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What is The best initial management of a tumor of anal canal of 2cm is: and explain in detail?
Ref: Bailey and Love's Short Practice of Surgery 25th EditionExplanation:SQUAMOUS CELL CARCINOMA OF ANAL CANALRisk factors:HPV ( especially subtypes 16. IS, 31 or 33)HIVTransplant 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 resection)APR) 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