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SQUAMOUS CELL CARCINOMA OF RECTUM; A RURAL TERTIARY CARE CENTER EXPERIENCE
Burt Cagir1,2, Ashley Berlot3,1, Hilary Keller*1,2
1Surgery, Guthrie/Robert Packer Hospital, Sayre, PA; 2Surgery, Geisinger Commonwhealt School of Medicine, Scranton, PA; 3Integrative Neuroscience, SUNY Binghampton University, Binghampton, NY
Introduction: Squamous cell carcinoma (SCC) of the rectum is exceedingly rare. The incidence of rectal SCC is approximately 0.01% to 0.025% of colorectal malignancies, and over 90% of rectal tumors are adenocarcinomas. The symptoms of rectal cancer are relatively non-specific and thus primary rectal SCC is typically a diagnosis of exclusion. There is little reported data on this rare disease, and therefore risk factors for rectal SCC and the appropriate definitive therapy remain unclear.
Methods: This study analyzed the medical records of patients in a regional hospital system diagnosed with SCC of the rectum between 1989 and 2017 to determine common characteristics of prior risk factors, symptoms, disease progression, treatment types and efficacy, and patient outcomes.
Results: Eight patients were identified, and we found that rectal SCC presented more frequently in females than males, and the average age of diagnosis was 67.4 years (65.4 for women and 70.7 for males). The patients all presented with similar symptoms, and the average overall survival was 6.05 years after initial diagnosis. All patients were found to have cancer specifically in the rectum. Half of the patients were diagnosed with poorly differentiated SCC of the rectum, and 75% of these patients died, with an overall survival of 4.67 years after diagnosis. The patients were diagnosed at the following stages: stage I (n=1), stage II (n=1), stage III (n=3), and stage IV (n=3). Patients with stage IV disease died in 19.25 months on average. Three patients had liver metastases; two were found to have liver metastases on initial diagnosis, and another was initially diagnosed with Stage III rectal SCC who later progressed. One patient underwent curative abdominoperineal resection (APR). All but one patient received chemotherapy, consisting of 5-fluorouracil (5-FU) with an alternating second agent, and 75% of patients underwent radiotherapy. A combination of chemotherapy and radiotherapy was effective in treating those diagnosed early.
Conclusion: Symptomatic patients at increased risk for colorectal malignancies should be examined with colonoscopy. Proactively screening patients with endoscopy may allow clinicians to diagnose the common colorectal pathology, as well as SCC of the rectum, ideally in its early stages. A combination of chemotherapy, radiotherapy, and surgery may potentially be curative with early diagnosis.
Patient characteristics and Disease description
| Patient | Year Diagnosed | Age of Diagnosis | Clinical Presentation | Method of Diagnosis | Location | Pathology | CEA | Surgery | | 1 | 1989 | 66 | Unknown | Unknown | Rectum | SCC | 2.0 | APR | | | 2 | 2014 | 60 | Cramping, tenesmus and pain in pelvis/rectum, constipation | Endoscopy and biopsy | Low rectum above dentate line | SCC | 0.3 | Diverting Colostomy | | | 3 | 2016 | 77 | Hematochesia | Endoscopy and biopsy | Low Rectum above dentate line | Poorly differentiated SCC | 1.2 | None | | | 4 | 2017 | 67 | Pain in rectum, tenesmus, constipation, and weight loss | Endoscopy and biopsy | Mid and low rectum | Poorly differentiated SCC | 2.3 | None | | | 5 | 2013 | 64 | Pain in rectum and vagina, tenesmus, Blood with wiping | Digital rectal exam and biopsy | Rectosigmoid junction and mid rectum | Poorly differentiated SCC | 1.4 | None | | | 6 | 2016 | 76 | Diarrhea, constipation, urgency, frequency, anemia, tenesmus | Digital rectal exam and biopsy | Rectum | SCC | None | None | | | 7 | 2017 | 70 | Hemathochesia, pain in tail bone | Colonoscopy and biopsy | Low rectum 2 cm above dentate line | SCC | 5.3 | None | | | 8 | 2014 | 59 | Pain, hemathochesia, urgency, frequency | Colonoscopy and biopsy | Low rectum above dentate line | Poorly differentiated SCC | None | None | |
Treatment Regimens and outcome | Patient | Stage at Diagnosis | METASTASIS | ADJUVANT THERAPY | Radiotherapy | Second Primary | OUTCOME | | 1 | III (TXN1M0) | None | 5FU+Carboplatin | Yes | Lung SCC | Died 144 Mos. after diagnosis | | 2 | IV (T3N1M1) | Liver | 5FU+Mitomycin | 5040 Gy | None | Died 16 Mos. after diagnosis | | 3 | IIA (T3N1M1) | None | 5FU+Mitomycin | 5040 Gy | Pancreatic Adenocarcinoma | Died 3 mos. after diagnosis | | 4 | IV (T4N1M1) | Liver, Lung and Adrenal | 5FU+Mitomycin | None | None | Died 3 mos. after diagnosis | | 5 | IIIB (T3N2MX) | None | None | 5040 Gy | None | Died 8 mos. after diagnosis | | 6 | IV | Spine and Pelvis | 5FU+Cisplatin | None | None | Died 0.25 mos. after diagnosis | | 7 | I (T2N0M0) | None | 5FU+Mitomycin | 5040 Gy | None | Alive 6 mos. after diagnosis | | 8 | IIIC (T4BN1M0) | Liver at 1 year after diagnosis | 5FU+Mitomycin | Yes | None | Alive as of 2015 |
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