Signet ring cell with mucoid

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Beloved fiancée
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Joined: Mon Jan 22, 2018 1:47 pm
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Signet ring cell with mucoid

Postby Beloved fiancée » Tue Jan 30, 2018 9:03 pm

Hello everyone,
My beloved was diagnosed on 0ct 20 2017 with signet ring cell Adenocarcinoma poorly differentiated and mucoid type. He is Stage 3B with 6 out of 12 lymp positive. Clear margins. He started chemo mid January due to surgical complications. He is on his second Folfox treatment. His oncologist said he will do a scan after his 12 Folfox treatment and follow up every 6 months. I Am afraid since his cancer is too aggressive. How are you all doing the follow up? Any advice? Are there any long term survival for his type of cancer? Thank you all for the replies
Diagnosed 0ct 2017 colon Cancer
Procedure: right hemicolectomy
Stage: 3BT4 Mucinous with Signet-Ring Cell poorly differentiated. :(
Treatment: Started Jan. 2018 Folfox
Ct scan July 2018: clear with prominent mesenteric 11X9 mm
Pet scab Aug 2018: CLEAR
Now and Forever Cured! Thank to the LORD

fumaros
Posts: 273
Joined: Sat Jul 02, 2016 10:26 pm
Location: Syracuse, NY
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Re: Signet ring cell with mucoid

Postby fumaros » Wed Jan 31, 2018 10:51 am

Hi Beloved fiancee,

Cancer is always shocking to hear as a diagnosis and signet ring cell (SRC) always feels like a double blow in an already crippling event. However, there are certainly long-term survivors who have had cancer with signet ring cell features. It is treatable. I would strongly state that the standard frequency of follow up scans for SRC have to be more frequent than every 6 months. I received a scan half way through chemo, and scans every 3 months for the first year, and will be getting scanned every 4 months for the second year after chemo. SRC is very aggressive compared to standard colorectal cancer (CRC), treatment is usually the standard chemo regimen for CRC, the only difference being the frequency of scans as it needs to be caught early if there is ever recurrence (hopefully not). Also, if your fiance hasn't, he might want to consider getting a second opinion at a major cancer treatment center like MSKCC.
Diagnosed 4/8/16, age 29
Colectomy 4/20/16
Stage III, T4bN1 Tumor 7x6.5x2. Muscinous Adenocarcinoma with SRC features
2/16 lymph nodes
Stage IV, Peri mets 5/2019
CEA 4/14/16 - 16.8
CEA 6/2/16 - 1.9
CEA 6/17/16 - 0.87, 7/16 - 1.33, 12/16 - 1.14, 4/17 - 0.6, 7/17 - 0.5, 10/17 - 0.9, 3/19 -5.8, 4/19 -10
FOLFOX began 6/24/16 - 11/25/16, FOLFIRI - 5/10/19
10 round FOLFOX, 2 round 5-FU & Leucovorin, 1 round FOLFIRI
MRI & CT 8/16 - NED, CT 12/16 - 10/17 - NED

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O Stoma Mia
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Location: On vacation. Off-line for now.

Re: Signet ring cell with mucoid

Postby O Stoma Mia » Fri Feb 02, 2018 3:06 am

I do not have any experience with SRC, but from what I have read I would agree with what fumaros has said. This is an aggressive type of cancer, and the medical team needs to be on top of things to catch any change or progression of the disease

By the way, for both Signet Ring Cell Carcinoma and Mucinous Adenocarcinoma, there are two levels of possiblediagnosis, one if the component is judged as > 50% and the other if the component is judged as < 50%. The latter is easier to treat than the former.

Here are some references from the Stanford Pathology Department that you may or may not have already seen

Signet Ring Adenocarcinoma of the Colon and Rectum
Definition
• Adenocarcinoma, arising in the colon or rectum, of which >50% of the lesion is composed of signet ring cells
Diagnostic Criteria
• Colorectal adenocarcinoma composed of >50% signet ring cells
o Distended mucin vacuole displaces cytologically atypical nucleus to one side
• May also be associated with extracellular mucin
o If >50% of area of tumor is extracellular mucin, see Mucinous Adenocarcinoma
• If ≤50% signet ring cells, designate as:
o Adenocarcinoma with signet ring component ...
Ref: http://surgpathcriteria.stanford.edu/gitumors/colorectal-signet-ring-adenocarcinoma/
= = =
Mucinous Adenocarcinoma of the Colon and Rectum
Definition
• Adenocarcinoma, arising in the colon or rectum, of which >50% of the lesion is composed of mucin
Diagnostic Criteria
• Colorectal adenocarcinoma of which >50% of the lesion is extracellular mucin
o Pools of mucin dissect through the stroma
• Mucin pools contain malignant epithelium
o Strips of cells may float freely in or partially line the pools
• Gland formation and single cells may be seen
o Signet ring cells may be present
If >50% of cells are signet ring, see Signet Ring Adenocarcinoma
• If <50% of lesion is composed of mucin, designate as:
o Adenocarcinoma with mucinous component
Ref: http://surgpathcriteria.stanford.edu/gitumors/colorectal-mucinous-adenocarcinoma/index.html


And here are some old bibliographic items related to SRC
Bibliography

• Sasaki S, Masaki T, Umetani N, Futakawa N, Ando H, Muto T. Characteristics in primary signet-ring cell carcinoma of the colorectum, from clinicopathological observations. Jpn J Clin Oncol. 1998 Mar;28(3):202-6.
• Kang H, O'Connell JB, Maggard MA, Sack J, Ko CY. A 10-year outcomes evaluation of mucinous and signet-ring cell carcinoma of the colon and rectum. Dis Colon Rectum. 2005 Jun;48(6):1161-8. https://www.ncbi.nlm.nih.gov/pubmed/15868237
• Pande R, Sunga A, Levea C, Wilding GE, Bshara W, Reid M, Fakih MG. Significance of signet-ring cells in patients with colorectal cancer. Dis Colon Rectum. 2008 Jan;51(1):50-5.

lkub
Posts: 21
Joined: Mon Mar 14, 2016 12:14 am

Re: Signet ring cell with mucoid

Postby lkub » Fri Feb 02, 2018 6:21 pm

My husband has SRC and it IMO it was not monitored closely enough. It's wonderful that his team is vigilant. I see that you joined the small SRC support group on FB. There are success stories there of people pre-stage 4.
DH-stage 3b rectal signet ring cell dx 11/15 age 41
rad/xeloda 12/15-1/16
total colectomy&ileo(jpouch) 3/16
4/16 CEA 0.6
oxali&xeloda 3/16-8/16
clean CT 9/16 NED
10/16 reversal
4/17 CEA 1.4
10/17 CEA 44.4
10/17 CT mets to nodes peritoneum pelvis-stage 4
10/17 biopsy KRAS/BRAF/NRAS wild
11/17 port
11/17 FOLFIRI+erb
1/18 Erb failed CT mets spine/pelvis
2/18 stent ureteral obst
2/18 FOLFIRI+Avastin
3/18 small bowel obstr
3/18 CEA 114
4/18 FOLFOX+Vbix FAILED
5/18 ascites
6/18 hospice
Lynch neg

Beloved fiancée
Posts: 8
Joined: Mon Jan 22, 2018 1:47 pm
Facebook Username: Silianai

Re: Signet ring cell with mucoid

Postby Beloved fiancée » Tue Feb 06, 2018 11:09 pm

lkub wrote:My husband has SRC and it IMO it was not monitored closely enough. It's wonderful that his team is vigilant. I see that you joined the small SRC support group on FB. There are success stories there of people pre-stage 4.



How often was your husband getting his scan/pet and colonoscopy? I am very sorry that his cancer returned :(

I’ve spoken with 2 oncologists and one agreed with me that follow up should be done every 3 months for the first year. And maybe every 4 months for the second year. And after every 6 months. I also want colonoscopy every year at least. It is so scary that this cancer are not well detected in scans. His CEA has been normal
Diagnosed 0ct 2017 colon Cancer
Procedure: right hemicolectomy
Stage: 3BT4 Mucinous with Signet-Ring Cell poorly differentiated. :(
Treatment: Started Jan. 2018 Folfox
Ct scan July 2018: clear with prominent mesenteric 11X9 mm
Pet scab Aug 2018: CLEAR
Now and Forever Cured! Thank to the LORD

lkub
Posts: 21
Joined: Mon Mar 14, 2016 12:14 am

Re: Signet ring cell with mucoid

Postby lkub » Wed Feb 07, 2018 8:15 pm

Beloved fiancée wrote:
How often was your husband getting his scan/pet and colonoscopy? I am very sorry that his cancer returned :(

I’ve spoken with 2 oncologists and one agreed with me that follow up should be done every 3 months for the first year. And maybe every 4 months for the second year. And after every 6 months. I also want colonoscopy every year at least. It is so scary that this cancer are not well detected in scans. His CEA has been normal



He had blood tests at 6 months and a CT scan at 1 year. He had his colon removed, so he had a scope of his j-pouch 6 months after his reversal. On one hand, I feel mad that he wasn't monitored more closely but on the other hand, if it wouldn't have changed the outcome then at least we had a year of ignorant bliss having no idea that his cancer was aggressive and rare and not thinking it would return.
DH-stage 3b rectal signet ring cell dx 11/15 age 41
rad/xeloda 12/15-1/16
total colectomy&ileo(jpouch) 3/16
4/16 CEA 0.6
oxali&xeloda 3/16-8/16
clean CT 9/16 NED
10/16 reversal
4/17 CEA 1.4
10/17 CEA 44.4
10/17 CT mets to nodes peritoneum pelvis-stage 4
10/17 biopsy KRAS/BRAF/NRAS wild
11/17 port
11/17 FOLFIRI+erb
1/18 Erb failed CT mets spine/pelvis
2/18 stent ureteral obst
2/18 FOLFIRI+Avastin
3/18 small bowel obstr
3/18 CEA 114
4/18 FOLFOX+Vbix FAILED
5/18 ascites
6/18 hospice
Lynch neg


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