Anal cancer is uncommon accounting for only 2% of anorectal cancers. The recognition of many similarities between cervical and anal cancer has stimulated research into the identification of a common aetiological agent. DNA from human papillomaviruses has consistently been found in both of these cancers and is thought to be an important factor in the development of both of these tumours. Simultaneously, epidemiological data from the west coast of America have indicated that the demography of anal cancer may be changing. Further studies in the USA and the UK have identified certain groups at high risk of developing anal cancer. These high-risk groups include ‘never married’ men and immunosuppressed patients both from iatrogenic immunosuppression in transplant patients and those infected with HIV. The potential increase in anal cancer cases, due to the ever increasing numbers of patients who have received transplants and the spiralling number of the population infected with HIV make it timely to review what is known of the aetiology, presentation and management of this cancer.