Practical points

♦ Rectal bleeding and anal pain are common—a high degree of suspicion is required to diagnose anal cancer correctly.

♦ Multifocal anal and genital disease may co-exist—be sure to examine the anal and genital areas.

♦ Examination under anaesthetic is essential for adequate staging and also permits a generous biopsy.

♦ Biopsy or needle aspiration of enlarged inguinal lymph nodes is essential prior to treatment.

♦ Local excision may be appropriate for small anal margin cancers.

♦ Chemo-irradiation is the treatment of choice for most anal squa-mous carcinomas.

1. Nigro, N.D., Vaitkevicius, V.K., Considine, B. (1974) Combined therapy for cancer of the anal canal. Diseases of the colon and rectum 27, 763-6.

2. Arnott, S.J., Cunningham, D., Gamacher, J., et al. (1996) Epidermoid anal cancer: Results from the UKCCCR randomized trial of radiotherapy alone versus radiotherapy, 5-fluorouracil and mitomycin. Lancet 348,1049-54.

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