# ESMO Clinical Practice Guideline on anal cancer: diagnosis, treatment and follow-up

Source: https://onco.cc/key-papers/paper-esmo-anal-cancer-guideline-ann-oncol-2021/  
OnCo record `paper-esmo-anal-cancer-guideline-ann-oncol-2021` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The European guideline for anal cancer, covering staging, chemoradiotherapy for localised disease, salvage surgery, and chemotherapy and immunotherapy for cancer that has spread.

## Summary

Evidence-graded guideline from the European Society for Medical Oncology on anal squamous cell carcinoma: diagnosis with MRI and PET-CT, HIV and HPV testing, radical chemoradiotherapy with fluorouracil (or capecitabine) and mitomycin using intensity-modulated radiotherapy, response assessment at 26 weeks, salvage abdominoperineal resection, and, for metastatic disease, carboplatin plus paclitaxel first line on the InterAACT result with anti-PD-1 antibodies after platinum.

It also addresses local excision for small perianal tumours, treatment in people living with HIV, and surveillance after treatment.

## Fields

- Kind: Key paper
- Last checked: 2026-09-18
- Journal: Annals of Oncology
- Year: 2021
- DOI: 10.1016/j.annonc.2021.06.015
- Authors: Rao S, Guren MG, Khan K, et al.
- What it means: Most decisions on the localised and metastatic anal cancer pages, from the chemoradiotherapy schedule to when to operate and what to give for metastatic disease, follow this guideline or its American counterpart.
- Caveats: Published before the POD1UM-303 result adding retifanlimab to first-line chemotherapy; check for updates.; Evidence for many recommendations in this rare cancer comes from single trials or consensus.

## Sources

- Ann Oncol 2021: https://doi.org/10.1016/j.annonc.2021.06.015
- PubMed: https://pubmed.ncbi.nlm.nih.gov/34175386/

## Connected records

- cancers: [Localised anal squamous cell carcinoma (stage I to III)](https://onco.cc/cancers/localised-anal-cancer/), [Metastatic and recurrent anal squamous cell carcinoma](https://onco.cc/cancers/metastatic-anal-cancer/)
- journals: [Annals of Oncology](https://onco.cc/journals/annals-of-oncology/)

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