Snapshot A 42-year-old woman presents to her primary care physician for rectal bleeding. She cannot identify a clear cause to her symptoms. She has noticed it being associated with constant pain. She has a medical history of HIV and condyloma acuminatum. Physical examination is notable for a mass arising from the anus. Introduction Overview the anal mucosa is comprised of 3 histological types glandular (proximal anus) can give rise to adenocarcinoma transitional can lead to squamous cell carcinoma (SCC) squamous (distal anus) can lead to SCC SCC is the most common anal cancer Epidemiology Risk factors female gender HPV HIV increased lifetime number of sexual partners cigarette smoking receptive anal intercourse ETIOLOGY Associated conditions HIV condyloma acuminatum Presentation Symptoms rectal bleeding most common initial symptom anorectal pain pruritus ani Physical exam anorectal mass IMAGING Sigmoidoscopy or anoscopy indication used to obtain a biopsy of the area for a histological diagnosis Differential Hemorrhoids differentiating factors painless rectal bleeding Anal fissure differentiating factors pain that is exacerbated by defecation longitudinal tear in the anoderm Treatment Treatment is dependent on the stage of the malignancy Medical chemotherapy indication metastatic anal cancer comments can be combined with radation Surgical local excision indication well-differentiated lesion without lymph node involvement