Squamous Cell Carcinoma Of Rectum Research Articles

The Enigma That is Rectal Squamous Cell Carcinoma: A Case Series

IntroductionColorectal cancer is the third most common cancer and the third leading cause of cancer deaths in the United States. As rectal squamous cell carcinoma (SCC) is an uncommon colorectal cancer, there is limited data on this clinical entity. We aimed to evaluate the tumor characteristics, treatment, and clinical outcomes of this rare deadly disease. MethodsPathological specimens from 2017 to 2022 at a single National Cancer Institute-designated cancer center were screened for all rectal cases with a diagnosis of SCC. All patients with a primary rectal SCC were included. Patients who had extension to the dentate line or evidence of an anal mass, and those who were treated at an outside institution, were excluded. Demographic, treatment, outcome, and surveillance data was extracted. ResultsThere were 56 specimens identified, nine of which met inclusion criteria. Most patients were White (78%), Hispanic (78%), and female (67%). The average age at diagnosis was 57 y [52-65]. All patients had nodal involvement at the time of clinical staging. All patients were treated with Nigro protocol, with one patient treated with surgery first. The median time of follow-up was 12 mo after initial treatment, 33% had recurrence, with median time to recurrence of 25 mo. Overall, mortality from rectal SCC was 33% at a median time of 37 mo from initial diagnosis. ConclusionsRectal SCC is a colorectal cancer that is not fully understood. Our findings showed that treatment mirrors that of anal SCC, with similar rates of survival to both rectal adenocarcinoma and anal SCC.

S2570 A Rare Occurrence of Basaloid Squamous Cell Carcinoma of Rectum

S2570 A Rare Occurrence of Basaloid Squamous Cell Carcinoma of Rectum

Characteristics, treatment, and outcomes of anal versus rectal squamous cell carcinoma, a retrospective cohort study

BackgroundAlthough squamous cell carcinoma is the most common malignancy of the anal canal, it rarely affects the rectum. The present study aimed to assess the differences in characteristics, treatments, clinical and pathologic outcomes, and survival between anal and rectal squamous cell carcinoma. MethodsThe United States National Cancer Databases (2004–2020) of anal canal and rectal cancer were used for this retrospective cohort analysis. Patients with anal or rectal squamous cell carcinoma were included in the analysis. The study's primary outcome was overall survival, and secondary outcomes were 30-day and 90-day mortality, 30-day readmission, and positive resection margins. ResultsThe present study included 76,830 patients with anal squamous cell carcinoma and 7,908 with rectal squamous cell carcinoma. Patients with anal squamous cell carcinoma presented more often with early clinical stage I and stage II disease (50.4% vs 45.9%, P < .001) and less often with stage IV disease (6.5% vs 15.1%, P < .001). Anal squamous cell carcinomas were more often treated with upfront surgery than were rectal squamous cell carcinomas (37.7% vs 19.7%, P < .001), whereas rectal squamous cell carcinomas were more often treated with chemoradiation therapy alone (68.3% vs 59.8%, P < .001). Anal squamous cell carcinomas were treated more often with local excision (33.4% vs 15.8%, P < .001) than rectal squamous cell carcinoma. Anal squamous cell carcinoma was associated with a higher incidence of positive resection margins (41.9% vs 32.8%, P < .001). The 30-day and 90-day mortality rates were higher after surgery for rectal squamous cell carcinoma than for anal squamous cell carcinoma (1.5% vs 0.4% and 4.1% vs 1.6%, respectively, P < .001). Anal squamous cell carcinoma had longer median overall survival (145.3 vs 90.3 months, P < .001) than rectal squamous cell carcinoma. ConclusionPatients with anal squamous cell carcinoma presented more often with early-stage disease and less often with distant metastasis and were more often treated with upfront surgery, mainly local excision. Anal squamous cell carcinoma was associated with lower 30-day and 90-day mortality and longer overall survival than rectal squamous cell carcinoma.

Case report of unusual synchronous anal and rectal squamous cell carcinoma: clinical and therapeutic lesson

Synchronous tumors of the rectum and anus are sporadic. Most cases in the literature are rectal adenocarcinomas with concomitant anal squamous cell carcinoma. To date, only two cases of concomitant squamous cell carcinomas of the rectum and anus are reported, and both were treated with up-front surgery and received abdominoperineal resection with colostomy. Here, we report the first case in the literature of a patient with synchronous HPV-positive squamous cell carcinoma of the rectum and anus treated with definitive chemoradiotherapy with curative intent. The clinical-radiological evaluation demonstrated complete tumor regression. After 2 years of follow-up, no evidence of recurrence was observed.

Treatment paradigm and prognostic factor analyses of rectal squamous cell carcinoma.

Rectal squamous cell carcinoma (rSCC) is a rare pathological subtype of rectal cancer. There is no consensus on the treatment paradigm for patients with rSCC. This study aimed to provide a paradigm for clinical treatment and develop a prognostic nomogram. Patients diagnosed with rSCC between 2010 and 2019 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. According to the TNM staging system, Kaplan-Meier (K-M) survival analysis was used to identify the survival benefits of different treatments in patients with rSCC. The Cox regression method was used to identify independent prognostic risk factors. Nomograms were evaluated by Harrell's concordance index (C-index), calibration curves, decision curve analysis (DCA) and K-M curves. Data for 463 patients with rSCC were extracted from the SEER database. Survival analysis showed that there was no significant difference in median cancer-specific survival (CSS) among patients with TNM stage 1 rSCC treated with radiotherapy (RT), chemoradiotherapy (CRT) or surgery (P = 0.285). In TNM stage 2 patients, there was a significant difference in median CSS among those treated with surgery (49.5 months), RT (24 months), and CRT (63 months) (P = 0.003). In TNM stage 3 patients, there was a significant difference in median CSS among those treated with CRT (58 months), CRT plus surgery (56 months) and no treatment (9.5 months) (P < 0.001). In TNM stage 4 patients, there was no significant difference in median CSS among those treated with CRT, chemotherapy (CT), CRT plus surgery and no treatment (P = 0.122). Cox regression analysis showed that age, marital status, T stage, N stage, M stage, PNI, tumor size, RT, CT, and surgery were independent risk factors for CSS. The 1-, 3-, and 5-year C-indexes were 0.877, 0.781, and 0.767, respectively. The calibration curve showed that the model had excellent calibration. The DCA curve showed that the model had excellent clinical application value. RT or surgery is recommended for patients with stage 1 rSCC, and CRT is recommended for patients with stage 2, and stage 3 rSCC. Age, marital status, T stage, N stage, M stage, PNI, tumor size, RT, CT, and surgery are independent risk factors for CSS in patients with rSCC. The model based on the above independent risk factors has excellent prediction efficiency.

Demographics, pattern of practice and clinical outcomes in rectal squamous cell carcinoma.

The aim of this study was to describe the baseline clinical features, treatment patterns and outcomes in rectal squamous cell carcinoma (SCC). This is a retrospective study of patients with rectal SCC treated at the Princess Margaret Cancer Centre (Toronto, Canada) between 1 January 1995 and 31 December 2020. Clinical factors associated with locoregional failure (LRF), distant metastases (DM), disease-free survival (DFS) and overall survival (OS), such as age, sex, HIV status, T-category, nodal status, grade and primary treatment, were investigated with univariate analysis (UVA). Twenty nine patients with rectal SCC were analysed with a median follow-up of 7.4 years (range 0.3-20.4 years). The median age at diagnosis was 52 years, with the majority presenting with clinical T3 disease or higher (n=21, 72%) and positive regional lymph nodes (n=16, 55%), while more than quarter of patients (28%) had metastatic disease. Definitive chemoradiation was the treatment modality of choice in more than half of all cases (n=17, 59%) with a response rate of 100%. The 10-year cumulative incidence of LRF and DM was, respectively, 12% (95% CI 1.8%-32.9%) and 31% (95% CI: 12.0%-52.6%). The 5- and 10-year OS was 82% (95% CI 66.1%-100%). UVA revealed a trend towards an association of male gender (hazard ratio=4.65, 95% CI 0.9%-24.1; p=0.067) and primary surgical treatment (hazard ratio=0.76, 95% CI 0.09-6.34; p=0.061) with DFS. Definitive chemoradiation is an effective and preferred treatment for rectal SCC allowing for sphincter preservation with complete clinical response observed in all patients.

Modified DCF (Docetaxel, Cisplatin and 5-fluorouracil) chemotherapy is effective for the treatment of advanced rectal squamous cell carcinoma.

Advanced rectal squamous cell carcinoma (rSCC) is a very rare and aggressive entity, and the best initial management is crucial for long survival as well as organ preservation and quality of life. Whereas local diseases are treated with chemo-radiotherapy and salvage surgery, data are scarce on how to treat more advanced diseases, and the role of induction chemotherapy is unknown. We retrospectively analyzed all consecutive patients with advanced rSCC and treated with modified DCF (docetaxel, cisplatin, 5-fluorouracil; mDCF) regimen, from January 2014 and December 2021 in two French centers. Exploratory endpoints were efficacy (overall survival, recurrence-free survival, response rate, organ preservation rate) and safety. Nine patients with locally advanced or metastatic diseases received a mDCF regimen and were included for analysis. The median age was 62.0 years, 7 patients (77.8%) were women, and all eight available tumors were positive for HPV, mostly (85.7%) to genotype 16. With a median follow-up of 33.1 months, 77.8% of patients were still alive and disease-free, and the median overall survival was not reached at six years. The objective response rate was 87.5% after mDCF, and the complete response rate was 25.0% after mDCF and was increased to 75.0% after chemoradiotherapy. Only one patient underwent surgery on the primary tumor, with a complete pathological response. The median mDCF cycle was eight over eight scheduled, and all patients received the complete dose of radiotherapy without interruptions. Induction mDCF chemotherapy followed by chemoradiotherapy is safe and highly effective in patients with advanced rSCC, and should be considered as an option in metastatic stage or locally advanced disease with an organ-preservation strategy.

The first comprehensive genomic characterization of rectal squamous cell carcinoma

BackgroundRectal cancers represent 35% of colorectal cancers; 90% are adenocarcinomas, while squamous cell carcinoma accounts for 0.3% of them. Given its rarity, little is known concerning its pathogenesis, molecular profile and therapeutic management. The current treatment trend is to treat rectal squamous cell carcinoma by analogy to anal squamous cell carcinoma with definitive chemo-radiotherapy, setting aside surgery in case of local recurrence.MethodsWe performed an in-depth genomic analysis (next-generation sequencing, copy number variation, and human papilloma virus characterization) on 10 rectal squamous cell carcinoma samples and compared them in silico to those of anal squamous cell carcinoma and rectal adenocarcinoma.ResultsRectal squamous cell carcinoma shows 100% HPV positivity. It has a mutational (PIK3CA, PTEN, TP53, ATM, BCL6, SOX2) and copy number variation profile (3p, 10p, 10q, 16q deletion and 1q, 3q, 5p, 8q, 20p gain) similar to anal squamous cell carcinoma. PI3K/Akt/mTOR is the most commonly affected signaling pathway similarly to anal squamous cell carcinoma. Most commonly gained or lost genes seen in rectal adenocarcinoma (FLT3, CDX2, GNAS, BCL2, SMAD4, MALT1) are not found in rectal squamous cell carcinoma.ConclusionThis study presents the first comprehensive genomic characterization of rectal squamous cell carcinoma. We confirm the existence of this rare histology and its molecular similarity with anal squamous cell carcinoma. This molecular proximity confirms the adequacy of therapeutic management based on histology and not localization, suggesting that rectal squamous cell carcinoma should be treated like anal squamous cell carcinoma and not as a rectal adenocarcinoma.

S2047 Is It Anal or Rectal? A Rare Case of Squamous Cell Carcinoma

Introduction: Primary rectal squamous cell carcinomas (SCC) are extremely rare and difficult to distinguish from anal cancers. The majority of rectal SCC are secondary to anal SCC extension and detected at an advanced stage. Although rectal and anal cancers are anatomically close, they are distinct entities with risk factors, different histologic features, patterns of spread, staging systems, and treatment pathways. We present a rare case of a middle-aged man with AIDS who presented with bloody diarrhea, eventually found to have a primary rectal SCC. Case Description/Methods: A 59-year-old-male with a history of AIDS presented with bloody diarrhea and fevers. He denied abdominal or rectal pain. Physical exam only revealed mild tenderness of the abdomen. Labs were unremarkable. Gastrointestinal PCR revealed shigella, enteroaggregative E. Coli, enterotoxigenic E. coli, and enteropathogenic E. coli infection. Computed tomography of the abdomen and pelvis revealed pancolitis and left irregular rectal wall thickening, concerning for rectal carcinoma. He was started on IV ciprofloxacin and metronidazole with improvement in symptoms. Colonoscopy revealed a non-obstructing mass in the rectum. Pathology demonstrated high-grade anal intraepithelial lesion (AIN-3) and focally invasive squamous cell carcinoma, with acute and chronically inflamed rectal mucosa. Given the incongruence between colonoscopy and pathology, it was uncertain whether a primary lesion of the rectum with spread to anus existed or if 2 separate pathologies were present. Repeat colonoscopy to define the anatomic location of the mass revealed a severely ulcerated, friable, rectal lesion, discontinuous from an area of anal inflammation, separated by normal mucosa. Repeat pathology revealed invasive and in situ SCC of the rectum. The patient was referred for chemoradiation with 5-fluorouracil and mitomycin (Figure). Discussion: Primary rectal SCC accounts for 0.01% of all colo-rectal carcinomas. Risk is increased in patients with a history of Human Papilloma virus infection. The diagnosis of primary rectal SCC requires 3 criteria: (i) exclusion of metastasis, (ii) no squamous-lined fistulous tract involving the affected rectum, and (iii) exclusion of anal SCC with proximal extension (absence of continuity between the tumor and the normal anal squamous epithelium). Our patient ultimately fulfilled all these criteria. Primary rectal SCC should be considered a differential diagnosis in patients with HIV/AIDS, presenting with bloody diarrhea and a rectal mass.Figure 1.: CT of the abdomen and pelvis (A) revealing an irregular, asymmetric rectal wall thickening centered laterally on the left, highly concerning for rectal carcinoma, in addition to a focal left-sided outpouching from the rectum, suggesting a thick-walled diverticulum. Colonoscopy showing a rectal mass with ulcerated and friable mucosa (B&D). Area of anal inflammation (yellow circle, C) discontinuous from rectal mass with an adjacent small area of normal epithelium.

Rare complications of pessary use: A systematic review of case reports.

IntroductionPessaries are desirable for its overall safety profiles. Serious complications have been reported; however, there is little summative evidence. This systematic review aimed to consolidate all reported serious outcomes from pessaries usage to better identify and counsel patients who might be at higher risk of developing these adverse events.MethodsWe performed a systematic literature review using search terms such as ‘prolapse’, ‘stress urinary incontinence’ and ‘pessary or pessaries or pessarium’ on PubMed, Embase and CINAHL. A total of 36 articles were identified. Patient‐level data were extracted from case reports to further describe complications on an individual level.ResultsOverall median age of the patients was 82 years (range 62–98). The most frequent complications were vesicovaginal fistula (25%, n = 9/36), rectovaginal fistula (19%, n = 7/36), vaginal impaction (11%, n = 4/36) and vaginal evisceration of small bowel through vaginal vault (8%, n = 3/36). In the vesicovaginal fistula cohort, none of the patients had a history of radiation, and two had histories of total abdominal hysterectomy (22%). In the rectovaginal fistula cohort, one patient had a history of pelvic radiation for rectal squamous cell carcinoma, and another had a history of chronic steroid use for rheumatoid arthritis. No other risk factors were reported in the other groups. Ring and Gellhorn were the most represented pessary types among the studies, 16 (44%) and 12 (33%), respectively. No complications were reported with surgical and non‐surgical treatment of the complications.ConclusionPessaries are a reasonable and durable treatment for POP with exceedingly rare reports of severe adverse complications. The ideal candidate for pessary should have a good self‐care index. Studies to determine causative factors of the more serious adverse events are needed; however, this may be difficult given the long follow‐up that is required.

P-146 The first comprehensive genomic characterization of rectal squamous cell carcinoma

Rectal cancers represent 35% of colorectal cancers; 90% are adenocarcinomas while rectal squamous cell carcinomas represents 0.3% of them. Given its rarity, little is known concerning its pathogenesis, molecular profile and therapeutic management. The current treatment trend is to treat rectal squamous cell carcinoma by analogy with anal squamous cell carcinoma with definitive chemoradiotherapy setting aside surgery in case of local recurrence. We performed an in-depth genomic analysis (Next Generation Sequencing – 400 gene panel, Oncoscan, Human Papilloma Virus characterization) on 10 rectal squamous cell carcinoma samples and compared them in silico to those of anal squamous cell carcinoma and rectal adenocarcinoma. Rectal squamous cell carcinoma shows 100% HPV positivity. It has a similar mutational (PIK3CA, PTEN, TP53, ATM, BCL6, SOX2) and copy number variations profiles (3p deletion and 3q, 5p, 8q, 20p gain) to anal squamous cell carcinomas. PI3K/Akt/mTOR is the most commonly affected signaling pathway similarly to anal squamous cell carcinoma. In addition, common genomic alterations seen in rectal adenocarcinoma (FLT3, CDX2, GNAS BCL2, SMAD4, MALT1 mutations) were not found in these rectal squamous cases. This study presents the first comprehensive genomic characterization of rectal squamous cell carcinoma. We confirm the existence of this rare histology and its molecular similarity with anal squamous cell carcinoma. This molecular proximity confirms the adequacy of therapeutic management based on histology and not localization.

S1972 Synchronous Rectal Adenocarcinoma and Anal Squamous Cell Carcinoma in an Elderly Woman

S1972 Synchronous Rectal Adenocarcinoma and Anal Squamous Cell Carcinoma in an Elderly Woman

HPV associated cancers in the United States over the last 15 years: Has screening or vaccination made any difference?

107 Background: Human papillomavirus is a causative agent of many human cancers. This study aims to determine the incidence and trends of HPV-related cancers in the United States. Methods: HPV-associated cancers as classified by the CDC were included: oropharyngeal squamous cell carcinoma (SCC), anal &amp; rectal SCC, vulvar SCC, vaginal SCC, cervical carcinoma, and penile SCC. Data were obtained from the United States Cancer Statistics program from 2001-2017. SEER*Stat 8.3.8 and Joinpoint regression program 4.8.0.1 were used to calculate incidence trends of HPV-associated cancers per 100,000. Results: The overall incidence of HPV related cancers for women was 13.68/100,000, more than half of which (52%) were cervical cancer, at 7.12/100,000 in the year 2017. Over the last 16 years, the incidence of cervical cancer has decreased at an annual percent change (APC) of 1.03% (p &lt; 0.001). In contrast, oropharyngeal (APC = 0.77%, p &lt; 0.001), anal &amp; rectal (APC = 2.75%, p &lt; 0.001), and vulvar SCC all increased significantly (APC = 1.27%, p &lt; 0.001). For older women, the incidence of anal &amp; rectal cancer approached that of cervical cancer. In those over 80, the incidence of cervical cancer was 6.95 (-2.90% APC, p &lt; 0.001), compared to 6.36 for anal &amp; rectal cancer (1.23% APC, p &lt; 0.001). Using a projection model, incidence of anal &amp; rectal cancer is expected to surpass that of cervical cancer by year 2025 for every age group over 55. For men, the incidence of all HPV-related cancers was 11.0/100,000 in the year 2017, 81% were associated with oropharyngeal cancer. Over the last 16 years, there was an overall annual increase in HPV related cancers at 2.36% per year (p &lt; 0.001) with the highest increase in oropharyngeal (APC = 2.71%, p &lt; 0.001) and anal &amp; rectal SCC (APC = 1.71%, p &lt; 0.001). Those at greatest risk of oropharyngeal cancer were older men aged 65-69 years with an incidence of 36.5/100,000 and annual percent increase of 4.24% (p &lt; 0.001). The intersectionality of age and race showed that White men age 65-69 years had the highest incidence of oropharyngeal at 41.6/100,000. Conclusions: Overall, there was a decrease in cervical cancer incidence likely due to screening or vaccination. However, over 80% of men with HPV related cancers had oropharyngeal cancer, a nearly fivefold higher incidence compared to women. In contrast, there was a significant increase in non-screenable HPV-related cancers and anal &amp; rectal SCC incidence is projected to surpass that of cervical cancer within 5 years for certain at-risk groups. Further resources and research should be conducted to address the lack of screening or vaccination in these preventable cancers.

Primary rectal squamous cell carcinoma resembling a submucosal tumor.

Primary rectal squamous cell carcinoma is an extremely rare tumor and, in most cases, detected at an advanced stage. In our case, the tumor was at an early stage and had a submucosal appearance. Thus, the tumor was difficult to differentiate from other rectal submucosal tumors and, it was removed by endoscopic submucosal dissection for excisional biopsy.

Unusual presentation of rectal squamous cell carcinoma perforation—case report and literature review

This is an unusual case of an obstructive rectal squamous cell carcinoma (SCC), causing perforation and a pelvic abscess, requiring source control and diverting colostomy. A 50-year-old female with chronic constipation presented with worsening right buttock pain for 1month. On exam, the patient reported right hip tenderness. A computer tomography (CT) revealed rectal wall thickening with a presacral abscess. Due to the concern of rectal perforation with abscess she was taken to the operating room for proctoscopy with biopsy, colostomy diversion and drainage of the abscess over the right buttock. Pathology reported invasive rectal SCC. Rectal SCC presents similarly to rectal adenocarcinoma but its diagnosis must include special markers for cytokeratins. The treatment approach is controversial but adequately treated offers better survival than rectal ADC. Rectal SCC is rare and treated with chemoradiation however it must also be tailored to the variable acute presentations.

Salvage Surgery for Locoregional Failure after Chemoradiation in Rectal Squamous Cell Carcinoma: A National Cancer Database Analysis

Parascandola, Salvatore MD; Hota, Salini MD; Boulos, Sameh N. BS; Cavallo, Kathryn BS; Dunn Sparks, Andrew MS; Obias, Vincent J. MD; Ng, Matthew MD Author Information

S1654 A Rare Case of Rectal Squamous Cell Carcinoma Presenting as Hematochezia

INTRODUCTION: Squamous cell carcinoma of the gastrointestinal (GI) tract is a rare malignancy. When encountered, it usually involves the esophagus or the anal canal. Squamous cell carcinoma of the rectum is extremely unusual and unlike squamous cell carcinoma of the esophagus and anal canal, little is known about the etiology, prognosis, and optimal treatment. We report an unusual case of rectal squamous cell carcinoma in a patient with hematochezia and constipation. CASE DESCRIPTION/METHODS: A seventy-six-year-old female with a past surgical history of TAH-BSO was initially referred from her OB/GYN who noted a heterogeneous, solid and cystic mass measuring 9.3 × 10.5 × 9.3 cm in the deep pelvis on computer tomography (CT) scan. The patient reported symptoms of intermittent lower gastrointestinal bleeding, decreased appetite, and right upper quadrant pain. She also complained of occasional constipation and a change in the texture and consistency of her stool. She denied NSAID use, dysphagia, odynophagia, nausea, vomiting, hematemesis, diarrhea, or unintentional weight loss. A palpable 1 cm ulcerated rectal mass was noted on digital rectal exam. The pelvic exam was notable for a large palpable mass appreciated in pelvis abutting posterior vaginal wall A diagnostic colonoscopy was performed which showed a 5 mm polyp in the cecum, a 1–2 cm subepithelial lesion seen in the mid rectum anda single 1 cm ulcerated lesion in the rectum which was biopsied with cold forceps. Non-bleeding internal hemorrhoids were also identified. Surgical pathology showed that the tumor cells were positive for p63, CK 5/6, CAM 5.2, KI-67 (95%), CK 7, p40 & p16 and negative for CD 56, synaptophysin, Chromogranin, CDX-2 and CK 20. The immunohistochemistry results supported the diagnosis of poorly differentiated squamous cell carcinoma. Endoscopic ultrasound (EUS) was performed for further evaluation of the pelvic mass. A 71.3 mm × 43.0 mm peri-rectal mass with solid and cystic components was visualized. Two sub centimeter lymph nodes were visualized and measured in the perirectal region. Fine needle biopsy wasperformed of the perirectal mass and surgical pathology and cytology were consistent with poorly differentiated squamous cell carcinoma. FNB of the lymph nodes were not performed due to the small size of the lymph nodes. DISCUSSION: Squamous cell carcinoma of the rectum is a rare clinical entity. Clinicians should be aware of SCC as a differential in evaluating hematochezia and rectal masses.Figure 1.: Colonoscopy showing rectal mass.Figure 2.: Endoscopic ultrasound of rectal mass.

Management of Para-Aortic Lymph Node Metastasis in Rectal Squamous Carcinoma

Background: Squamous cell carcinoma (SCC) of the rectum is a rare malignancy, and retroperitoneal nodal metastasis (RNM) represent 1-2% of colorectal cancer metastasis (CRC), and radical retroperitoneal lymphadenectomy (RRL) in this setting remains controversial. However, there are no reports in the literature on how to treat SCC retroperitoneal lymph node metastasis. Case Presentation: The patient was a 47-years-old woman with SCC of the rectum. Concomitant chemoradiotherapy (CRT) followed by surgery was planned. After 8 weeks, CT of the abdomen for restaging showed a 6 cm para-aortic mass involving and obstructing the medium third of the left ureter. The patient was submitted to abdominoperineal rectal resection with left nephrectomy and en-bloc resection of para-aortic tumor (nodal bulking). Conclusion: After a thorough review of the literature regarding RNM for rectal SCC, we found no mention of how to treat RNM for rectal SCC. The purpose of this paper is to report a very rare case of RNM for rectal SCC and to discuss the surgical approach. Surgery seems to be the best option for local control and improvement in overall survival (OS).

Evaluating treatment protocols for rectal squamous cell carcinomas: the Duke experience and literature.

Colorectal cancer is the third most common cancer in the United States and associated with significant morbidity and mortality. Within colorectal cancer histologies, squamous cell carcinomas (SCC) are rare compared to adenocarcinomas, with only about 200 cases reported to date. Because rectal SCC is rarely encountered, there is a lack of literature and clinical consensus surrounding its optimal treatment approach. Staging and management of SCC can be partly analogous to both rectal adenocarcinoma and anal canal SCC, which leads to a dilemma in how to best approach these patients. As large randomized prospective trials are unrealistic in the setting of this rare malignancy, this study evaluates an institutional experience and reviews the existing literature to help guide future management approaches. This retrospective study compared various treatment regimens for rectal SCC patients treated at Duke University Medical Center from January 1, 1980 through December 31, 2016. Patients ≥18 years old with histologically confirmed, nonmetastatic rectal SCC were included. Due to small sample size, all statistical analyses were descriptive. For our systematic review, a comprehensive search of PubMed from 1933 to March 2018 was performed, with selected articles referenced to ensure all relevant publications were included. A qualitative analysis was performed to examine patient diagnoses, treatments, and disease- and treatment-related outcomes. Eight patients were included. Three patients underwent initial, curative attempt surgery and two of these patients required colostomy. With follow-up ranging from 7.1 to 31.5 months, one patient was alive with no evidence of disease while two developed local/regional recurrences. Five patients received definitive chemoradiation. Of these, three patients developed local/regional and/or metastatic recurrence. Two patients achieved complete response on imaging and currently remain disease-free (follow-up of 31.5 and 33.6 months). Although the review of our institutional experience is limited by small numbers, our analysis suggests that definitive chemoradiation therapy is the preferred treatment approach to rectal SCC based on improved disease-related outcomes, sphincter preservation and morbidity profiles. This conclusion is supported by a systematic literature review.

Survival and prognostic factors in patients with rectal squamous cell carcinoma

BackgroundSquamous cell carcinoma (SCC) of the rectum is a rare form of gastrointestinal malignancy. The current knowledge on the natural history is primarily derived from case series. MethodsUsing the National Cancer Data Base (NCDB), we determined the prognostic factors and overall survival (OS) outcomes of rectal SCC reported to NCDB between 2004 and 2015. Kaplan-Meier method and log-rank test were used to perform OS analysis. Propensity matched analysis was undertaken to compare the OS outcomes between rectal and anal SCC. ResultsOf the 3405 cases included in our analysis, 67% were female. Median age at diagnosis was 61 years and did not differ by sex. In stages I-III, patients who received definitive chemoradiation only (108 months) had a better median OS as compared to surgery alone (76 months) (p = 0.012). On multivariate analysis, age <60 years, female sex, and receipt of chemoradiation with or without surgery were independent predictors of better OS in stage I-III disease. Administration of chemoradiation was associated with better OS in stage IV disease. On propensity matched analysis comparing outcomes to anal SCC, OS of rectal SCC was inferior (79 months) to anal SCC (113 months) (p < 0.001), no such difference in OS was noted in the cohorts that received surgery plus post-surgical chemoradiation (p = 0.12). ConclusionOutcomes of rectal SCC were dependent upon age, sex, comorbidity score, and therapy received. Chemoradiation alone or in combination with surgery was associated with a better median OS in patients with stages I-III.