Revised 26 Sept 2012

• Digital rectal examination​ to determine local involvement
• Anoscopy or sigmoidoscopy with biopsy
• CT scan of the chest, abdomen and pelvis is recommended to assess of local, regional involvement and to exclude distant metastases.
• Consider pelvic MRI and PET/CT for staging locally advanced cases.
• Female patients should have a gynecologic examination (with Pap smear) to exclude a synchronous cervical cancer, as both types of cancer are related to human papilloma virus (HPV) infection
• ​If suspected, human immunodeficiency virus (HIV) serology and CD4 count