Concurrent Chemoradiation With 5-Fluorouracil and Mitomycin in Squamous Cell Carcinoma of the Rectum

Abstract

Rectal carcinoma-squamous type is infrequently seen. Etiopathogenesis, prognosis, and therapeutic management of rectal squamous cell carcinoma (SCC) are not clearly defined. Rectal SCC is now approached with definitive upfront chemoradiotherapy (CRT), with 5-fluorouracil (5-FU) and mitomycin with a goal to avoid surgery. However, its management is planned based on histology features regardless of the localization of SCC rectal cancer. We present a case of a 47-year-old Caucasian female with rectal SCC who is under remission for two years after being treated with upfront chemoradiation with mitomycin and 5fluorouracil (5-FU).

Comprehensive look at rectal squamous cell carcinoma

“…Rectal squamous cell carcinoma is a rare type of rectal cancer, with a poor prognosis, which starts in the squamous cells that line the rectum. Similarly to colorectal adenocarcinoma, it is more common in the elderly but, in contrast, it is more common in women 2. Risk factors are not entirely known.…”

“…Risk factors are not entirely known. For instance, regarding HPV, its role in rectal cancer is controversial, although it is a well-known risk factor for other squamous cell cancer types (namely cervix) 2. Theories have been proposed to explain the origin of squamous cell rectal cancer, including the presence of pluripotent stem cells in the rectum, most blaming chronic damage such as inflammatory bowel disease, viral infections or radiation exposure 11…”

“…Of these, around 9 in 10 are adenocarcinomas. Rectal squamous cell carcinoma (rSCC) accounts for less than 0.5% of all rectal cancers and it is more common in women and the elderly 1 2. This type of cancer is thought to arise in the squamous cells of the transitional zone between the rectum and anal canal 1 3.…”

“…However, more recent studies have shown it to be more closely related to anal cancer. Thus, nowadays histology, rather than location, dictates the treatment, and the treatment strategy used for anal cancer is preferred 2. The treatment and surveillance guidelines are changing, with the goal of organ preservation and better quality of life for patients 3.…”