Expert: Claes-Gustaf Nordquist, M.D. - 8/15/2006

Question
I have another question to ask of you. How many patients have you had with signet ring cell carcinoma,what were their survival rates,what were your recommendations as far as treatment for them? If they're still living,how long have they had this cancer?  Sincerely,Lisa
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Followup To

Question -
First I want to thank you,for your insight,and truthfulness.To answer your questions you've asked,my mother is in stage 3,the tumor had penetrated through the wall,her surgeon removed 11 lymph nodes,and they all came back positive. She had to be hopitalized back in May,she was running a high fever of 104 degrees,they had to give her blood transfusions,her wbc was .7 and her red blood cell count was 7,she was in alot of pain,because she had this big mass the size of a baseball,when they went to do another CT scan to be able to do the biopsy,they couldn't,because it had broken up into pieces in her body,but the lymph nodes around the aorta were enlarged,and now her medical doctor thinks she may have Lymphoma, Now that she has had 8 treatments her oncologist has her set up for her to have another CT scan Monday 8-14-06,and she'll see him on the 16th for the results,and her 9th treatment,if she's able,her hemoglobin hematicrit is always low.We will also have the CEA results,which at the time of her surgery was51%,and then in April it was 32%,and in June it was 8.5%. Her oncologist said that if the CT scan shows that the lymph nodes are still enlarged,a biopsy would need to be done to see if it is the same cancer from her colon or a different kind of cancer,he said she would have to be opened up,which her surgeon doesn't want to do. Her oncologist said if it turns out to be a different cancer,there would be no reason to continue chemo,because it's difficult to treat 2 different kinds of cancer with chemo. It upsets me ,because We've asked the oncologist to do a PET scan,just to see if it has spreaded to any other organs,but he won't do one. My mom keeps getting these big hard lumps in her legs,arms, and breasts. I believe her tumor was 3.5cm. I will have to make sure and get back to you on that.I hope this information will help you to answer my questions.  Sincerely,Lisa
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Followup To

Question -
What can you tell me about signet cell carcinoma? What clinical facts do you need,I will be glad to tell you what I can.What is the survival rate,with someone,who has signet ring cell carcinoma?  Sincerely,Lisa
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Followup To

Question -
My mother was diagnosed with colon cancer in January,and the cancer she has is signet ring cell carcinoma,her surgeon recommended she not take chemo,but she is just in case she's that 1 in a 1000 that it will help.She hasn't been doing well on the chemo,and wishes she didn't take it,her lymph nodes are enlarged around her aorta,and the doctor's think she may have another cancer growing.I don't want my mother through any more chemo if it's not going to help her. She has 4 more treatments to go,12 treatments all together. Any information you can give me would be greatly appreciated.

Answer -
All I can say - not being there and having all clinical facts at hand - is that since the chance of success is so small and she suffers so severe side effects it does not seem in any way a wise decision to continue with her chemo therapy. Finally, your mother has the last word in any such decision! If she does not want to continue that is it!


Answer -
A signet ring carcinoma (can be of the large bowel/rectum, of the stomach and of the breast) is a special form of cancer with a worse prognosis than the ordinary adenocarcinomas of these sites. The name comes from the fact that in a microscope the cancer cells look somewhat like signet rings. To be able to evaluate her situation in any way I do need to know her stage! That means that I need to KNOW to what extent her cancer has spread to other sites (surroundings, lymph nodes & other organs). If that is not KNOWN I can not make any evaluation. IF her cancer has indeed spread to some lymph nodes, then a cure is unfortunately no longer possible and it is very likely that she will die of her cancer - or rather certain unless she dies of something else in the meantime. How long that is going to take is however impossible to say because of lack of information. At this moment as far as I understand we do not even KNOW if her cancer has indeed spread. So any real evaluation is at present not possible.
I'm sorry but that is all I can tell you at present!


Answer -
Yes in that case she is at least a stage 3. Yes I agree that a biopsy/or biopsies is/are necessary! I agree with her oncologist. You do need to know what those enlarged lymph nodes are. If her CEA has gone down as stated then the chemo is at least having some effect, but if there is another tumour too then there is not much to be done! A PET can of course be done but will hardly change the practical situation since the biopsy need will not change. In other respects my previous statement is not changed. Thanks!


Answer
Lisa, I suffered a stroke 3.5 years ago, am partly paralyzed in my left side. Due to this catastrophy I retired. The computer of my office is stored in my attic. I have no possibility of helping you with that kind of research. Furthermore, my professional career spanned more than 30 years. I have worked in many places. Though I worked part time in my private practice since May 1979 and full time from May 1997 I also worked in many government (Swedish) hospitals - both civilian and military from around 1970 until I left the military just before going private full time. Also my private practice was not computerized until 1995. All this means that I do not at present have access to the material I would need to have in order to answer your questions. I have seen such patients yes, but I can not give you more statistics than that. Due to the fact that I have had such patients I also had to read the available litterature on the subject. It is now many years later difficult to remember what is based on personal experience and what is based on those litterature studies. The same applies too on more common tumours like for example breast cancer. Besides during all this time treatment has changed. When I entered oncologu and radiation therapy almost 36 years ago only surgery was available for the intestinal tumours. Chemo therapy of any value came much later. Radiation therapy is of value for rectum cancers but hardly for the rest of the large bowel. So therapy and therapy results have changed over time. That is all I can tell you in my present situation.