Anal cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up.

Small, early cancers are sometimes diagnosed serendipitously following the removal of anal tags. More advanced lesions present as a mass, non-healing ulcers, pain, rectal bleeding, itching, discharge and faecal incontinence. A relevant history to elicit symptoms and predisposing factors should be documented. Proctoscopy and examination under anaesthesia facilitates biopsy. Diagnosis requires histological confirmation.