Accounts for 1–2% of large-bowel cancer, 8300 cases and 1290 deaths in 2019; associated with chronic irritation, e.g., from condyloma acuminata, perianal fissures/fistulas, chronic hemorrhoids, leukoplakia, trauma from anal intercourse. Women are more commonly affected than men. Homosexual men are at increased risk. Human papillomavirus is etiologic. Presents with bleeding, pain, and perianal mass. Radiation therapy plus chemotherapy (5FU and mitomycin) leads to complete response in 80% when the primary lesion is <3 cm. Abdominoperineal resection with permanent colostomy is reserved for those with large lesions or whose disease recurs after chemoradiotherapy.