Systematic review of risk factors, prognosis, and management of colorectal signet-ring cell carcinoma

Colorectal Cancer in Elderly Patients: Insights into Presentations, Prognosis, and Patient Outcomes

Background and Objectives: Colorectal cancer (CRC) ranks as the third most prevalent cancer globally and is the third leading cause of cancer-related deaths. In 2020 alone, there were over 1.9 million new cases of CRC and nearly 0.9 million deaths worldwide. The incidence and outcomes of CRC exhibit significant geographical and temporal variations, largely influenced by diverse risk factors among populations. Recognizing the prognostic factors and the presenting symptoms of CRC, a leading global cancer with high mortality, can enhance early detection and thereby improve clinical outcomes. Materials and Methods: This retrospective, observational study analyzed 724 CRC elderly patients aged 70 and over (median age 80, 53.17% male), treated at a single center. Data on demographics, clinical characteristics, and outcomes were collected. Overall survival was analyzed using Kaplan-Meier curves, with stratification based on tumor location, disease staging, lymph node involvement, and family history. Results: Our study encompassed all CRC cases treated with surgery and systemic therapies (chemotherapy or biological agents) from July 2002 to September 2020. We focused on comparing prognosis between left-sided and right-sided CRC, as well as rectal cancer. We found that left-sided CRC demonstrated a superior prognosis compared to rectal cancer (p = 0.0022). Furthermore, among patients with CRC, tumors originating in the rectum were associated with worse outcomes compared to those arising in both the right and left colon, regardless of disease stage (p = 0.0049). Additionally, a family history of CRC was associated with poorer prognosis, impacting both metastatic (p = 0.0022) and localized disease (p = 0.035). The main symptoms prompting patients to start an investigation of CRC were abdominal pain (31.49%), anemia (18.08%), rectal bleeding (hematochezia) (17.82%), change in bowel habits (9.94%), and weight loss (7.60%). Conclusions: This study provides valuable insights into the symptoms prompting initial investigation and the prognostic factors associated with CRC in an elderly population with varied characteristics. It underscores the need for increased vigilance in recognizing key symptoms and the importance of personalized treatment strategies tailored to these prognostic factors.

Primary Signet-Ring-Cell Carcinoma in the Colorectum: A Case-Based Literature Review

Primary colorectal signet-ring-cell carcinoma of the colon and rectum (PSRCCR) is an extremely rare subtype of mucinous adenocarcinoma with a reported rate of less than 1%. This low rate is mainly because it is generally diagnosed at advanced stages. The most common stage at which it is diagnosed for the first time is III or IV, with a lower median survival than other histological subtypes. To diagnose PSRCCR of the colon, at least half of the tumor must be consistent with a signet-ring-cell pattern. This review aims to provide a comprehensive overview of PSRCCR by synthesizing the existing literature and clinical data. Our objective was to elucidate the clinical features, diagnostic challenges, histopathological characteristics, molecular alterations, treatment modalities, and prognostic factors associated with this carcinoma. Additionally, we highlighted the significance of early detection, accurate diagnosis, and personalized therapeutic approaches in improving outcomes for patients with this challenging malignancy. By presenting a case report on the topic, we aimed to enhance understanding among clinicians, pathologists, and researchers, ultimately contributing to optimized management strategies and improved patient care for PSRCCR.