BALTIMORE, Maryland – Signet Ring Cell carcinomas develop in the organs of the GI tract: the stomach, appendix, colon, bladder and pancreas.
The cancer gets its name from the ring appearance the cells take on under the microscope.
It's been, historically, tough to treat.
But in some patients, surgery and a new method of delivering chemo are making a difference.
76-year old Jim Gibbs was working full-time and feeling healthy until Super Bowl Sunday 2016 when he had a sudden pain in his left side.
"The next day I was attending some meetings and it was there nagging."
"There were no signs. no other signs," explained his wife Carol.
A CT scan showed something unusual on his appendix. His doctor ordered more tests.
Jim Gibbs remembered it well.
"He called me a week later and said, 'Well, it's cancerous and it's Signet Ring Cell cancer'."
Surgical oncologist Vadim Gushchin says Signet Ring Cell carcinomas are aggressive.
Patients have very few symptoms, so the cells often spread before they're caught.
"By the time a typical diagnosis of a Signet Ring Cell carcinoma of the stomach is made, the entire stomach is engulfed in tumor," said Dr. Gushchin.
Surgery may be a treatment option, but doctors can't always remove all the cancer.
For Jim, Dr. Gushchin added HIPEC, heated intraoperative peritoneal chemotherapy.
"They hook you up to a pumping system that pumps in heated chemotherapy and it bathes the entire abdominal cavity, and then they pump it out," said Gibbs.
TREATMENT: Signet ring cell cancer is a subtype of adenocarcinoma, which is the most common type of cancer arising from the stomach. Surgical removal of stomach cancer is the treatment of choice, although 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.
"These tumors typically spread early on and they typically present with advanced disease," explained Dr. Gushchin.
He said tumors of the appendix "spread on the surfaces of the bowel pretty commonly and that's where the technique of site reduction surgery with HIPEC becomes very handy."
"The tumor is very difficult to treat," he added, "and we think that the treatment matches the enemy."
Most cancers recur within two years after surgery so Jim spent that time volunteering, doing cancer charity walks.
"I can look back and say you know I spent that time in the most life-giving way I could."
Jim finished his treatment more than two years ago and he remains disease-free.
Dr. Gushchin cautions even with the addition of HIPEC, the cancer is still tough to wipe out.
He says patients who do best with this treatment have no lymph nodes involved and have the tumor contained within one of the organs.
If this has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Jim Mertens at email@example.com or Marjorie Bekaert Thomas at firstname.lastname@example.org.