This map explains anal cancer step by step: what it is, the types, the tests, the stages, the treatment and its side effects.
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Why this matters: the common type is cured with chemoradiotherapy without major surgery; the less common types are treated differently.
About 85 out of 100 anal cancers. Very sensitive to chemoradiotherapy. This map is mainly about this type.
Rare. Treated like rectal cancer. Colon and rectal cancer
Small tumours of the skin at the anal margin can be removed with surgery alone. Anal melanoma is rare and treated like melanoma. Skin cancers
Tap a test on the map to see why it is done.
Please wait for all the reports. Why we wait
Examination of the anus and back passage, often under anaesthesia, with a biopsy. The groins are examined for lymph nodes.
Shows the size of the tumour, its relation to the sphincter muscles and nearby organs, and the pelvic lymph nodes.
Checks the lymph nodes, including in the groin, and other organs. Helps plan the radiotherapy area.
Advised for every patient. If positive, HIV treatment is continued alongside cancer treatment, and outcomes are good.
Radiotherapy to the pelvis affects fertility. Ask about sperm or egg storage before treatment.
Before starting chemotherapy, immunotherapy or targeted therapy, these tests check that you are fit for treatment, and give a starting point to compare with later.
| Test | Why it is done |
|---|---|
| CBC (complete blood count) | Haemoglobin, white cells and platelets. Treatment can lower them. |
| RFT (kidney function) | Many medicines are cleared by the kidneys; the dose may need to change. |
| LFT (liver function) | Many medicines are processed by the liver. |
| Viral markers: HBsAg, anti-HCV, HIV | Hepatitis B can flare up during treatment. If positive, a tablet is given to prevent this. |
| Blood sugar (and HbA1c if diabetic) | Steroids given with chemotherapy can raise blood sugar. |
| ECG and 2D Echo | Check the heart rhythm and pumping before treatment, as some medicines affect the heart. |
Before immunotherapy, also:
| Test | Why it is done |
|---|---|
| Serum TSH (thyroid) | Immunotherapy can affect the thyroid gland. |
| Serum cortisol (morning sample) | Immunotherapy can affect the adrenal and pituitary glands. |
Sometimes needed, depending on your treatment:
Your doctor will choose the tests that apply to you. Some of them are repeated during treatment.
Tap your stage on the map.
Tumour up to 2 cm, no lymph nodes. The aim is cure.
Tumour larger than 2 cm, no lymph nodes. The aim is cure.
Spread to lymph nodes in the pelvis or groin, or grown into nearby organs such as the vagina, urethra or bladder. The aim is still cure.
Spread to distant organs such as the liver or lungs. Treatment aims to control it.
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Side effects: chemoradiotherapy
Side effects: chemotherapy · immunotherapy
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Fever of 38°C or more, severe pain or bleeding, inability to pass urine, more than 4 to 6 loose stools a day with dizziness, or a stoma that stops working need urgent care.
This information is general. Your own treatment plan may be different. Please discuss it with your doctor.
Written and medically reviewed by Dr Prathyusha Eaga, MD, DM (Medical Oncology). Last reviewed: 12 October 2026. Based on NCCN and ESMO guidelines.
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