Dados do Resumo

Título

Squamous Cell Carcinoma of the Rectum: A Report of a Rare Case

Introdução

Squamous cell carcinoma (SCC) of the rectum is extremely rare, accounting for 0.002% to 1% of colorectal malignancies. Its clinical presentation is similar to that of adenocarcinoma, and diagnosis relies on physical examination, endoscopy, and immunohistochemistry. The treatment remains controversial, with debates between primary surgery and neoadjuvant therapy.

Objetivo

This study aims to report a case of rectal squamous cell carcinoma (SCC) treated with radiotherapy and chemotherapy, followed by surgical intervention. It also presents a literature review, as a randomized study comparing surgery and chemoradiotherapy for this rare cancer is unlikely to be conducted.

Métodos

A 47-year-old female patient with a history of smoking and breast cancer presented with changes in bowel habits. Colonoscopy diagnosed her with moderately differentiated squamous cell carcinoma in the rectum, 10 cm from the anal verge. Initial treatment included neoadjuvant chemotherapy and radiotherapy. The patient later developed acute abdominal obstruction, requiring a sigmoidostomy. Re-staging revealed peri-aortic lymph nodes and a tumor mass in the rectum with adhesions and purulent secretion. She underwent a retossigmoidectomy, Hartmann’s procedure, and transanal closure of the rectal stump.

Resultados

Rectal squamous cell carcinoma (SCC) is rare and may be associated with chronic inflammatory conditions such as radiation, colitis, HPV, and schistosomiasis. Symptoms are similar to those of adenocarcinoma, including tenesmus and rectal bleeding, but diagnosis often occurs at advanced stages. Diagnosis involves physical examination, endoscopy, and histopathological analysis with immunohistochemistry. Staging, performed through endoscopic ultrasound and computed tomography, is crucial for prognosis and treatment planning, with surgery being the main approach. Recent advances include neoadjuvant therapy. Rectal SCC may arise from squamous metaplasia or embryonic ectopia. Treatment typically involves anterior or abdominoperineal resection, with radiotherapy used as adjuvant or neoadjuvant therapy.

Conclusões

Chemoradiation is increasingly being used as a treatment option for cancer, either alone or in combination with surgery. The effectiveness of chemoradiation is assessed through histopathology, but no definitive protocol exists. The combination of 5-FU and high-dose radiotherapy appears promising, although further research is needed to establish the optimal regimen. Comparative studies between surgery and chemoradiation are unlikely for this rare cancer. Thus, chemoradiation may be considered the primary treatment, with surgery as a rescue option.