The different ways of metastases of carcinoma of the anus can hardly be removed by radical surgery and require other procedures than the lower carcinoma of the rectum. In comparing Miles operation in T3/T4 carcinomas of the anus with the combined therapy of local excision and radiotherapy results showed no great difference in T1/T2 tumors the Miles operation is not necessary. In T3/T4 carcinomas irradiation derives its worth from the few possible procedures ro radical surgery. In T1/T2 tumors irradiation can be an alternative (T1) or an additional treatment (T2) to the local excision.