Abstract
The symptoms of small bowel malignancies are mild and frequently nonspecific, thus patients are often not diagnosed until the disease is at an advanced stage. Moreover, the lack of sufficient studies and available data on small bowel cancer makes diagnosis difficult, further delaying proper treatment for these patients. In fact, only a small number of published studies exist, and there are no studies specific to Thailand. Radiologic and endoscopic studies and findings may allow physicians to better understand the disease, leading to earlier diagnosis and improved patient outcomes. To retrospectively analyze the clinical, radiologic, and endoscopic characteristics of small bowel cancer patients in Thailand's Siriraj Hospital. This retrospective analysis included 185 adult patients (97 men, 88 women; mean age = 57.6±14.9) with pathologically confirmed small bowel cancer diagnosed between January 2006 and December 2013. Clinical, radiologic, and endoscopic findings were collected and compared between each subtype of small bowel cancer. Of the 185 patients analyzed, gastrointestinal stromal tumor (GIST) was the most common diagnosis (39.5%, n=73). Adenocarcinoma was the second most common (25.9%, n = 48), while lymphoma and all other types were identified in 24.3% (n = 45) and 10.3% (n = 19) of cases, respectively. The most common symptoms were weight loss (43.2%), abdominal pain (38.4%), and upper gastrointestinal bleeding (23.8%). Based on radiology and endoscopy, this study revealed upper gastrointestinal bleeding, an intra-abdominal mass, and a sub-epithelial mass as common symptoms of GIST. Obstruction and ulcerating/circumferential masses were findicative of adenocarcinoma, as revealed by radiology and endoscopy, respectively. Finally, no specific symptoms were related to lymphoma.
Highlights
Small bowel cancer is a rare malignancy that accounts for only 2% of all gastrointestinal cancers (Paski, 2009; Pan et al, 2011)
Most cases of small bowel cancer are diagnosed late in the course of the disease because of its vague clinical presentations, and patients who present with obvious clinical manifestations such as gastrointestinal bleeding, intestinal obstruction, or ascites are almost always diagnosed with advanced stage cancer
The 185 small bowel cancer patients enrolled in the study were classified into four major histological subtypes: gastrointestinal stromal tumor (GIST), adenocarcinoma, lymphoma, and other
Summary
Small bowel cancer is a rare malignancy that accounts for only 2% of all gastrointestinal cancers (Paski, 2009; Pan et al, 2011). Most cases of small bowel cancer are diagnosed late in the course of the disease because of its vague clinical presentations (e.g. abdominal pain and abdominal discomfort), and patients who present with obvious clinical manifestations such as gastrointestinal bleeding, intestinal obstruction, or ascites are almost always diagnosed with advanced stage cancer. The most common malignancy lesions are adenocarcinoma, neuroendocrine tumor (NET), sarcomas, and small bowel lymphoma. The lowest relative survival rate occurred with adenocarcinoma, while lymphomas, sarcomas, and carcinoid tumors showed slightly better outcomes (Pan et al, 2011). Radiologic and endoscopic studies and findings may allow physicians to better understand the disease, leading to earlier diagnosis and improved patient outcomes. Results: Of the 185 patients analyzed, gastrointestinal stromal tumor (GIST) was the most common diagnosis (39.5%, n=73). Conclusions: Based on radiology and endoscopy, this study revealed upper gastrointestinal bleeding, an intra-abdominal mass, and a sub-epithelial mass as common symptoms of GIST.
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