A 58-year-old woman presents with high-grade squamous intraepithelial lesion (HSIL) of the anal canal confirmed on HRA (high-resolution anoscopy) biopsy. Which of the following best describes the appropriate management according to current guidelines following the ANCHOR trial?

• A Annual surveillance HRA only, as lesions have low progression rate
• B Treatment of HSIL (ablation or excision) reduces risk of progression to anal cancer ✓
• C Abdominoperineal resection for HSIL to prevent cancer
• D Topical 5-fluorouracil cream is the preferred first-line treatment for HSIL

Explanation

The ANCHOR (Anal Cancer HSIL Outcomes Research) trial, published in NEJM 2022, randomised HIV-positive individuals aged ≥35 with anal HSIL to treatment (HRA-guided ablation/excision) versus surveillance. The trial was stopped early because treatment reduced anal cancer incidence by 57% compared with active monitoring. This established that treatment of anal HSIL is beneficial and cost-effective, reversing prior uncertainty about whether HSIL progression warranted intervention. APR has no role in pre-cancerous HSIL. Topical agents are used in some settings but HRA-guided ablation is the 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.