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Ablative therapy after four-quadrant biopsy to rule out invasive cancer. (Electrocautery, cryoablation, or laser ablation may be performed at the discretion of the treating physician.) For invasive anal cancer: surgical excision 6 local radiotherapy may be considered for small, localized cancers with minimal depth of invasion. Combined modality therapy (external beam radiotherapy + 5-fluorouracil / mitomycin or 5-fluorouracil / cisplatinum chemotherapy).