A 40-year-old man with squamous cell carcinoma of the anal canal (T2N0M0) is staged by MRI. Per current ESMO guidelines, what is the primary treatment modality?
- A Nigro protocol: concurrent 5-FU + mitomycin C with radiotherapy ✓
- B Abdominoperineal resection (APR) upfront
- C Cisplatin + capecitabine chemotherapy alone
- D Wide local excision with inguinal node dissection
Explanation
The Nigro protocol (concurrent chemoradiotherapy with 5-fluorouracil and mitomycin C) is the established standard of care for anal canal squamous cell carcinoma, achieving 5-year local control rates of 65–80% and preserving sphincter function. APR is reserved for residual or recurrent disease after CRT failure, not as primary treatment. Chemotherapy alone lacks evidence as definitive therapy. Wide local excision is appropriate only for perianal skin tumors (<2 cm, T1) not involving the internal sphincter. Preservation of sphincter function is the primary goal of current guidelines.
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.