A 50-year-old woman presents with rectal bleeding. Sigmoidoscopy reveals an anal canal lesion at the dentate line, biopsy confirms squamous cell carcinoma. The standard curative treatment is:
- A Nigro protocol: concurrent mitomycin-C, 5-fluorouracil and external beam radiation ✓
- B Abdominoperineal resection (APR) as primary treatment
- C Local excision alone if T1 lesion
- D Chemotherapy with FOLFOX followed by APR
Correct answer: A. Nigro protocol: concurrent mitomycin-C, 5-fluorouracil and external beam radiation
Explanation
Squamous cell carcinoma of the anal canal is treated with the Nigro protocol (chemoradiation: mitomycin-C + 5-FU + 45–54 Gy radiation), which achieves complete response in approximately 80–90% of cases and preserves the sphincter. APR is now reserved for residual or recurrent disease after chemoradiation failure, not as primary treatment. This approach was established by Nigro et al. in 1974 and has become the standard of care, making anal canal SCC one of the few GI malignancies managed primarily non-surgically.
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.