The most common initial symptoms of anal cancer are anal pain and bleeding. However, many people don’t experience any symptoms until the cancer has spread to other parts of the body.

Anal cancer makes up roughly 2.5% of cancers of the digestive tract in the United States. It develops in your anal canal at the end of your digestive tract where your stool leaves your body.

Some people with anal cancer don’t have any early symptoms and don’t develop problems until the cancer spreads to other body parts. When symptoms do appear, they can mimic those of other conditions like hemorrhoids. Anal pain and bleeding are among the most common early symptoms.

In this article, we cover the early signs and symptoms of anal cancer as well as risk factors and treatment options.

According to the American Society of Colon & Rectal Surgeons, up to 20% of people with anal cancer don’t have symptoms. When symptoms do appear, they can be similar to those of anal fissures or hemorrhoids.

The most common initial symptoms of anal cancer are anal pain and bleeding. These are the first symptoms in more than 50% of people with anal cancer.

Other early symptoms can include:

Is it hemorrhoids or anal cancer?

Hemorrhoids are much more common than anal cancer. It’s estimated about 75% of people in the United States will experience hemorrhoidal symptoms at some point in their life. They’re caused by swollen veins inside your rectum that can become irritated and bleed.

Hemorrhoids can be painful or not. Both hemorrhoids and anal cancer can lead to a mass at the anal opening.

It’s often impossible to tell apart anal cancer or hemorrhoids without visiting a doctor. A doctor can usually feel hemorrhoids with a digital examination where they insert a gloved finger into your rectum. However, an anoscopy is the best way to see and diagnose hemorrhoids and anal cancer.

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Anal cancer is strongly linked to infection with human papillomavirus (HPV), the most common sexually transmitted infection (STI) in the United States. More than 90% of cases of anal cancer are associated with HPV.

Other risk factors for anal cancer include:

Many people with anal cancer delay seeing their doctor either out of embarrassment or because they assume that their symptoms are caused by something less serious. More than half of cases of anal cancer are delayed or misdiagnosed.

Getting a diagnosis as soon as possible is critical. Doctors start the diagnostic process for anal cancer by reviewing your personal and family medical history and performing a physical exam.

Your physical exam will likely include a digital rectal exam where your doctor inserts a lubricated gloved finger into your anus and rectum to feel for abnormalities. People assigned female at birth may also receive a pelvic exam and Pap test.

If your doctor finds abnormal areas, they may order other tests, such as:

  • Anoscopy: A short tube about 3 to 4 inches long with a light is inserted into your anus.
  • Rigid proctosigmoidoscopy: A tube that’s about 10 inches long is inserted into your anus to visualize your anus, rectum, and lower colon.
  • Flexible sigmoidoscopy. This procedure lets a doctor see inside your sigmoid colon using a flexible tube with a light on the end.
  • Endoscopy: A tube with a light and camera is inserted into your anus to allow your doctor to see your anus, rectum, and entire colon. Your doctor can use an endoscope to take a biopsy.
  • Biopsy: A biopsy is the main test used to help diagnose anal cancer. A biopsy is a small tissue sample that’s analyzed in a lab for cancer cells.
  • Imaging: Imaging can help identify cancer, see how far it’s spread, or help doctors understand if treatment is working. You may receive:
  • Blood tests: A blood test can identify HIV cases and measure your organ function.

Anal cancer is usually treated with some combination of:

Researchers are also investigating the following in clinical trials:

  • radiosensitizers, chemicals that enhance the effect of radiation therapy
  • immunotherapy, drugs that boost your immune system’s ability to kill cancer cells

Is anal cancer curable?

Anal cancer is often curable when it’s caught in the early stages. People with stage I anal cancer live at least 5 years about 82% as often as somebody in the general population. Doctors often consider your cancer cured if there are no signs of the disease for 5 years.

Stage IV anal cancer can be very challenging to cure, and treatment usually focuses on minimizing your symptoms and improving your quality of life. People in this stage live at least 5 years about 35% as often as people without anal cancer.

Learn more about the stages of anal cancer.

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The most common initial symptoms of anal cancer are anal bleeding and pain. Some people don’t develop any symptoms until their cancer spreads to other body parts.

Many people delay seeing their doctor when they have anal cancer symptoms either out of embarrassment or because they assume their symptoms are caused by something less serious.

It’s essential to see your doctor anytime you develop anal cancer symptoms to receive a diagnosis as quickly as possible.