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  • Review Article
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Advances in the care of patients with mucinous colorectal cancer

Nature Reviews Clinical Oncology volume 13, pages 361–369 (2016)Cite this article

Subjects

Key Points

  • Mucinous adenocarcinoma represents a distinct molecular and clinical tumour subtype, which should be recognized during the multimodality treatment approach in patients with colorectal cancer

  • The benefits of (neo)adjuvant treatment modalities in patients with colorectal cancer are applicable to those with the mucinous subtype as well

  • Preoperative MRI is a more-accurate method than biopsy sampling for detection of mucinous adenocarcinoma in patients with rectal cancer and provides valuable information for surgical planning

  • Patients with mucinous rectal cancer have a high risk of incomplete tumour resection, irrespective of use of preoperative therapies

  • Mucinous adenocarcinoma is characterised by an aberrant metastatic pattern, which might explain the poor prognosis of patients with stage IV disease

  • Advances in molecular tumour characterization will improve prediction of the course of disease and might enable further tailoring of treatment

Abstract

The majority of colorectal cancers (CRCs) are classified as adenocarcinoma not otherwise specified (AC). Mucinous carcinoma (MC) is a distinct form of CRC and is found in 10–15% of patients with CRC. MC differs from AC in terms of both clinical and histopathological characteristics, and has long been associated with an inferior response to treatment compared with AC. The debate concerning the prognostic implications of MC in patients with CRC is ongoing and MC is still considered an unfavourable and unfamiliar subtype of the disease. Nevertheless, in the past few years epidemiological and clinical studies have shed new light on the treatment and management of patients with MC. Use of a multidisciplinary approach, including input from surgeons, pathologists, oncologists and radiologists, is beginning to lead to more-tailored approaches to patient management, on an individualized basis. In this Review, the authors provide insight into advances that have been made in the care of patients with MC. The prognostic implications for patients with colon or rectal MC are described separately; moreover, the predictive implications of MC regarding responses to commonly used therapies for CRC, such as chemotherapy, radiotherapy and chemoradiotherapy, and the potential for, and severity of, metastasis are also described.

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Figure 1: Forrest plot depicting outcomes from studies of palliative and adjuvant chemotherapy for patients with MC versus those with AC.
Figure 2: Differences between MC and AC.
Figure 3: Schematic axial view of rectal tumours.
Figure 4: Forrest plot depicting the outcomes of studies investigating the frequency of downstaging in response to chemoradiotherapy in patients with MC versus those with AC.
Figure 5: Identification of mucinous carcinoma.
Figure 6: Potential contributions from different medical specialties.

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Authors and Affiliations

  1. Department of Surgery, Radboud University Medical Centre, P.O. Box 9101, Nijmegen, 6500 HB, Netherlands

    Niek Hugen & Johannes H. W. de Wilt

  2. Department of Pathology, Radboud University Medical Centre, P.O. Box 9101, Nijmegen, 6500 HB, Netherlands

    Iris D. Nagtegaal

  3. Department of Radiology, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, Surrey, UK

    Gina Brown

  4. Department of Clinical Oncology, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, HA6 2RN, Middlesex, UK

    Robert Glynne-Jones

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All authors made a substantial contribution to researching data, discussion of content, writing of the article and reviewing and editing of the manuscript before submission.

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Correspondence to Niek Hugen.

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Hugen, N., Brown, G., Glynne-Jones, R. et al. Advances in the care of patients with mucinous colorectal cancer. Nat Rev Clin Oncol 13, 361–369 (2016). https://doi.org/10.1038/nrclinonc.2015.140

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