Signet Ring Cell Cancer

Li Liu, MD
Last Modified: November 1, 2001

Dear OncoLink "Ask the Experts,"
My 72-year-old father is suffering from stomach cancer that has started to spread. It is a signet-ring cell cancer. The cancer was found incidentally, when he was undergoing surgery to remove a stricture in his duodenum. Unfortunately the disease is spreading rapidly.

He will start with the chemo this week. We would like to help him to fight against his disease.

So, maybe you can give my family and I some tips?  
Thank you for your help,

Li Liu, MD, Editorial Assistant for OncoLink, responds:

Dear C,
Thank you for your question and interest.

Signet-ring cell cancer is a subtype of adenocarcinoma, which is the most common type of cancer arising from the stomach. It has a distinct appearance under the microscope as a result of the clear mucin it produces either inside or outside the cells. In most series, this cancer has a poor prognosis.

Surgical removal of stomach cancer is the treatment of choice, although, if you say the cancer has spread, an operation to remove the cancer is unlikely to be of benefit. Several clinical studies have reported results that indicate a moderate survival or palliative benefit for patients with advanced stomach cancer. There is no combination of chemotherapy which is clearly superior to others, but most active regimens include 5-Fluorouracil (5-FU), Cisplatin, and/or Etoposide. The combination of 5-Fluorouracil, doxorubicin, and mitomycin (FAM) has been used in the past with modest success. A prospectively randomized trial tested 5FU, Doxorubicin, and Methotrexate versus Etopiside, Leucovorin, and 5FU versus Cisplatin and 5FU. There was no statistically significant difference in survival among the various chemotherapy combinations on their preliminary report. Some newer agents, including Taxol and Gemcitabine (Gemzar®) are under investigation.

As far as diet, nutritional support of stomach cancer is a very important component of the treatment. Many patients are malnourished with some extent of weight loss prior to their diagnosis. If he is able to eat, well balanced diet with adequate protein and vegetables is appropriate. Liquid nutritional supplements such as Ensure and Carnation Instant Breakfast are recommended if oral intake is inadequate. If he is unable to swallow, feeding tube placement may be required.

You should discuss these issues with his oncologists. Also getting some input from psychosocial personnel and a dietitian may help you and your father to cope with his disease and treatment.