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Anal cancer is usually staged based on the results of a physical exam, biopsy, and imaging tests. If surgery is done, the pathologic stage (also called the surgical stage) is determined by examining tissue removed during an operation. The most recent version of tnm staging of anal cancer is as follows. the american joint committee on cancer (ajcc) tumornodemetastasis (tnm) classification and staging system for anal cancer are provided below. The clinical stage of anal cancer is determined during diagnosis of the disease, which may include a physical exam, imaging tests andor biopsy. Surgical or pathological staging (if surgery has been performed) is done by examining tissue. The most commonly used anal cancer staging system is the tnm system established by the american joint committee on cancer. Find out how anal cancer is tested for, diagnosed, and staged. Anal cancer early detection, diagnosis, and staging what cancer patients, their families, and caregivers need to know about the coronavirus. Anal cancer is not usually found during a regular screening colonoscopy for colorectal cancer. If anal cancer is suspected, your primary care doctor should refer you to a specialist for additional tests. Getting the right diagnosis is an important first step toward successful treatment. ajcc 7th edition staging was sunset on december 31, 2017 as of january 1, 2018, use of the 8th edition is mandatory terminology. The tnm staging of anal cancer did not change in the latest edition of the ajcc cancer staging manual and is shown in table 1. In general, two examinations are performed one for locoregional staging using mri with or without transanal endoscopic ultrasound and another to search for distant metastases with ct or, more recently, with fdg petct.