Fewer than 100 cases in medical history — and a freshman wrote the definitive review

Published in Frontiers in Oncology, February 2026. Lead author: Eesha Oza, NJIT/Rutgers BS/MD program.

A 72-year-old woman arrived at the hospital with abdominal pain that had been worsening for weeks. She had never had a colonoscopy — none of the age-recommended screenings that guidelines suggest. When doctors finally looked, they found a tumor on the left side of her colon. Further testing confirmed it was cancer, but not the usual kind. The malignant cells were squamous — a cell type that lines the skin and some internal surfaces but is not supposed to be in the colon at all.

Squamous cell carcinoma (SCC) of the colon is so rare that it accounts for somewhere between 0.02% and 0.1% of all colon cancers. Fewer than 100 cases have been described in medical literature, ever. The scarcity of data means there is no standardized approach to diagnosis, no consensus on treatment, and no clear understanding of why squamous cells — cells that have no business being in the colon — occasionally give rise to aggressive tumors there.

The woman's doctors treated her with surgery followed by 12 rounds of chemotherapy. It worked. More than 12 years after her diagnosis, she remained cancer-free.

The person who turned her case into something larger was a college freshman.

Seventy years of scattered data

Eesha Oza is a first-year biomedical engineering student at the New Jersey Institute of Technology, enrolled in an accelerated seven-year BS/MD program with Rutgers New Jersey Medical School. She is the lead author of a study published in February 2026 in Frontiers in Oncology that does two things: it presents the 72-year-old woman's case report, and it systematically reviews 62 cases of colorectal SCC documented between 1955 and 2025.

When Oza began digging into the existing literature as background research, the state of knowledge surprised her. The publications were short, isolated, and disconnected from one another. Individual doctors had written up individual patients, but nobody had pulled the threads together to look for patterns across cases. Each report existed as a fragment — clinically useful for the physician who wrote it, perhaps, but contributing little to a broader understanding of the disease.

Patterns in the fragments

By aggregating decades of scattered case reports, Oza and her co-authors were able to identify several consistent features. Imaging emerged as critical to proper diagnosis. Technologies like contrast-enhanced computed tomography (CT) and positron emission tomography (PET) proved important for identifying tumors early, distinguishing SCC from other colon pathologies, and mapping how far the cancer had spread.

Surgery was the primary treatment in most documented cases, with chemotherapy increasingly added for patients diagnosed at later stages. The 72-year-old woman's combination of surgical resection and chemotherapy aligned with the more successful outcomes in the literature.

But the review also highlighted how much remains unknown. Scientists still cannot explain why squamous cells appear in the colon in the first place. Several hypotheses exist — including the possibility of metaplasia (transformation of one cell type into another) or stem cell differentiation errors — but none has been definitively proven. That uncertainty complicates diagnosis, because doctors can't screen for something when they don't understand what triggers it.

The survival cliff

For colon cancer generally, early detection transforms outcomes. Patients diagnosed before the cancer spreads have a five-year survival rate of approximately 90%. When the cancer invades nearby organs, that drops to around 73%. If it metastasizes to distant sites, the survival rate falls to roughly 16%.

These numbers apply to colon cancer broadly, not specifically to the squamous cell variant — there simply aren't enough SCC cases to generate reliable survival statistics for that subtype alone. But the pattern underscores why delayed diagnosis is so dangerous. SCC of the colon produces symptoms that resemble ordinary colon cancer — abdominal pain, changes in bowel habits, bleeding — but those symptoms tend not to appear until later stages. By the time a patient presents, the window for early intervention may already be closing.

The rarity itself is the obstacle. When a cancer occurs in fewer than one in five thousand colon cancer patients, no single hospital accumulates enough experience to develop expertise. Treatment decisions are made ad hoc, based on whatever the treating physician judges best for the patient in front of them. That's not negligence — it's the reality of a disease that doesn't generate enough cases to build an evidence base.

What a review can and cannot do

Oza's study does not solve this problem. A literature review, however comprehensive, cannot substitute for the prospective clinical trials that would be needed to establish treatment protocols. With a disease this rare, such trials may never be feasible — you can't randomize patients to treatment arms when you see one case every few years.

What the review does provide is a consolidated reference. A physician encountering colorectal SCC for the first time can now consult a single source that aggregates outcomes across 62 cases and seven decades. That's not a treatment guideline, but it is better than the fragmented landscape that existed before — individual case reports scattered across dozens of journals with no synthesis.

The study also establishes a baseline for tracking future cases. If clinicians adopt a more standardized approach to documenting colorectal SCC — including consistent imaging protocols, pathology details, and long-term follow-up — the next review could draw on richer data and potentially move closer to evidence-based recommendations.

Where the unknowns remain

The fundamental biology of this cancer is still opaque. How do squamous cells arise in tissue that normally contains only columnar epithelium? Is there a common genetic driver? Do certain patient populations face higher risk? These questions remain open, and the rarity of the disease means answers will come slowly, if at all.

The sample itself is inherently limited. Sixty-two cases over 70 years, drawn from published reports across different countries, health systems, and eras of medical technology, cannot produce the kind of statistical power that larger cancer datasets allow. Reporting bias is also a concern — cases with unusual presentations or favorable outcomes may be more likely to get published than routine ones.

Still, for a cancer so rare that most oncologists will never see a single case, any organized attempt to learn from the cases that do exist serves a purpose. The 72-year-old woman who walked into the hospital with worsening abdominal pain is cancer-free 12 years later. The patterns drawn from her case and 61 others won't rewrite oncology textbooks. But they might help the next doctor who encounters a squamous cell where it doesn't belong.