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Anal duct carcinoma, also known as anal gland carcinoma or adenocarcinoma of the anal canal, is an unusual anal cancer that accounts for approximately 0.1% of all gastrointestinal cancers. Delays in diagnosis most likely account for the poor prognosis associated with this cancer. Presenting symptoms often mimic those of more common benign anorectal pathologic processes. Multimodality treatment that includes surgery, chemotherapy, and radiation therapy is often recommended. The authors describe a typical case of anal duct carcinoma and its management. They also discuss the findings of a survey of the combined experience of members of the American Osteopathic College of Proctology and review the literature.