Question

Treatment of squamous cell carcinoma of the anal canal is:

• A. Cisplatin based chemotherapy followed by radical radiotherapy
• B. Abdominoperineal resection
• C. Radical radiotherapy
• D. Radical radiotherapy followed by mitomycin C based chemotherapy

Hint:

Anal canal SCC is cured with combined chemotherapy and radiotherapy, not surgery first; surgery is kept for salvage.

Answer 1

The Correct Option is A

Step 1: Recall how anal canal cancer is treated.
Squamous cell carcinoma of the anal canal is not treated by surgery first. The tumor is treated with combined chemotherapy and radical radiotherapy, a plan often called chemoradiation. This approach cures most patients while keeping the anal sphincter intact, so a colostomy is avoided in most cases.

Step 2: Understand why chemotherapy comes before or with the radiotherapy.
Chemotherapy is started first because it shrinks the tumor and makes the cells more sensitive to the radiation that follows. This is the basis of the combined regimen that replaced surgery as the first line of treatment for this cancer.

Step 3: Rule out abdominoperineal resection.
Abdominoperineal resection removes the anus, rectum, and nearby tissue, leaving a permanent colostomy. It used to be the standard operation, but today it is kept for cases where chemoradiation fails or the cancer comes back, not for a newly diagnosed case.

Step 4: Rule out radiotherapy alone.
Radiotherapy by itself gives poorer local control because it misses the sensitizing effect of chemotherapy. Combined treatment consistently gives better cure rates than radiotherapy alone.

Step 5: Rule out radiotherapy followed by chemotherapy.
Giving the radical radiotherapy first and the chemotherapy afterward reverses the working order of the regimen. The chemotherapy needs to run before or together with the radiotherapy to sensitize the tumor, not after it.

Step 6: Final answer.
The sequence of chemotherapy followed by radical radiotherapy is the one that matches the combined modality plan used for this cancer.
\[ \boxed{\text{Chemotherapy followed by radical radiotherapy}} \]
Note: many current treatment guidelines run the chemotherapy (typically 5-fluorouracil with mitomycin C) at the same time as the radiotherapy rather than strictly before it, and cisplatin based regimens are used as an alternative to mitomycin C in some protocols. Among the four choices given here, chemotherapy paired with radical radiotherapy is still the closest match to the accepted non-surgical, sphincter-sparing approach, so option 1 is kept as the answer.