Another option is immediate abdominal-perineal resection of the primary tumor as the initial treatment, with removal of the involved inguinal nodes a few weeks later, but this is now employed infrequently.

Five-Year Survival  20 percent 

Stage IV 
TNM Any T, any N, M1 
The cancer has spread to distant lymph nodes beyond the pelvis or to other organs in the body such as the liver or lung.

Standard Treatment  There is no standard treatment for patients with metastatic anal carcinoma . Relieving the symptoms produced by the primary cancer is the major consideration. This can often be achieved best by following the treatment guidelines outlined above for patients without metastases.
    If the metastases cause symptoms, these can sometimes be palliated by local radiation therapy . Various drug combinations, including 5-FU + cisplatin or 5-FU + mitomycin-C or experimental combinations may sometimes cause temporary regression of metastases.

Five-Year Survival  Unusual