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Small cell rectal cancer: a therapeutic challenge
Alex Fitzhugh1, Alison Corr2, Arshi Denton3
1Department of Inherited Intestinal Cancer Syndromes, St Mark's Hospital and Academic Institute, Harrow, UK.
BMJ Case Reports
|October 9, 2021
Summary
Extrapulmonary small cell carcinoma (EPSCC) of the rectum is rare. This case highlights challenges in diagnosis and treatment, with limited evidence for managing this aggressive rectal cancer.
Area of Science:
- Gastroenterology
- Oncology
- Pathology
Background:
- Extrapulmonary small cell carcinoma (EPSCC) is a rare malignancy.
- Rectal EPSCC presents diagnostic and therapeutic challenges due to limited evidence.
- Small cell lung cancer (SCLC) treatment protocols are often extrapolated for EPSCC.
Observation:
- A 71-year-old man presented with altered bowel habits and hematochezia.
- Colonoscopy revealed a rectal mass with histological features of EPSCC.
- Imaging showed limited-stage disease with a threatened circumferential resection margin.
Findings:
- The patient received modified platinum chemoradiotherapy for SCLC with an excellent response.
- Surgery was precluded due to cardiac function.
- The patient developed hepatic metastases, local recurrence, and died 15 months post-diagnosis.
Implications:
- Rectal EPSCC management requires a multidisciplinary approach.
- Treatment strategies often rely on SCLC protocols.
- Immunotherapy shows promise for metastatic EPSCC.
- Further research is needed to define optimal surgical and medical management.
