A 50-year-old man has T2N0 anal squamous cell carcinoma (SCC). What is the standard definitive treatment according to the Nigro protocol?
- A Abdominoperineal resection (APR)
- B Radiotherapy alone
- C Concurrent chemoradiotherapy with mitomycin-C and 5-fluorouracil ✓
- D Wide local excision followed by adjuvant chemotherapy
Correct answer: C. Concurrent chemoradiotherapy with mitomycin-C and 5-fluorouracil
Explanation
Anal SCC is treated with the Nigro protocol (definitive chemoradiotherapy), which combines concurrent radiation (45-54 Gy) with mitomycin-C and 5-fluorouracil (5-FU) chemotherapy. This sphincter-preserving approach achieves complete response in ~80% of cases, avoiding the need for APR and permanent colostomy. Surgery (APR) is reserved for residual or recurrent disease after chemoradiotherapy. The Nigro protocol transformed anal SCC management when introduced in the 1970s and remains the standard of care.
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.