A 70-year-old man presents with a 3 cm anal canal squamous cell carcinoma (SCC) without inguinal lymph node involvement. What is the FIRST-LINE treatment?

• A Abdominoperineal resection (APR) with permanent colostomy
• B Wide local excision with 1 cm margins
• C Radiotherapy alone without chemotherapy
• D Chemoradiotherapy — the Nigro protocol (mitomycin-C + 5-fluorouracil + radiotherapy) ✓

Explanation

Anal canal SCC is treated with primary chemoradiation (the Nigro protocol: concurrent mitomycin-C + 5-FU + external beam radiotherapy), which achieves complete response in 70-90% of patients and preserves sphincter function. Surgery (APR) is reserved for residual or recurrent disease after chemoradiation. This landmark approach from Nigro (1974) changed the paradigm from surgery to organ-preserving chemoradiation as first-line treatment. Wide local excision is appropriate only for small (<2 cm) perianal margin tumours.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.