A 55-year-old woman presents with a 3 cm squamous cell carcinoma of the anal canal (above the dentate line). She has no distant metastases. The standard of care first-line treatment is:

• A Abdominoperineal resection (APR) with permanent colostomy
• B Nigro protocol: concurrent 5-fluorouracil + mitomycin C and external beam radiation (45–54 Gy) ✓
• C Local excision with 1 cm margins followed by adjuvant capecitabine
• D FOLFOX chemotherapy for 6 cycles followed by reassessment

Explanation

Squamous cell carcinoma of the anal canal is treated with the Nigro chemoradiotherapy protocol (concurrent 5-FU + mitomycin C + radiation), which achieves complete response in 80–90% of patients, sparing the sphincter and avoiding permanent colostomy. APR is reserved for residual or recurrent disease after chemoradiation. Local excision alone is appropriate only for small (<2 cm) perianal margin tumours. FOLFOX is used for colorectal adenocarcinoma, not anal SCC.

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.