Update on diagnosis and treatment of early signet-ring cell gastric carcinoma: A literature review

Abstract

Gastric signet-ring cell gastric carcinoma (GSRC) is an unfavorable subtype of gastric cancer (GC) that presents with greater invasiveness and poorer prognosis in advanced stage than other types of GC. However, GSRC in early stage is often considered an indicator of less lymph node metastasis and more satisfying clinical outcome compared to poorly differentiated GC. Therefore, the detection and diagnosis of GSRC at early stage undoubtedly play a crucial role in the management of GSRC patients. In recent years, technological advancement in endoscopy including narrow-band imaging and magnifying endoscopy has significantly improved the accuracy and sensitivity of the diagnosis under endoscopy for GSRC patients. Researches have confirmed that early stage GSRC that meets the expanded criteria of endoscopic resection showed comparable outcomes to surgery after receiving endoscopic submucosal dissection (ESD), indicating that ESD could be considered standard treatment for GSRC after thorough selection and evaluation. This article summarizes the current knowledge and updates pertaining to the endoscopic diagnosis and treatment of early stage signet-ring cell gastric carcinoma.

Keywords: Endoscopic submucosal dissection; Gastric signet-ring cell gastric carcinoma; Magnified endoscopy; Narrow-band imaging.

Figure 1

Endoscopic images of gastric signet ring cell carcinoma. A: Endoscopy with white light imaging revealed a 0-IIc lesion with discoloration at the lesser curvature of the gastric body; B: Magnifying endoscopy combined with narrow-band light imaging revealed the irregular capillaries in a corkscrew pattern of a gastric signet ring cell carcinoma (GSRC) lesion; C: A GSRC demonstrating an elongated or “stretched” gastric gland (white circle) compared to the normal gastric glands (black circle); D: GSRC under Non-magnifying narrow-band imaging showed an isolated, clear area compared to the surrounding mucosa.