The short answer
NCI lists five anal cancer symptoms: bleeding, a lump near the anus, pain or pressure, itching or discharge, and a change in bowel habits. All five are far more often caused by hemorrhoids or fissures. NCI's PDQ summary names tumor size and node status as the only two major prognostic factors, with tumors under 2 cm carrying a better prognosis.
NCI's symptom page lists exactly five findings: bleeding from the anus or rectum, a lump near the anus, pain or pressure around the anus, itching or discharge, and a change in bowel habits.
NCI's PDQ summary names only two major prognostic factors — tumor size and node status — and says tumors smaller than 2 cm have a better prognosis.
PDQ says anal cancer is usually curable: fewer than 20% of patients have node-positive disease when first seen, and 5-year survival for early-stage disease exceeds 85%.
PDQ reports that 95% of anal cancers are HPV related, with serotypes 16 and 18 carrying the highest risk, and that risk is rising as HPV infection becomes more common.
On this page
Choose how you want to read this
The whole article, with every detail and caution.
This page is for anyone with a symptom near the anus who wonders whether it could be cancer. It covers the signs NCI lists, why tumor size matters, the outlook, and what happens after a diagnosis.
What NCI actually lists
NCI's anal cancer symptom page is short. It names five things and says each may be caused by anal cancer or by other conditions.
- Bleeding from the anus or rectum
- A lump near the anus
- Pain or pressure in the area around the anus
- Itching or discharge from the anus
- A change in bowel habits
That list is the whole list. Nothing on it is unique to cancer. Hemorrhoids, which are swollen veins around the anus, and anal fissures, which are small tears in the lining, produce the same complaints far more often.
One more finding that belongs on the list
NCI's PDQ summary for health professionals adds something the symptom page does not. Lymph drainage from the anus follows the inguinal vein, which runs toward the groin. PDQ says the first evaluation includes a careful exam of the groin. Any lymph node that can be felt gets a biopsy.
So a swollen groin node is not a symptom people are told to watch for, but it is something a clinician will deliberately check.
Why size matters more than almost anything else
PDQ names only two major prognostic factors for anal cancer: tumor size and node status. It says primary tumors smaller than 2 cm carry a better prognosis.
Those centimeters run straight through the staging tables. In the AJCC system PDQ reprints, T1 is a tumor 2 cm or smaller. T2 is larger than 2 cm and up to 5 cm. T3 is larger than 5 cm. T4 is any size that has invaded a neighboring organ such as the vagina, urethra, or bladder.
A delay is not an abstract risk. It is the difference between one line of that table and the next.
The outlook, in PDQ's own words
PDQ states that anal cancer is usually curable. The figures behind that sentence are worth reading carefully.
Fewer than 20% of patients have cancer in lymph nodes when first seen. For early-stage patients, PDQ puts 5-year survival above 85%.
Even with node-positive disease, PDQ says 5-year survival exceeds 50%, provided the cancer has not invaded adjacent organs or spread to distant sites.
Read together, those two facts explain why the awkwardness of the exam is a poor trade. The prognosis is good, and it is best when the tumor is small.
How common it is, and why it is rising
The American Cancer Society projects 11,270 new cases of anal, anal canal, and anorectal cancer for 2026, and 1,700 deaths. SEER Stat Facts carries that projection. That is uncommon next to breast, lung, or colorectal cancer.
But PDQ says the risk is rising, and it names the reason: more human papillomavirus (HPV) infection. It states that 95% of anal cancers are HPV related. Serotypes 16 and 18 carry the highest risk. Pathologists can tie HPV involvement to P16 staining on the tissue.
PDQ adds that people with HIV have a higher rate of HPV coinfection and, as a result, a higher risk of anal cancer. That link makes the virus worth reading about on its own. Prevention and symptom-checking are separate conversations.
What the pathology report will probably say
PDQ describes anal cancers that arise from squamous cells. It notes that tumors once called cloacogenic are now counted as nonkeratinizing squamous cell cancers, tied to HPV in the same way.
Location changes the label. PDQ calls lesions in the hair-bearing skin beyond the squamous mucocutaneous junction perianal cancers.
Two things sit outside this picture. Adenocarcinomas that start in anal glands or in a fistula are rare. PDQ says they behave more like rectal adenocarcinoma. Anal melanoma is not covered by this summary at all.
Which nodes count, and where
The N categories in the anal system are geographic. PDQ's tables define N1 as spread to inguinal, mesorectal, internal iliac, or external iliac nodes. N1a covers inguinal, mesorectal, or internal iliac nodes. N1b covers external iliac nodes. N1c covers external iliac nodes together with any N1a node.
Stage 0 sits apart from all of it. PDQ defines Tis as high-grade squamous intraepithelial lesion. That label replaced older ones, including carcinoma in situ and Bowen disease.
What follows a confirmed diagnosis
PDQ's treatment table is short enough to read in one pass:
- Stage 0: surgical resection for lesions not involving the anal sphincter.
- Stages I, II, and III: local resection, or external-beam radiation combined with chemotherapy, or alternative strategies, or radical resection.
- Stage IV: palliative surgery, palliative radiation, palliative chemotherapy with or without radiation, or checkpoint inhibitors. Palliative means aimed at easing symptoms.
Getting checked
There is no NCI-published waiting period after which a symptom becomes urgent. The symptom page simply says to check with your doctor about any of the five findings. Do not wait for a symptom to get worse. If bleeding is heavy or you feel faint, get urgent care right away.
Three things can be said without inventing a threshold:
- These symptoms overlap almost fully with common harmless conditions.
- The staging tables reward finding a tumor while it is under 2 cm.
A symptom that is not clearing with usual hemorrhoid care is worth a look, rather than another month of ointment.
Bleeding, lumps, itching, and changes in bowel habits are ordinary reasons for an appointment.
Where to read next
The disease as a whole is described in anal cancer. How the T and N categories combine into stages is covered in anal cancer stages. The virus behind 95% of these cancers is explained in HPV and cancer.
Sources
- NCI: anal cancer symptoms
- NCI PDQ: anal cancer, HP version
- SEER Stat Facts: anal cancer (2026 case and death projections from the American Cancer Society)
Common questions
What are the symptoms of anal cancer?
NCI lists five: bleeding from the anus or rectum, a lump near the anus, pain or pressure in the area around the anus, itching or discharge from the anus, and a change in bowel habits. NCI states these may be caused by anal cancer or by other conditions. NCI's PDQ summary for health professionals adds that lymph drainage from the anus follows the inguinal vein, so the initial evaluation includes a careful clinical examination of the groin with biopsy of any palpable node.
How can hemorrhoids be told apart from something more serious?
Not by how it feels. Hemorrhoids, which are swollen veins around the anus, and anal fissures, which are small tears in the lining, produce the same complaints far more often than cancer does. Only an examination distinguishes them. NCI's guidance on its symptom page is simply to check with a doctor about any of the five findings; it publishes no waiting period after which a symptom becomes urgent.
Why does finding it early matter so much here?
Because size is one of only two major prognostic factors PDQ names, and it runs straight through the staging tables. T1 is a tumor 2 cm or smaller, T2 is larger than 2 cm up to 5 cm, T3 is larger than 5 cm, and T4 is any size invading an adjacent organ such as the vagina, urethra, or bladder. PDQ says tumors smaller than 2 cm carry a better prognosis.
Is anal cancer common?
The American Cancer Society projection carried on SEER Stat Facts is 11,270 new cases of anal, anal canal, and anorectal cancer and 1,700 deaths in the United States during 2026 — uncommon next to breast, lung, or colorectal cancer. PDQ says the risk is rising because of increased HPV infection, and that people with HIV have a higher rate of HPV coinfection and therefore higher anal cancer risk.
What is the outlook?
PDQ states that anal cancer is usually curable. Fewer than 20% of patients have node-positive disease when first seen. For early-stage patients, 5-year survival exceeds 85%. Even with node-positive disease, 5-year survival exceeds 50% in the absence of invasion into adjacent organs or distant metastases.
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Last updated: 2026-10-02Next planned review: 2027-08-03
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Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes, and this is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and then compared with the sources listed on it, looking for statements those sources do not back up. That check is not a sentence-by-sentence record and can miss errors. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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