Primary Squamous Cell Carcinoma of Colon and Rectum: A Systematic Review of the Literature

Squamous cell carcinoma of the colon: evaluation of treatment modalities and survival

BACKGROUND

Squamous cell carcinoma of the colon (CSCC) is a rare subtype of colon cancer. This study aimed to evaluate treatment strategies and overall survival (OS).

METHODS

Using the Surveillance, Epidemiology, and End Results program database from 2008 to 2019, patients aged 18 years with CSCC were identified. Treatment strategies and OS were summarized using the Kaplan-Meier analysis and the log-rank test. Adjusted Cox proportional hazards regression model ratios were calculated to evaluate the effect of confounding variables.

RESULTS

After exclusions, 153 patients met the inclusion criteria. The most common treatment modalities included surgery alone (52.1%), surgery and adjuvant chemotherapy (12.9%), and no treatment (26.4%). Kaplan-Meier analysis revealed that patients who underwent surgery and adjuvant chemotherapy had significant improvements in OS (log-rank P = .002). Cox regression analysis revealed tumor grade (hazard ratio [HR], 2.12; 95% CI, 1.17-3.86) and receipt of chemotherapy (HR, 2.66; 95% CI, 1.23-5.76) as the only factors associated with improvements in OS.

CONCLUSION

Patients who underwent surgery in combination with chemotherapy had better OS than those who underwent surgery alone. Tumor grade and receipt of chemotherapy were independently associated with OS.

Rectal squamous cell carcinoma treated with neoadjuvant fluorouracil, oxaliplatin, cetuximab, and radiation: A case report of pathological complete response

RATIONALE

Treatment strategies for rectal squamous cell carcinoma (rSCC) are yet to be established, given its rarity. Although squamous cell carcinoma has been reported to be highly sensitive to cetuximab and radiation, there is no report of combination therapy of cetuximab and radiation for rSCC. In this study, we firstly reported a case of rSCC in which a complete response was achieved with the original chemoradiotherapy comprising oxaliplatin, S-1, cetuximab, and simultaneous radiation.

PATIENT CONCERNS

A 46-year-old women presented to our hospital with lower abdominal pain and fatigue.

DIAGNOSES

Based on tumor marker analyses, histological examination of biopsy specimens, and comprehensive imaging, the patient was diagnosed with rSCC.

INTERVENTIONS

Neoadjuvant chemoradiotherapy (50.4 Gy) was administered in 28 fractions, along with concurrent chemotherapy comprising SOX (S-1: 80 mg/m2, days 1-5 and 8-12, oxaliplatin: 85 mg/m2, day 1) and cetuximab (400 mg/m2, day 1, 250 mg/m2, after day 8).

OUTCOMES

Five weeks after chemoradiation, the patient underwent laparoscopic partial intersphincteric resection, achieving a complete pathological response.

LESSONS

This case firstly highlights the usefulness of SOX plus cetuximab combined with radiation in the treatment of locally advanced rSCC. However, a large-scale study is required to establish safe and effective treatment regimens.

Primary Squamous Cell Carcinoma of the Cecum: A Case Report

Primary squamous cell carcinoma (SCC) of the colon is an exceptionally rare diagnosis. The etiology and pathogenesis of this entity remain unclear. It usually presents in patients as an emergency, typically with the tumor in the advanced stage. We report a case of SCC of the cecum presenting with perforation, initially diagnosed as SCC of unknown origin. The patient underwent a limited right hemicolectomy and end ileostomy outside our center. The patient was referred to us for further workup and possible adjuvant chemotherapy. She was assessed clinically and found to have had poor appetite and anorexia for a month, with an intermittent fever documented at 39 degrees. Thus, the patient was elected to get admitted for a septic workup and re-staging by CT scan and tumor biomarkers. CT showed a phlegmon and abscess formation at the right iliac fossa that was attached to surrounding structures, including the abdominal wall. Drain placement at the site of the phlegmon was attempted but failed due to bowel overlapping. Therefore, the patient was booked for surgical exploration and drainage, where all structures were resected en bloc. Histopathological examination revealed well-differentiated keratinized SCC with lymph node metastasis. The diagnosis of primary SCC of the cecum was confirmed after investigations to rule out primary sources were negative. Surgical resection remains the mainstay of management, with a possible role for chemotherapy and radiation therapy. The prognosis in these cases is usually poor. This warrants early diagnosis and management. Studies are needed to establish a management protocol for this entity.

Comprehensive look at rectal squamous cell carcinoma

Rectal squamous cell carcinoma (rSCC) is a rare cancer (0.5% of all rectal cancers). It typically presents at an advanced stage and has a poor prognosis. Recently, chemoradiotherapy with organ preservation has become an option for complete response (CR). Surveillance is essential to prompt recognition of recurrence due to its high risk. We present a case of an elderly woman with rSCC stage cT4N1aM0 who underwent a combination of chemotherapy (mitomycin and fluoropyrimidine) and radiotherapy with CR and organ preservation. The patient has been in follow-up for 2 years with digital rectal examination, tumour markers, pelvic MRI, thoracic and upper abdominal CT, proctoscopy and positron emission tomography, with no disease recurrence. This highlights the success of chemoradiotherapy for rSCC treatment, allowing organ preservation.

Case Report: A management strategy and clinical analysis of primary squamous cell carcinoma of the colon

Primary colorectal squamous cell carcinoma (CSCC) is a rare pathological subtype. Currently, clinical data with regards to its prognosis and treatment is limited, and there is no optimal treatment method. The case presented involves a proficient mismatch repair (pMMR) and microsatellite-stable (MSS) Colorectal cancer (CRC) patient with squamous cell carcinoma (SCC) located transversely in the colon. Based on the imaging assessment, the tumor infiltration depth is classified as T4. After receiving 4 cycles of neoadjuvant treatment with oxaliplatin and capecitabine (XELOX), the patients were evaluated for partial response (PR) in 2 cycles and stable disease (SD) in 4 cycles. The patient underwent a right hemicolectomy and received postoperative paclitaxel/cisplatin (TC) adjuvant chemotherapy. After 23 months, a systemic examination revealed abdominal metastasis. A needle biopsy was conducted on the detected abdominal metastases, with the resulting pathology indicating the presence of metastatic SCC. The individual exhibited expression of programmed cell death ligand 1 (PD-L1) and a mutation in the TP53 gene. Considering the patient's disease recurrence based on medical history, a treatment plan was formulated. This involved Sintilimab plus Cetuximab and the combination of leucovorin, fluorouracil, and irinotecan (FOLFIRI) regimen. The patient received four cycles of treatment with an efficacy evaluation of SD- and seven cycles of treatment with an efficacy evaluation of SD+, which resulted in a progression-free survival (PFS) duration of 7 months. This case study presents the conventional XELOX chemotherapy protocol, which has shown limited effectiveness, and highlights the favorable results achieved by implementing the TC adjuvant chemotherapy regimen in individuals diagnosed with primary colonic SCC. Furthermore, combining immune checkpoint blockade (ICB) with other therapies for patients with advanced disease is anticipated to provide an extended duration of survival.

Difficult diagnosis in the clinical evaluation of a patient with squamous cell carcinoma of the sigmoid colon: a case report

BACKGROUND

Squamous cell carcinoma (SCC) of the sigmoid colon is an exceedingly rare subtype of colorectal cancer (CRC) associated with chronic inflammatory conditions. Due to its variable clinical presentation ranging from subclinical to fully symptomatic and limited available information, it poses a diagnostic challenge. We aim to provide a review of the current literature and raise awareness about the importance of a thorough clinical analysis for an early diagnosis.

CASE PRESENTATION

We describe the case of a 59-year-old Peruvian woman with a medical history of diverticular disease and irritable bowel syndrome. The patient presented with nonspecific symptoms such as abdominal discomfort, constipation, and bloating. Diagnostic tests and biopsy revealed a rare case of squamous cell carcinoma of the sigmoid colon. The patient underwent surgical resection and adjuvant chemotherapy.

CONCLUSION

Despite the rarity of this type of cancer in the colon, the patient's clinical course highlights the importance of considering it as a potential diagnosis in patients with nonspecific symptoms and a history of gastrointestinal disorders. Surgical treatment followed by radiotherapy is the preferred management. Factors such as lack of postoperative complications and the stage of the neoplasia can augur a positive.

PROGNOSIS

A prompt diagnosis is crucial, as detecting a neoplasia in its early stages can make surgery more effective.

Treatment paradigm and prognostic factor analyses of rectal squamous cell carcinoma

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Primary Squamous Cell Carcinoma of the Sigmoid Revealed by Acute Intestinal Occlusion in Moroccan Young Male Patient: A Case Report and Literature Review

Primary colorectal squamous cell carcinoma (SCC) is an extremely rare subtype of colon cancer, with an incidence of less than 1% of colorectal malignancies. We report a case of a 40-year-old male patient admitted to the emergency department with symptoms of acute intestinal obstruction. Histopathological evaluation of colonoscopic biopsies revealed squamous cell carcinoma. A sigmoidectomy was performed. In order to enrich the medical literature, we add our case to the collection of colorectal squamous cell carcinoma cases by analyzing and summarizing the clinical, pathological, and therapeutic features of this rare entity.

A primary squamous cell carcinoma of the sigmoid colon in a young patient: A case report and literature review

Colon cancer is among the most common types of cancer with adenocarcinomas being the most common type. Herein we report a young patient who presented with primary colonic squamous cell carcinoma without risk factors. To the best of our knowledge, this is the youngest patient with such diagnosis worldwide.

Primary synchronous rectal squamous cell carcinoma and its exceptional response to chemoradiotherapy

A 51-year-old female presented with rectal bleeding and anal pain. A colonoscopy was performed revealing a large lesion in the middle and lower rectum. These findings were confirmed on the CT scan. Nevertheless, the histopathological analysis revealed a more uncommon synchronous squamous cell carcinoma. Thus, due to the histology, pelvic radiotherapy with concurrent chemotherapy was administered.