Surgery is no longer the standard upfront treatment for squamous carcinoma of anal canal--brief introduction of the 2014 ESMO guideline for anal cancer

The 2014 ESMO guideline for anal cancer is used for diagnosis, treatment and follow-up of squamous cell carcinoma of the anus, including anatomically anal canal, anal margin and perianal skin. High risk includes anal intercourse, HIV infection and HPV infection. The current staging system for anal cancer is still the UICC/AJCC TNM classification for malignant tumor. Treatment goal for localized anal cancer is to achieve good control for primary lesion and preserve the function of anal sphincter. Standard primary treatment for this setting is 5-fluorouracil (5-FU)-based concurrent chemoradiation (CRT), leading to complete tumour regression in 80%~90% of patients. In this setting, surgery is used mainly as a salvage treatment, or the primary option for small lesion involving perianal skin. For metastatic disease, systemic chemotherapy with 5-FU and cisplatin-based regimen is the primary treatment. Key words: Anal canal; Neoplasms, squamous cell; Guideline