Diagnosis
Anal cancer often develops slowly over many years from HPV‑related precancerous changes. Tests and procedures used to diagnose anal cancer include:
Digital rectal exam. During a digital rectal exam, a healthcare professional inserts a gloved finger, coated with a water-based jelly, into the anus. The health professional feels the anal canal and rectum for growths or other signs of cancer.
Anoscopy. During an anoscopy, a healthcare professional inserts a thin, flexible tube with a light through the anal canal and rectum. This tube is called an anoscope. A lens on the anoscope allows a healthcare professional to examine the inside of the anal canal.
Imaging tests. Imaging tests make pictures of the body. They can show the location and size of the cancer. Tests might include ultrasound, X-ray, MRI, CT scan and positron emission tomography scan, which also is called a PET scan.
Biopsy. A biopsy is a procedure to remove a sample of tissue for testing in a lab. The sample is often collected during an anoscopy. Special tools can go through the anoscope to collect the cells. The sample is tested in a lab to see if it is cancer. Other special tests give more details about the cancer cells. Your healthcare team uses this information to make a treatment plan.
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Treatment
Anal cancer treatment often starts with chemotherapy and radiation therapy. Sometimes surgery is used to remove cancer. When the cancer spreads to other parts of the body, different treatments might be used. These might include chemotherapy on its own and immunotherapy. The treatment that's best for you depends on several factors. These include the stage of your cancer, your overall health and your own preferences.
Combined chemotherapy and radiation
Anal cancer is usually treated with a combination of chemotherapy and radiation. Together, these two treatments enhance each other to kill cancer cells.
- Chemotherapy. Chemotherapy treats cancer with strong medicines. Treatment often involves a combination of chemotherapy medicines. Some are injected into a vein and others come in pill form.
- Radiation therapy. Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, a machine directs beams of energy to specific points on the body to kill the cancer cells there.
Radiation is typically given daily over several weeks. How often you receive chemotherapy treatments over those weeks will depend on what medicines your healthcare team chooses. Your care team tailors your treatment schedule based on characteristics of your cancer and your overall health.
Surgery
Surgery might be used to treat anal cancer in certain situations. Operations might include:
- Surgery for cancer that hasn't responded to other treatments. If the cancer remains after chemotherapy and radiation, your doctor may recommend abdominoperineal resection (APR). During APR, the surgeon removes the anal canal, rectum and part of the colon. The surgeon then attaches the remaining part of your colon to an opening in your abdomen called a stoma. Waste leaves the body through the stoma and collects in a colostomy bag.
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Surgery for very small anal cancers. Though it's very uncommon, some very small anal cancers are treated with surgery alone. The surgeon removes the cancer and some of the healthy tissue around it. This ensures that all the cancer cells are removed.
This might be an option only if the cancer is very small and the surgery won't hurt the muscles that surround the anal canal. These muscles, called anal sphincter muscles, control bowel movements.
Depending on your type of anal cancer, chemotherapy and radiation after surgery also may be recommended.
Treatments for cancer that has spread
If anal cancer spreads to other parts of the body, other treatments might be used. Chemotherapy and immunotherapy medicines may be used at the same time or separately to treat advanced anal cancer.
- Chemotherapy. Chemotherapy medicines can control the growth of cancer cells throughout the body.
- Immunotherapy. Immunotherapy is a treatment with medicine that helps the immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body, such as cancer cells. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. There are several immunotherapy medicines used to treat anal cancer that spreads. Treatment usually starts with retifanlimab (Zynyz) combined with chemotherapy medicines.
Palliative care
Palliative care is a special type of care to help you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A team that may include doctors, nurses and other specially trained health professionals provides palliative care. The team's goal is to improve quality of life for you and your family.
Palliative care specialists work with you, your family and your care team. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time you're getting strong cancer treatments, such as surgery, chemotherapy or radiation therapy.
The use of palliative care with all the other appropriate treatments can help people with cancer feel better and perhaps live longer.
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Alternative medicine
Alternative medicine treatments won't kill cancer cells. But some alternative medicine treatments may help you cope with the side effects of cancer treatment, such as fatigue. Your healthcare team can treat many side effects, but sometimes medicines aren't enough. Alternative treatments may offer additional comfort and help with stress.
Speak with your healthcare team about:
Gentle exercise
If you get the OK from your healthcare team, start with gentle exercise. Add more exercise as you feel up to it. Consider walking, swimming, yoga and tai chi.
Managing stress
Try stress relief techniques such as muscle relaxation or visualization. Writing in a journal also may help.
Massage therapy
During a massage, a massage therapist applies pressure to your skin and muscles. Some massage therapists are specially trained to work with people who have cancer. Ask your healthcare team for names of massage therapists in your community.
Acupuncture
During an acupuncture session, a trained acupuncturist inserts thin needles into precise points on your body. Some acupuncturists are specially trained to work with people with cancer. Ask your healthcare team to recommend an acupuncturist at Mayo Clinic or within your community.
Coping and support
People facing a serious illness often say they feel worried about the future. With time, these strategies may help you find comfort:
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Ask questions about anal cancer. Write down questions you have about your cancer. Ask these questions at your next appointment. Also ask your healthcare team for reliable sources where you can get more information.
Knowing more about your cancer and your treatment options may make it easier to make decisions about your care.
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Stay connected to friends and family. Keeping in touch with friends and family may give comfort during a time that is difficult for everyone.
Your friends and family will likely ask if there's anything they can do to help you, so think of tasks you might like help with. For example, you may ask a friend to be there for you when you want to talk. You may ask for help caring for your home if you must stay in the hospital.
You may find comfort in the support of a caring group of your friends and family.
- Find someone to talk with. Find someone you can talk to who has experience helping people facing a life-threatening illness. Ask your healthcare team to suggest a counselor, clergy member or medical social worker you can talk with. For support groups, contact the American Cancer Society or ask your healthcare team about local or online groups.
Preparing for your appointment
Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.
If your health professional thinks you have anal cancer, you may be referred to a specialist. Often this is a surgeon or doctor who treats digestive diseases, called a gastroenterologist. You also may be referred to a doctor who specializes in treating cancer, called an oncologist.
Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance. For example, you might need to limit what you eat.
- Write down symptoms you're experiencing, including any that may not seem related to the reason for which you scheduled the appointment.
- Write down key personal information, including major stresses or recent life changes.
- Make a list of all medicines, vitamins or supplements you're taking and the doses.
- Take a family member or friend along. Sometimes it can be difficult to remember all the information given during an appointment. Someone who comes with you may remember something that you missed or forgot.
- Write down questions to ask your healthcare team.
Your time with your healthcare team is limited. Prepare by making a list of questions. List your questions from most important to least important in case there isn't enough time. For anal cancer, some basic questions to ask include:
- What is the stage of my cancer?
- What other tests do I need?
- What are my treatment options?
- Is there one treatment that's best for my type and stage of cancer?
- What are the potential side effects for each treatment?
- Should I seek a second opinion? Can you give me names of specialists you recommend?
- Am I eligible for clinical trials?
- Are there brochures or other printed material that I can take with me? What websites do you recommend?
- What will determine whether I should plan for a follow-up visit?
What to expect from your doctor
Be prepared to answer questions about your symptoms and your health, such as:
- When did you begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
Feb. 03, 2026