Abstract
Background: Colorectal cancer is the third most commonly diagnosed cancer in the world. Primary signet-ring cell carcinoma of the colon and rectum (PSRCCR) is a rare form of adenocarcinoma, with a reported incidence of less than 1%. Because symptoms of PSRCCR often develop late, it usually has a poor prognosis.

Case Presentation: A 44-yearold male presented to his general practitioner with complaints of inadequate evacuation of stool, abdominal bloating and irregular bowel movements in the last 6 months and bleeding per rectum in the past 2 weeks. Colonoscopy showed growth in the rectum; hence, a biopsy and magnetic resonance imaging (MRI) of the pelvis were done. Discussion: The patient received short course chemotherapy followed by low anterior resection with transverse loop colostomy. Out of 17 resected mesorectal lymph nodes, 7 nodes were positive. Due to the
patient’s young age and having locally advanced cancer with aggressive histology, adjuvant chemotherapy was started with intravenous (IV) oxaliplatin and oral capecitabine to prevent recurrence and improve overall survival. Patient completed 6 cycles of adjuvant therapy, after which end-to-end anastomosis was done, and the patient remained disease-free.

Conclusion: Patients with locally advanced growth of rectal signet-ring cell carcinoma (SRCC) should be offered preoperative short-course radiotherapy with curative intent. Though the patient’s cancer was in the T3N2b stage, he responded well to treatment. The chemotherapy nurse plays a significant role to ensure patients have the basic knowledge necessary to decide about treatment options.

Key words: Colorectal adenocarcinoma, Signet-ring cell carcinoma, Short course radiation therapy, Adjuvant chemotherapy, Low anterior resection