Signet ring colorectal carcinoma: Do we need to improve the treatment algorithm?

Area of Science:

• Gastroenterology
• Oncology
• Surgical Pathology

Background:

• Signet ring cell colorectal cancer (SRCC) is a rare and aggressive subtype of colorectal cancer.
• Understanding its unique behavior, particularly its propensity for peritoneal dissemination, is crucial for effective management.

Purpose of the Study:

• To describe the clinical and pathological characteristics of SRCC.
• To analyze patterns of recurrence and survival in patients with SRCC.
• To identify prognostic factors associated with SRCC outcomes.

Main Methods:

• A retrospective analysis of 170 patients diagnosed with SRCC between 2011 and 2014 at a tertiary cancer center in India.
• Evaluation of clinico-pathological variables, including tumor location, stage, metastasis patterns, and circumferential resection margin (CRM) involvement.

Main Results:

• SRCC constituted 11.4% of all colorectal cancers, with a median age of 41 years.
• Most patients presented with advanced disease (Stage III/IV), frequently with isolated peritoneal metastases (86.5%).
• Colonic SRCC showed a higher incidence of peritoneal metastases and recurrences compared to rectal primaries. CRM involvement and colonic origin were linked to poorer relapse-free and overall survival.

Conclusions:

• SRCC exhibits a strong predilection for peritoneal dissemination.
• Consideration of more aggressive chemotherapy regimens and prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) during primary surgery may benefit patients.
• Early detection and tailored treatment are essential for managing this aggressive cancer subtype.