Primary malignant small bowel tumors
Authors:
P. Zonča; M. Peteja
; V. Richter; P. Vávra; P. Ihnát
Authors place of work:
Chirurgická klinika, FN a LF Ostravské univerzity, Ostrava, přednosta: doc. MUDr. P. Zonča, Ph. D., FRCS
Published in the journal:
Rozhl. Chir., 2016, roč. 95, č. 9, s. 344-349.
Category:
Review
Summary
Introduction:
Small bowel presents 75% of the gut length and 90% of the gut surface. However, primary malignant tumors of the small bowel represent only 1–3% of all malignant gastrointestinal tumors. The aim of the present paper is to offer a current review of primary malignant small bowel tumors – their epidemiology, localization, symptoms, diagnostic and treatment options.
Methods:
The authors have performed a comprehensive review of databases Medline, Scopus and Google Scholar focusing on studies regarding small bowel cancer.
Results:
The most frequent small bowel tumors are adenocarcinoma (30–40%), neuroendocrine tumors (35–44%), lymphomas (10–20%) and gastrointestinal stromal tumors (12–18%). Symptomatology is non-specific and varies widely, which is why small bowel cancer is usually diagnosed in a locally advanced stage of the disease. Diagnosis is determined through standard methods (gastroscopy, colonoscopy, CT) and complementary special diagnostic modalities (capsule enteroscopy, enteroscopy, octreotide scan, etc.). Diagnostic process with a negative outcome frequently leads to diagnostic laparoscopy/laparotomy.
The treatment of small bowel cancer in patients operated in acute settings is done according to acute abdomen management guidelines. Elective surgery of small bowel cancer differs with respect to the tumor type. Adenocarcinomas and neuroendocrine tumors should be treated with surgical R0 resection with radical lymphadenectomy (and multivisceral resection if necessary). Patients with GIST should undergo en bloc resection with 2–3cm safety resection margins (lymphadenectomy is not necessary). Palliative resection of neuroendocrine tumors can be associated with a significant clinical effect. On the other hand, palliative resection of adenocarcinomas of GIST is not advocated.
Conclusion:
Small bowel cancer is an infrequent condition. Symptoms are non-specific; patients are often diagnosed in an advanced stage of the disease. Achieving R0 surgical resection is usually difficult due to locally advanced stage of the disease. Besides the tumor type, patients’ prognosis is influenced by very late diagnosis of the tumor.
Key words:
primary tumor – small intestine – diagnostics – treatment options – surgical resection
Zdroje
1. DiSario JA, Burt RW, Vargas H, et al. Small bowel cancer: epidemiological and clinical charasteristics from a population-based registry. Am J Gastroenterol 1994;89:699–701.
2. Pennazio M, Rondonotti E, de Franchis R. Capsule endoscopy in neoplastic diseases. WJG 2008; 14: 5245–53.
3. Weiss NS, Yang CP. Incidence of histologic types of cancer of the small intestine. J Natl Cancer Inst. 1987;78:65.
4. Bilimoria KY, Bentrem DJ, Wayne JD, et al. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg 2009;249:63.
5. Hoffmann J, Neu B, Tympner C, et al. Dünndarmtumoren, Manual Gastrointestinale Tumoren. 8. Auflage 2010:131–8., Mnichov, Zuckschwerdt verlag
6. Oliverius M, Wohl R. Adenocarcinoma of the small intestine. Rozhl Chir 2003;82:529–32.
7. Chmátal P, Lednický L, Hájek M. Adenocarcinoma of the small intestine: a rare diagnosis. Rozhl Chir 2003;82:324–6.
8. Xynopoulos D, Mihas A, Paraskevas E, et al. Small bowel tumors. Annals of Gastroenterology 2002;15:18–35.
9. Rindi G, Kloppel G, Couvelard A, et al. TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system. Virchows Arch 2007;451:757–62.
10. Turan M, Karadayi K, Duman M, et al. Small bowel tumors in emergency surgery. Turkish Journal of Trauma & Emergency Surgery 2010;16:327–33.
11. Amin S, Warner RR, Itzkowitz SH, et al. The risk of metachronous cancers in patients with small-intestinal carcinoid tumors: a US population-based study. Endocr Relat Cancer 2012;19:381–7.
12. Kharazmi E, Pukkala E, Sundquist K, et al. Familial risk of small intestinal carcinoid and adenocarcinoma. Clin Gastroenterol Hepatol 2013;11:944–9.
13. Järhult J, Landerholm K, Falkmer S, et al. First report on metastasizing small bowel carcinoids in first-degree relatives in three generations. Neuroendocrinology 2010;91:318–23.
14. Nilsson B, Bümming P, Meis-Kindblom JM. Gastrointestinal stromal tumors: The incidence, prevalence, clinical course, and prognostication in the preimatinib era. Cancer 2005;103:821–9.
15. Pohnán R, Ryska M, Dolezel R, et al. Gastrointestinal stromal tumor – analysis of a patient group, literature overview. Rozhl Chir 2009;88:629–33.
16. Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 2006;23:70–83.
17. Dallenbach FE, Coupland SE, Stein H. Marginalzonenlymphome: extranodale vom MALT-typ, nodale und splenische. Pathologe 2000;21:162–77.
18. Hiller E, Ihrler R, Wilkowski R. Gastrointestinale Lymphome. Manual gastrointestinale Tumoren. 8. Auflage 2010:243−52.
19. Smejkal P, Pazdro A, Smejkal M, et al. Lymphoma of the small intestine. Rozhl Chir 2002;81:37–9.
20. Attanoos R, Williams GT. Epithelial and neuroendocrine tumors of the duodenum. Sem Diagn Pathol 1991;8:149–62.
21. Ihnát P, Vávra P, Zonča P. Treatment strategies for colorectal carcinoma with synchronous liver metastases: Which way to go? World J Gastroenterol 2015;21:7014−21.
22. Pape UF, Böhmig M, Berndt U, et al. Survival and clinical outcome of patients with neuroendocrine tumors of the gastroenteropancreatic tract in a German referral center. Ann NY Acad Sci 2004;1014:222–33.
23. Castillo JG, Filsoufi F, Adams DH, et al. Management of patients undergoing multivalvular surgery for carcinoid heart disease: the role of the anaesthetist. Br J Anaesth 2008;101:618–26.
24. Dubaj M, Bakos E, Galko J, et al. Primary tumors of the duodenum and the small intestine in our clinical study subjects over a ten-year period. Rozhl Chir 2006;85:90–2.
25. Burkill GJ, Badran M, Al-Muderis O, et al. Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread. Radiology 2003;226:527–32.
26. Auernhammer CJ, Assmann G, Bartenstein P, et al. Neuroendokrine Tumoren des Gastrointestinaltraktes. Manual gastrointestinale Tumoren. 8. Auflage, Mnichov, V. Zuskschwerdt Verlag 2010;229–42.
27. Abrahamas NA, Halverson A, Fascio VW, et al. Adenocarcinoma of the small bowel. A study of 37 cases with emphasis on histologic prognostic factors. Dis Colon Rectum 2002;45:1496–1502.
28. Baily AA, Debinski HS, et al. Diagnosis and outcome of small bowel tumors found by capsule endoscopy: a three-center Australian experience. Am j Gastroenterol 2006;101:2237–43.
29. Bakaeen FG, Murr MM, Sarr MG et al. What prognostic factors are important in duodenal adenocarcinoma? Arch Surg 2000;135:635–41.
30. Ihnát P, Ihnát Rudinská L, Zonča P. Radiofrequency energy in surgery: state of the art. Surg Today 2014;44:985–91.
31. deHerder WW, O´Tolle D, Rindi G, et al. ENETS Consensus Guidelines for the Diagnosis and Treatment of Neuroendorine Gastrointestinal Tumors, 2008, Part 2 - midgut and hindgut tumors. Neuroendoscrinology 2008;87:1–63.
32. Pierie JP, Choundry U, Mizikansky A, et al. The effect of surgery and grade on outcome of gastrointestinal stromal tumors. Arch Surg 2001;136:383–9.
33. Fiala L, Šefr R, Kocáková I, et al. Treatment of gastrointestinal stromal tumors – a comprehensive view of the surgeon. Rozhl Chir 2015;94:189–92.
34. Ihnát P, Martínek L, Ihnát Rudinská L, et al. Circumferential resection margin in the modern treatment of rectal cancer. Rozhl Chir 2013;92:297–303.
35. Miettinen M, Majidi M, Lasota J. Pathology and diagnostic criteria of gastointestinal stromal tumors (GISTs): a review. Eur J Cancer 2002;38 Suppl 5.39–51.
36. Ramot B, Shahin N, Bubis JJ. Malabsorption in a lymphoma of small intestine. A study of 13 cases. Isr Med Sci 1995;1:221–6.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2016 Číslo 9
- Metamizole vs. Tramadol in Postoperative Analgesia
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Spasmolytic Effect of Metamizole
Najčítanejšie v tomto čísle
- Primary malignant small bowel tumors
- Corpus alienum – migrating foreign body
- Circumscribed and diffuse peritonitis: severe complications in bariatric and metabolic surgery; specifics related to their diagnosis and therapy
- Postpancreatectomy haemorrhage (PPH), prevalence, diagnosis and management