Malignant Small Bowel Tumors: Diagnosis, Management and Prognosis

Abstract

adenocarcinoma (n = 11), seguido do sarcoma (n = 6), linfoma (n = 6) e tumores neuroendócrinos (n = 3). A principal forma de apresentação esteve relacionada com perdas hemáticas ou obstrução intestinal. Ao diagnóstico, 46% dos doentes tinham metástases distantes/tumor irressecável. A maioria dos tumores foi diagnosticada por técnicas endoscópicas (41%) ou imagiológicas (35%). No primeiro ano após o diagnóstico, 29% dos doentes faleceram. Na análise multivariada, o adenocarcinoma permaneceu fator independente para pior sobrevida. Discussão: Os doentes com adenocarcinoma apresentaram-se em estádios tardios e com tumores irressecáveis, contribuindo para um pior prognóstico. É necessário um elevado grau de suspeita clínica para o diagnóstico de cancro do intestino delgado. Conclusão: As características dos doentes foram globalmente consistentes com o descrito na literatura. A cápsula endoscópica e a enteroscopia assistida por balão são úteis no diagnóstico, gestão e vigilância do cancro do intestino delgado. Palavras-chave: Endoscopia por Cápsula; Neoplasias Intestinais; Portugal.ABSTRACT Purpose: Despite being rare entities, the incidence of malignant small bowel tumors seems to be rising. The development of capsule endoscopy and balloon assisted enteroscopy provided an advance in the assessment of small bowel lesions. We aim to describe the clinical and pathological characteristics of patients with small bowel cancer and ascertain what roles these endoscopic techniques currently have. Material and Methods:A retrospective study of patients diagnosed with small bowel cancer, from January 2010 to October 2014, was performed. The data was submitted to statistical analysis. Results: Of the 28 diagnosed patients, 54% were female. The mean age at diagnosis was 61 years. Adenocarcinoma was the most frequent tumor (n = 11), followed by sarcoma (n = 6), lymphoma (n = 6) and neuroendocrine tumors (n = 3). The main form of presentation was related to blood loss or intestinal obstruction. By the time of diagnosis, 46% of patients had distant metastasis/ unresectable cancer. Most of the tumors were diagnosed by endoscopic (41%) or imaging techniques (35%). In the first year after diagnosis, 29% of patients died. In multivariate analysis, adenocarcinoma remained an independent factor for worse survival. Discussion: Patients with adenocarcinoma presented at late stages and with unresectable tumors, contributing to a worse outcome. A high degree of clinical suspicion for the diagnosis of small bowel cancer is necessary. Conclusion:The characteristics of the patients were generally consistent with those described in the literature. Capsule endoscopy and balloon assisted enteroscopy are useful in the diagnosis, management and surveillance of small bowel cancer.

Prognostic Factors and Survival Time in Patients with Small Bowel Tumors: A Retrospective Observational Study

“…In line with previous studies, the prognosis of adenocarcinoma was also poor in the present study and the median survival time was only one year. Cardoso et al [21] reported that adenocarcinoma has the lowest survival time among all the subtypes, but according to the present study, adenocarcinoma does not have a significantly lower survival time than lymphoma. This variation may be explained by the different sample size of the two studies.…”

Validation of SPICE, a method of differentiating small bowel submucosal lesions from innocent bulges on capsule endoscopy

“…In other series, SBTs were found in 8.9% (Cobrin et al [19]), 6.3% (Bailey et al [20]), 2.5% (Urbain et al [21]) and 4.3% (Cheung et al [22]) of cases. When performed to explore obscure bleeding, the main form of presentation of SBTs (23), the sensitivity for SBT diagnosis is 89-95%, with a specificity of 75-95% (24,25).…”

“…Another drawback of SBCE is represented by the difficulty in distinguishing a submucosal lesion from an innocent bulge, a smooth protrusion of normal mucosa resulting from loop angulation and/or the impression of an adjacent loop. Up to half of the most common histological types of small bowel cancer, namely adenocarcinomas, neuroendocrine tumors, lymphomas and sarcomas (9,23), can appear endoscopically as smooth, round, protruding lesions (18). To determine the nature of small bowel protrusions on CE, Shyung et al described a scoring system composed of five suspicious characteristics: bleeding, mucosal disruption, irregular surface, color, and white villi (26).…”

Small Bowel Enteroscopy – A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups

“…If there are no doubts about the diagnosis of SBT at CE, direct surgery is acceptable if cross-sectional imaging excludes inoperability [1]. In all other cases, histological confirmation is crucial to make treatment decisions [83,90,91]. Biopsies have a high diagnostic value, especially for adenocarcinoma and lymphoma (71.4 and 60%, respectively) [87].The need for histology of GISTs must be thoroughly balanced, since the rate of a positive histological diagnosis by DAE does not exceed 46.7% and the risk of bleeding is not negligible [92,93].…”