Anus

Anal cancer, like carcinoma of the cervix, is strongly associated with human papilloma virus (HPV) infection. In the past few decades, treatment has swung away dramatically from primary surgery to definitive chemoradiotherapy, with the evident physical and psychosocial benefits of organ preservation. Tumours of lower stage T1 or T2, N0, have an excellent outcome with the chemoradiotherapy approach. Unfortunately, many patients present with T3, T4 or N ≥ 1 disease and they have a significant risk of both locoregional and subsequent distant failure. Half of patients still die within 5 years of treatment. Therefore, efforts are ongoing to improve outcomes via better local and systemic therapy