<prompt> The best initial management of a tumor of anal canal of 2cm is:Wide excisionChemoradiationAbdominoperineal resectionRadiotherapy alone  <response>: Ref: Bailey and Loves Short Practice of Surgery 25th EditionExplanation:SQUAMOUS CELL CARCINOMA OF ANAL CANALRisk factors:HPV especially subtypes 16. IS, 31 or 33HIVTransplant recipients Clinical features:Pain and bleeding- Most commonCan also present with discharge, mass or pruritusAdvanced tumours may cause faecal incontinenceSpreads to inguinal lymph nodesDiagnosis: By BiopsyManagementConcurrent Chemoradiation Nigro Protocol is the treatment of choiceExternal-beam radiation therapy combined with 5-fIuorouracil 5-FU and Mitomycin C based chemotherapyRole of surgeryAbdomino Perinael resectionAPR i-. indicated inpatients who are already in need of a stoma for fecal incontinencewhen chemotherapy or radiation therapy is contraindicated,residua disease after radiation therapy plus chemotherapy Wide local excision may be considered for small lesions, but Chemoradiation is the treatment of choice 