A 44-year-old woman presents with rectal bleeding. Sigmoidoscopy reveals a 3 cm lesion at the dentate line. Biopsy shows squamous cell carcinoma. The current first-line treatment for carcinoma of the anal canal (not anal margin) is:

• A Abdominoperineal resection (APR) with permanent colostomy
• B Local excision with 1 cm margin
• C Cisplatin + RT without 5-FU
• D Chemoradiotherapy (Nigro protocol: 5-FU + mitomycin C + RT) ✓

Explanation

Squamous cell carcinoma of the anal canal is treated non-operatively with the Nigro protocol (concurrent 5-FU + mitomycin C + external beam radiotherapy), which achieves >80% complete response and organ preservation in most patients. APR is reserved for residual or recurrent disease after chemoradiation failure. Local excision is appropriate for small anal margin lesions, not anal canal SCC. Cisplatin-based regimens show similar efficacy but mitomycin C remains standard.

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.