A 45-year-old man presents with anal canal squamous cell carcinoma measuring 4 cm (T2N0M0) confirmed on MRI. He has no distant metastases. The standard of care treatment is:
- A Abdominoperineal resection (APR) as primary surgery
- B Nigro protocol — chemoradiotherapy with 5-FU and mitomycin C ✓
- C Chemoradiotherapy with 5-FU and cisplatin
- D Local excision followed by adjuvant radiotherapy
Correct answer: B. Nigro protocol — chemoradiotherapy with 5-FU and mitomycin C
Explanation
The Nigro protocol (concurrent chemoradiotherapy with 5-fluorouracil plus mitomycin C, delivered with 45-54 Gy radiotherapy) is the standard curative treatment for anal canal SCC regardless of stage, preserving the sphincter in the majority of patients. This was established by Norman Nigro's landmark work and subsequently validated in randomised trials (UKCCCR ACT I, EORTC). APR is reserved for salvage when chemoradiotherapy fails. Cisplatin-based regimens (ACT II trial) showed no superiority over mitomycin C.
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.