Thank you for your reply and for providing the additional information. At this point, I will address only the issue of your mother's tentative diagnosis, in particular, the tumor type as reported in the biopsy report.
Apparently, your mother was diagnosed with "Adenocarcinoma with signet cells". This particular diagnosis is one of two possible SRC diagnoses. In essence, it is an "early stage" SRC, not a "late-stage" SRC.
The details for the two definitions and diagnosis codes for Signet Ring Cell are given below:
Colon and rectumICD10: C18-C20
A usually aggressive, poorly differentiated invasive adenocarcinoma characterized by the presence of malignant glandular cells in which the nucleus is pressed to one side by the presence of intracytoplasmic mucus.
Signet ring cell carcinoma of the colon and rectumThis variant of adenocarcinoma is defined by the presence of > 50% of tumour cells with prominent intracytoplasmic mucin, typically with displacement and moulding of the nucleus. Signet-ring cells can occur within the pools of mucinous adenocarcinoma or in a diffusely infiltrative process with minimal extracellular mucin in a linitis-plastica pattern. Large signet-ring cells can be termed "globoid cells". Some signet ring cell carcinomas are MSI-H and are low-grade, but those that lack MSI-H are usually highly aggressive
6 .
Carcinomas with signet-ring cell areas of < 50% are categorized as
Adenocarcinoma with a signet-ring cell component.
◄◄ NoteReference:
https://codes.iarc.fr/code/2981
Please note that there are two different possible diagnosis codes, corresponding to two different levels or stages of SRC, as follows:
- 8490 - Signet ring cell carcinoma of the colon and rectum: "This variant of adenocarcinoma is defined by the presence of > 50% of tumour cells with prominent intracytoplasmic mucin, typically with displacement and moulding of the nucleus
- 8140 - Adenocarcinoma with a signet-ring cell component: "Carcinomas with signet-ring cell areas of < 50%"
The difference between the two is that the first one contains more than 50% SRC cells, and the second one contains less than 50% SRC cells.
Apparently, your mother has been diagnosed with "
8140 - Adenocarcinoma with a signet ring cell component", which is the less aggressive of the two (i.e., early stage SRC).
This may explain why the doctors are not particularly concerned at the moment. Since your mother has been tentatively staged as Stage IIIA (with no remote metastases), this means that all of the malignancy is thought to be contained in the tumor itself and the adjacent lymph nodes, which will all soon be removed completely by surgery (after the 6 weeks of neoadjuvant chemo/radiation, of course).
The 6 weeks of chemo/radiation should be fairly effective in attacking any circulating tumor cells that happen to be in the pelvic region.
After the surgery to remove the primary tumor and all of the adjacent lymph nodes, there will be about 4 months of adjuvant ("mop-up") chemotherapy to take care of circulating tumor cells that may be present in the rest of the body.
This is my personal view of the situation. But please keep in mind that I am not a doctor or medical professional. This is only my personal opinion after reading some of the on-line articles on Signet Ring Cell carcinoma.