Neuroendocrine tumors include a wide spectrum of lesions including microcarcinoid, carcinoid, and mixed endocrine/exocrine tumors, and small cell carcinoma (SCC). SCC most commonly originates in the lungs, but it can originate anywhere in the body, including the esophagus , large bowel  or urinary bladder , and is then referred to as extrapulmonary SCC.
Gastrointestinal (GI) SCC is a type of extrapulmonary carcinoma, and the GI tract is known to have the largest population of neuroendocrine cells . Approximately 650 cases of SCC of the GI tract have been reported in the literature . Colorectal SCC was reported to comprise 25% of all reported SCC cases of the GI tract , and the incidence of this carcinoma is less than 0.2% of all types of colorectal cancers .
Staging  and management  of GI tract SCC have been proposed and implemented in case reports and a few retrospective studies. The staging system was introduced by the Veteran’s Administrating Lung Study Group (VALSG) for primary SCC of the lung . According to this system, SCC can be divided into two categories: 1) limited disease, in which the tumor is contained within a localized region; and 2) extensive disease, in which the tumor is outside the locoregional boundaries. The treatment for limited disease is local treatment in the form of radiotherapy, surgery, or both, plus platinum-based chemotherapy [7, 9, 10]. Distant metastasis (extensive disease) is treated with platinum-based combination chemotherapy [9, 11].
Unfortunately, patients with SCC of the GI tract have a dismal prognosis, with a median survival of only 6 to 20 months [2, 12, 13]. Moreover, patients with liver metastasis have a median survival of a few weeks [14–16]. Thus, very few cases of colorectal SCC have been reported in the literature, Only three cases of colorectal SCC metastasizing to the liver have been reported and the outcome was extremely poor.
We therefore describe the first such case, to our knowledge, of successful surgical treatment of SCC of the rectum with advanced stage liver metastasis, followed by combination chemotherapy achieving long-term survival.