title: Signet ring colorectal carcinoma: Do we need to improve the treatment algorithm?
abstract: OBJECTIVE
  To elaborate about this peculiar variant from a tertiary cancer center from India.
  
  
  METHODS
  It's a retrospective study (2011-2014) of all patients diagnosed with signet ring colo-rectal cancer (SRCC). Various clinico-pathological variables were studied.
  
  
  RESULTS
  One hundred and seventy consecutive patients with SRCC were diagnosed (11.4% of all colorectal cancers). Median Age of the cohort was 41 years. Most common location was recto-sigmoid area (54.7%). Majority patients presented in stage III and IV (91.2%). Most of the stage IV patients had isolated peritoneal metastases (86.5%). Colonic tumors had higher incidence of peritoneal metastases (91.8%vs83.3%) as well as isolated peritoneal recurrences (37.5%vs16.7%) than rectal primaries. Thirty-seven point five percent of patients recurred after curative surgery. Amongst them 63.63% patients had isolated peritoneal recurrences. Circumferential resection margin (CRM) was involved in 17.9% patients. Median relapse free survival (RFS) and overall survival (OS) of the cohort were 14.9 and 18.13 mo respectively. CRM involvement, colonic primary were associated with poorer RFS and OS.
  
  
  CONCLUSIONS
  SRCC has predilection for peritoneal dissemination. More aggressive and/or extended chemotherapy schedules as well as prophylactic hyperthermic intra-peritoneal chemotherapy at the time of primary surgery may be attempted in these patients.
authors.affiliation: Anup Sunil Tamhankar, Parag Ingle, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra 400012, India.
authors.forename: Anup Sunil
authors.initials: AS
authors.lastname: Tamhankar
authors.affiliation: Anup Sunil Tamhankar, Parag Ingle, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra 400012, India.
authors.forename: Parag
authors.initials: P
authors.lastname: Ingle
authors.affiliation: Anup Sunil Tamhankar, Parag Ingle, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra 400012, India.
authors.forename: Reena
authors.initials: R
authors.lastname: Engineer
authors.affiliation: Anup Sunil Tamhankar, Parag Ingle, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra 400012, India.
authors.forename: Munita
authors.initials: M
authors.lastname: Bal
authors.affiliation: Anup Sunil Tamhankar, Parag Ingle, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra 400012, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Ostwal
authors.affiliation: Anup Sunil Tamhankar, Parag Ingle, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra 400012, India.
authors.forename: Avanish
authors.initials: A
authors.lastname: Saklani
keywords: Colorectal cancer; Hyperthermic intra-peritoneal chemotherapy; Peritoneal metastases; Signet ring cell carcinoma