# Signet ring cell carcinoma of the colon and rectum

Source: https://onco.cc/cancers/colorectal-signet-ring-cell-carcinoma/  
OnCo record `colorectal-signet-ring-cell-carcinoma` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Signet ring cell carcinoma is a rare form of bowel cancer, about one in a hundred, in which the cells fill with mucus that pushes the nucleus aside, like a ring. It occurs in younger people, favours the right colon, is usually found at an advanced stage and often spreads across the lining of the abdomen, so its outlook is poor; it is treated like other bowel cancer for want of trials of its own.

## Summary

The WHO classification defines signet ring cell carcinoma by signet ring cells making up more than 50 percent of the tumour (Nagtegaal 2020). The review evidence associates it with young age, proximal site, advanced stage, high grade, frequent node involvement, peritoneal metastasis and a significantly poor prognosis; molecularly, the classic WNT, RAS-MAPK and PI3K pathways are mutated less often than in ordinary adenocarcinoma while RNF43, CDH1, SMAD4 and TGF-beta pathway genes are altered more often, and many but not all studies report more BRAF mutation and microsatellite instability (Pathology Oncology Research 2021). In the meta-analysis, signet ring cell patients were younger and twice as likely to have right-sided disease (odds ratio 2.12), and five-year overall survival was worse than adenocarcinoma (hazard ratio 2.54 for signet ring and mucinous combined) (Discover Oncology 2021). In the Munich registry it was diagnosed at more advanced stages, with reduced survival (J Cancer Res Clin Oncol 2016).

How it differs from its parent: it is the histology with the worst outlook among colorectal cancers and with peritoneal rather than liver spread, and it shares its cell type and CDH1 biology with diffuse gastric cancer rather than with ordinary colon adenocarcinoma.

How common: about 1 percent (Discover Oncology 2021).

Treatment: as the parent by stage and mismatch repair status; peritoneal disease follows the colorectal page's approach to peritoneal metastases; there is no trial in the type.

## Fields

- Kind: Cancer
- Last checked: 2026-09-24
- Also known as: Signet-ring cell colorectal cancer; Signet ring cell carcinoma; Signet ring cell adenocarcinoma of the colon; Signet-ring cell carcinoma of the colorectum
- Tags: subtype-page; wave4; colorectal
- Group: gastrointestinal
- Burden: About 1 percent of colorectal cancers: 11,510 of 1,087,055 patients (1.06 percent) in the meta-analysis (Discover Oncology 2021) and 160 of 28,056 (0.6 percent) in the Munich registry (J Cancer Res Clin Oncol 2016).
- Subtypes: Signet ring cell carcinoma, mismatch-repair deficient (MSI-high; right-sided); Signet ring cell carcinoma, mismatch-repair proficient (CDH1, RNF43 and SMAD4 altered; peritoneal spread); Mucinous adenocarcinoma with signet ring cells under 50 percent (classified as mucinous)
- Biomarkers: Signet ring cells over 50 percent of the tumour; Mismatch repair status; CDH1, RNF43 and SMAD4 alterations (research); Peritoneal disease on imaging

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/colorectal-signet-ring-cell-carcinoma/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/colorectal-signet-ring-cell-carcinoma/#overview
- What it is (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/colorectal-signet-ring-cell-carcinoma/#what-it-is [3 subtypes]
- Finding it (on the hub): How it shows itself, how it is confirmed, what screening exists, and the biomarkers clinicians test for. https://onco.cc/cancers/colorectal-signet-ring-cell-carcinoma/#finding-it [4 biomarkers]
- Treating it (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/colorectal-signet-ring-cell-carcinoma/#treating-it [1 setting]
- Evidence (on the hub): Trials recruiting now, the landmark trials, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/colorectal-signet-ring-cell-carcinoma/#evidence
- The science (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/colorectal-signet-ring-cell-carcinoma/#science
- Where you are (own page): Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record. https://onco.cc/cancers/colorectal-signet-ring-cell-carcinoma/where-you-are/
- Living with it (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/colorectal-signet-ring-cell-carcinoma/#living-with-it [8 questions, 1 red card]
- What is coming (own page): Everything in development, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/colorectal-signet-ring-cell-carcinoma/coming/ [1 medicine]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/colorectal-signet-ring-cell-carcinoma/data/ [3 connected records]

## Standard of care

- All stages: Treated as the colorectal page by stage and mismatch repair status; no trial in the type. ([Colorectal cancer](https://onco.cc/cancers/colorectal/), [Colon cancer (adenocarcinoma of the colon)](https://onco.cc/cancers/colon-cancer/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/))

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Signet_ring_cell_carcinoma
- Nagtegaal 2020, Histopathology: the 2019 WHO classification of tumours of the digestive system: https://doi.org/10.1111/his.13975
- Pathology Oncology Research 2021: clinicopathological and molecular characteristics of colorectal signet ring cell carcinoma (review): https://doi.org/10.3389/pore.2021.1609859
- Discover Oncology 2021: signet ring cell and mucinous carcinoma versus adenocarcinoma, meta-analysis of 1,087,055 patients: https://doi.org/10.1007/s12672-021-00398-6
- J Cancer Res Clin Oncol 2016: mucinous and signet ring cell colorectal cancer in 28,056 Munich registry patients: https://doi.org/10.1007/s00432-016-2224-2

## Connected records

- cancers: [Appendiceal adenocarcinoma (mucinous and non-mucinous, including signet ring cell)](https://onco.cc/cancers/appendiceal-adenocarcinoma/), [Colon cancer (adenocarcinoma of the colon)](https://onco.cc/cancers/colon-cancer/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Early-onset colorectal cancer (under 50)](https://onco.cc/cancers/early-onset-colorectal/), [Mucinous adenocarcinoma of the colon and rectum](https://onco.cc/cancers/colorectal-mucinous-adenocarcinoma/)
- drugs: [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/)

---
JSON: https://onco.cc/api/v1/entities/colorectal-signet-ring-cell-carcinoma.json