Small bowel adenocarcinoma: An overview

Abstract

Small bowel adenocarcinoma (SBA) is a rare malignancy of the gastrointestinal tract. However, these tumors are among those with worst prognosis. Vague clinical signs and symptoms and radiological diagnostic challenges often delay treatment, which negatively impacts the prognosis of the patients. However, recent advances in imaging technology, like multidetector computed tomography, magnetic resonance imaging, and capsule endoscopy, have made earlier and accurate diagnosis possible. Surgery is the treatment of choice followed by adjuvant therapy. However, there are no strict treatment guidelines available for the management of SBA. Most of the available evidence from colorectal and gastric carcinoma has been extrapolated to adequately manage SBA. Prognosis for SBA is better than gastric carcinoma but worse than colorectal carcinoma. Currently, there is not enough information on the molecular characteristics and tumor pathogenesis. Because the incidence of SBA is very low, there is a need for further studies to evaluate the possible application of newer investigative agents and strategies to obtain a better outcome within the framework of international collaborations.

Metastatic renal cell carcinoma to the small bowel 6 years postnephrectomy

“…CT/MR enterography is the preferred diagnostic and staging modality, while PET-CT can aid in initial diagnosis and staging, although it is not routinely recommended. Small bowel video capsule endoscopy has limitations due to its inability to obtain tissue samples and its restricted use in cases of small bowel obstruction, with a reported false negative rate of up to 18.9% 6…”

Perforated Small Bowel Adenocarcinoma: An Interesting Presentation of a Rare Disease

“…Adjuvant chemotherapy remains controversial, again due to the rarity of this disease; however, general consensus suggests observation for stage one or low-risk stage two disease after curative surgery and adjuvant chemotherapy for high-risk stage two and any stage three or four disease, with studies showing significant improvement in survival noted with the addition of adjuvant therapy in stage three disease [ 1 ]. The National Comprehensive Cancer Network (NCCN) suggests 5-fluorouracil with leucovorin (5FU/LV) or capecitabine for early-stage disease requiring adjuvant treatment and either FOLFOX (folinic acid, fluorouracil, oxaliplatin), CAPEOX (capecitabine, oxaliplatin), or 5FU/LV for three to six months for higher-stage disease [ 12 ].…”

“…Primary small bowel malignancy is a rare disease with increasing incidence; it often presents with non-specific symptoms and is difficult to diagnose radiologically, making diagnosis challenging [ 1 - 2 ]. Of these malignancies, small bowel adenocarcinoma (SBA) and neuroendocrine tumors are the two most common etiologies, each accounting for 35%-40% of primary small bowel neoplasms [ 1 ], with the ileum being the least common location [ 3 ]. While inherited cancer syndromes increase the risk of developing SBA, most cases are sporadic and occur in patients with inflammatory bowel disease [ 4 ].…”

“…While inherited cancer syndromes increase the risk of developing SBA, most cases are sporadic and occur in patients with inflammatory bowel disease [ 4 ]. Small bowel adenocarcinomas usually present later in life, with a median age of 60 years at diagnosis [ 1 ], typically presenting with non-specific abdominal pain, nausea, vomiting, anemia-gastrointestinal bleeding, and/or weight loss [ 5 ].…”

“…There is also no definitive guideline regarding treatment; however, like colon cancer, non-metastatic SBA is typically treated by surgical resection with at least 5 cm of proximal and distal margins, as well as resection of adjacent mesentery and at least 10-15 nodes [ 1 ]. Small bowel adenocarcinoma involving the distal ileum should be treated with ileocecectomy or right hemicolectomy and associated mesentery [ 8 ].…”