An Insight into the Peculiarities of Signet-Ring Cell Carcinoma of the Colon – a Narrative Review

Abstract

Background: Signet-ring cell carcinoma of the colon (SRCC) is a rare and distinct form of colon cancer associated with a poor prognosis. Despite the rapid advancement of personalized cancer treatments, there is currently no recommended specific treatment for this histological subtype. Materials and Methods: In this literature review, we explored and described the features that distinguish SRCC from other forms of colorectal cancer, focusing on clinical presentation, preoperative workup, and treatment. Results: One of the aspects that makes SRCC unique is that it is detected more often in the ascending vs other parts of the colon, regardless of age and gender. As a result, patients, unfortunately, present with a more advanced stage than other locations upon the initial diagnosis.Imaging techniques and tumor markers alone often fall short of revealing the extent of a tumor, and curative surgery procedures are rare. Neoadjuvant therapy in SRCC is currently recommended only in the context of a clinical trial. Adjuvant chemotherapy, on the other hand, appears promising in improving survival, especially in the stage III subgroup. SRCC have a higher incidence of BRCA1 and BRAF gene mutations when compared to adenocarcinomas, alongside to an increase in microsatellite instability. These particularities suggest that a targeted therapeutic approach may sometimes be considered. Conclusion: Given its specific clinical characteristics and poor survival outcomes, SRCC should be considered a distinct colon cancer entity. Although its rarity makes prospective trials difficult, a timely diagnosis and a correct treatment decision-making algorithm is important.