks for anal cancer.

Diagnosis of Anal Cancer

Possible signs of anal cancer include bleeding from the anus or rectum or a lump near the anus.

These and other symptoms may be caused by anal cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur: -
  • Bleeding from the anus or rectum.
  • Pain or pressure in the area around the anus.
  • Itching or discharge from the anus.
  • A lump near the anus.
  • A change in bowel habits.
Tests that examine the rectum and anus are used to detect (find) and diagnose anal cancer.

The following tests and procedures may be used: -
  • Physical exam and history: - An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
  • Digital rectal examination (DRE): - An exam of the anus and rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual.
  • Anoscopy: - An exam of the anus and lower rectum using a short, lighted tube called an anoscope.
  • Proctoscopy: - An exam of the rectum using a short, lighted tube called a proctoscope.
  • Endo-anal or endorectal ultrasound: - A procedure in which an ultrasound transducer (probe) is inserted into the anus or rectum and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
  • Biopsy: - The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If an abnormal area is seen during the anoscopy, a biopsy may be done at that time.

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