Roshan Ara Ghoorun, Yi Liao, Chunyu Chen, Senmao Li, Feng Lin and Zuli Yang
Background: Classified as “diffuse” by the Lauren’s classification gastric signet ring cell carcinoma is an adenocarcinoma with distinct features which separates it from other types of gastric cancer. Affecting mainly young female patients, gastric SRC is mainly due to the loss of E-cadherin and CDH1+. In this review we look into the pathogenesis, clinical features, diagnosis, treatment, and prognosis of gastric SRC.
Materials and Methods: We reviewed the literature published until September 2014 to identify studies of gastric SRC. Studies were identified by using the Medline and PubMed databases using the terms “gastric signet ring cell carcinoma”, “gastric signet ring cell cancer”, “signet ring cell cancer”, “signet ring cell carcinoma”. Researches on esophageal SRC, intestinal SRC were excluded in our study.
Results: A down-regulation of epithelial cadherin is essential for the initiation, and progression of gastric signet ring cell cancer cells. Once gastric cells lose E-cadherin, they have an increase in motility due to epithelial-mesenchymal transition. A strong correlation in the mutation of Snail, Slug, and Twist as well as an activation of the phosphatidylinositol 3 kinase (PI3K)/AKT axis, Wnt/β-catenin signaling pathway, and transforming growth factor β have been found to be associated with the pathogenesis of gastric signet ring cell cancer. Diagnosis relies mainly on histological findings. While surgical treatment includes resection and lymphadenectomy with retrieval of at least 15 lymph nodes, few patients respond well to chemotherapeutic regimens.
Conclusion: Despite recent advances, more patients are being diagnosed with advanced gastric SRC. Understanding the pathogenenis of gastric signet ring cell cancer is critical in the treatment and improving the prognosis of patients.
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