A 28-year-old man is found to have anal cancer (SCC) on biopsy. CT and PET show T2N0M0 staging. What is the standard treatment per Nigro protocol?

• A Abdominoperineal resection (APR) with permanent colostomy
• B Radiotherapy alone (55 Gy) without chemotherapy
• C Wide local excision with inguinal lymph node dissection
• D Concurrent chemoradiotherapy (mitomycin C + 5-fluorouracil + 45 Gy RT) ✓

Explanation

Squamous cell carcinoma of the anal canal is treated with concurrent chemoradiotherapy (the Nigro protocol) — mitomycin C (day 1) + 5-fluorouracil (continuous infusion) + external beam radiotherapy 45–54 Gy. This organ-sparing approach achieves complete response in approximately 80–90% of patients and avoids permanent colostomy. APR is reserved for residual or recurrent disease after primary CRT. Surgery as primary treatment is no longer the standard since the UKCCCR ACT I trial.

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.