Cases Of Small Bowel Cancer Research Articles

Patient characteristics and survival outcomes in gastrointestinal cancers harboring RNF43 mutations or RSPO3 fusions: a retrospective analysis.

473 Background: The growth of intestinal epithelium is dependent on the Wnt/β-catenin signaling pathway. The R-Spondin (RSPO) family of proteins form complexes with Wnt ligand and RNF43 protein, which promote ubiquitination and degradation of Wnt receptors. Patients with gastrointestinal cancers harboring RSPO3 gene fusions or RNF43 gene mutations may benefit from Wnt pathway inhibitors. Methods: We retrospectively studied 51 patients at our institution diagnosed with gastrointestinal cancers with RSPO3 gene fusions or RNF43 gene mutations identified using Caris Life Sciences next-generation sequencing (NGS). Microsatellite-instability (MSI) was evaluated using NGS. Tumor mutational burden (TMB) was estimated from 592 genes by counting all nonsynonymous missense mutations not previously defined as germline mutations, expressed as mutations per megabase. First-line median progression-free survival (PFS) and median overall survival (mOS) were estimated using the Kaplan-Meier method. Results: Of the 51 patients in our study, 44 (86.3%) had RNF43 mutations and 7 (13.7%) had RSPO3 fusions, 6 of whom had colorectal cancer (CRC) and had PTPRK as the fusion partner, 1 case of small bowel cancer had a RSPO3: IFNGR1 fusion. Median age at diagnosis was 64.0 ± 12.0 years. The most common primary tumors were CRC in 23 patients (45.1%) and pancreas in 12 patients (23.5%). Co-occurring mutations in CRC patients with RSPO3 fusions included KRAS (50%, Q61H, G12C, and G12V), BRAF V600E (50%), and TP53 (100%), none were MSI-H, median TMB (mTMB) was 9.5 (range 7-11). Sixty-seven percent of RNF43-mutated CRC patients had the G659fs mutation. Co-occurring findings in RNF43-mutated CRC patients included 67% MSI-H, median TMB 27 (range 6-123), KRAS (28%), BRAF V600E (28%), and TP53 mutations (33%). Twenty-two patients (43.1%) had stage IV disease, 18 (35.3%) had stage III disease and 11 (21.6%) had stage II disease. Thirty RNF43-mutated patients (58.8%) underwent definitive surgical resection, with a mean time to recurrence of 22.2 months and mOS of 43.0 months (95% CI, 15.6-70.4). Among RNF43-mutated stage IV CRC (mCRC) patients, median PFS was 8.0 months (95% CI, 5.9-10.1). Stratified by stage, mOS was 111.0 months for stage II disease, 72.0 months for stage III disease, and 37.0 months for stage IV disease (95% CI, 14.7-59.3). Conclusions: RNF43 correlates with overall favorable mOS in patients with mCRC. mOS in RNF43-mutated mCRC is similar to those of RAS and BRAF wild-type subgroups as reported in the TRIBE study (Cremolini et al. 2015). Therefore, RNF43 mutational status appears to be useful in predicting clinical outcomes for patients with stage IV CRC and overlaps significantly with MSI-H. RSPO3 fusions are rare events and the clinical outcomes of this subset of patients with tumors with RSPO3 fusions remains largely unknown.

Inflammatory bowel disease and risk of small bowel cancer: a binational population-based cohort study from Denmark and Sweden

ObjectiveCrohn’s disease (CD) is associated with increased risk of small bowel cancer (SBC), but previous studies have been small. We aimed to examine the risk of incident SBC and death...

OP08 Inflammatory bowel disease and risk of small bowel cancer: A binational population-based cohort study from Denmark and Sweden

Abstract Background Crohn’s disease (CD) is associated with increased risk of small bowel cancer (SBC), but previous studies were limited by a small number of cases, short follow-up, lack of individually matched comparators, and over-representation of tertiary referral centres, leading to exaggerated relative risks and incidence data. Data on ulcerative colitis (UC) and SBC are scarce. Methods In a binational, population-based cohort study from Sweden and Denmark of patients diagnosed with inflammatory bowel disease (IBD) during 1969–2017 and matched reference individuals from the general population, we evaluated the risk of incident SBC, including SBC subtypes (small bowel adenocarcinoma, neuroendocrine tumours, and sarcoma). Cox regression was used to compute adjusted hazard ratios (aHRs) as a measure of relative risks for incident SBC and SBC subtypes. Results We identified 161,896 individuals with IBD (CD: 47,370; UC: 97,515; unclassified IBD:17,011). During follow-up, 237 cases of SBC were diagnosed in patients with IBD (CD: 24.4/100,000 person-years; UC: 5.88/100,000 person-years), compared with 640 cases in reference individuals (2.81/100,000 person-years and 3.32/100,000 person-years, respectively, Table). This corresponded to one extra case of for small bowel cancer in 385 CD patients, and one extra case in 500 UC patients, followed-up for 10 years. The aHR for incident SBC of 9.09 (95% CI = 7.34–11.3) in CD patients and 1.85 (95% CI = 1.43–2.39) in UC patients (Figure). When the first year after IBD diagnosis was excluded, the aHRs for incident SBC decreased to 4.96 in CD patients and 1.69 in UC patients. Among CD patients, relative risks were highest for recently diagnosed, childhood-onset, ileal, and stricturing CD; among UC patients, relative risks were highest for those with extensive colitis and primary sclerosing cholangitis (PSC). In CD patients, the risk of all SBC subtypes was increased (aHR 15.8 for adenocarcinoma, 5.51 for neuroendocrine tumours, and 4.04 for sarcoma) whereas in UC patients only the risk of adenocarcinoma (aHR 1.99) and neuroendocrine tumours (aHR 2.01) were increased. Conclusion SBC was more common in IBD patients, particularly among patients with CD, although absolute risks were low. Further studies should evaluate the utility of SBC surveillance in selected populations such as those with ileal CD, extensive colitis, or UC-PSC.

Small Bowel Cancer Complicating Inflammatory Bowel Disease: A Tertiary Referral Center Experience

Introduction: The incidence of small bowel cancer is rising in the U.S. While the association between inflammatory bowel disease (IBD) and colorectal cancer has been demonstrated, recent studies have suggested that IBD, specifically Crohn's disease (CD), may be associated with an increased risk of small bowel cancer (SBC). This association carries an especially poor prognosis, possibly explained by delayed diagnosis prior to the development of devastating complications. Data on the relationship between CD and small bowel cancer is limited. Methods: We performed an 8-year longitudinal analysis (2009-2016) of demographic, clinical, laboratory, and treatment data from an IBD registry at the University of Pittsburgh Medical Center to investigate the period prevalence of SBC in this referral population. Patients were identified using computer searches of comprehensive pathology and treatment data, with manual confirmation. Results: A total of 2,259 IBD patients were included (mean age 46, 52.5% women) of whom 848 had ulcerative colitis (UC) and 1,411 had CD. There were no cases of SBC in patients with UC. There were 8 cases (0.57%) of SBC in patients with CD. Five of these patients had adenocarcinoma, 2 had carcinoid tumors, and 1 had lymphoma. Of the 5 patients with small bowel adenocarcinoma, the mean age was 63.8, 3 (60%) were women, 3 (60%) had a history of smoking, and all were Caucasian. The average duration of CD to time of diagnosis of adenocarcinoma was 30 years. While 4 patients (80%) had exposure to immunosuppressive therapy, only 1 patient (20%) had exposure to anti-TNF biologic therapy. Two of the 5 patients (40%) with adenocarcinoma died from this complication during the observation period. Conclusion: Small bowel adenocarcinoma is a rare, albeit significant, complication of CD. Development of adenocarcinoma may be associated with longstanding disease and low rates of anti-TNF biologic use. In CD patients with longstanding disease and limited therapy, clinical suspicion for this complication is warranted. Future studies incorporating multiple clinical sites are necessary to better define the incidence and clinical characteristics of SBC in this population and to investigate the feasibility of screening patients with higher susceptibilities.670_A Figure 1. Small bowel adenocarcinoma detected on esophagogastroduodenoscopy (EGD)670_B Figure 2. Small bowel carcinoid detected on colonoscopy

First Case of Small Bowel Cancer in a Post Roux-en-Y Gastric Bypass Weight-Loss Surgery: A Case Report

First Case of Small Bowel Cancer in a Post Roux-en-Y Gastric Bypass Weight-Loss Surgery: A Case Report

First Case of Small Bowel Cancer in a Post-Roux-en-Y Gastric Bypass Weight-Loss Surgery: A Case Report

First Case of Small Bowel Cancer in a Post-Roux-en-Y Gastric Bypass Weight-Loss Surgery: A Case Report

The effects of chemotherapy on primary small bowel cancer: A retrospective multicenter observational study in Japan

Small bowel cancer is relatively rare among gastrointestinal tract cancers, including esophageal, gastric and colorectal cancers. The majority of cases of small bowel cancer are diagnosed at an advanced stage, resulting in poor outcomes. The clinical effects of chemotherapy on small bowel cancer have been investigated in a limited number of studies from Europe and the USA. However, they have not yet been fully investigated in Asian countries, including Japan. This retrospective multicenter observational study was designed to investigate the efficacy of chemotherapy on small bowel cancer. A questionnaire survey was conducted in 28 hospitals affiliated with the Osaka University Hospital. We retrospectively reviewed the medical records of 61 patients with small bowel cancer (32 patients who were unable to undergo curative resection or had unresectable distant metastases and 29 who underwent curative resection), treated between 1996 and 2009, to evaluate the outcomes and the efficacy of chemotherapy. There was no significant difference in the overall survival between the patients undergoing curative resection with postoperative adjuvant chemotherapy and those without postoperative adjuvant chemotherapy. In patients with non-curative resection or unresectable distant metastases, the response rate to chemotherapy was 31.6% and the overall survival was significantly higher compared to that without chemotherapy (P=0.008). The study results suggested that chemotherapy is effective for Japanese patients with small bowel cancer who cannot undergo curative resection or have unresectable distant metastases.

Cancer risk in Japanese Crohn's disease patients: Investigation of the standardized incidence ratio

There have been very few reported investigations on the standardized incidence ratio (SIR) of intestinal cancer and all cancers other than intestinal cancer with Crohn's disease (CD) by organ in Japan. This study examined the risk of developing cancer (i.e. SIR) that occurs in association with CD. The subjects were 770 CD patients managed at our hospital department, which specializes in inflammatory bowel disease, during the approximately 25 years from July 1985 to August 2010. The number of expected cancer patients in a healthy population matched for sex and age with the CD patients in our hospital was then calculated. The relative risk, or SIR, was also calculated. The total observation period was 10,552 person-years, during which 19 cases (2.5%) of cancer were discovered in 770 subjects. The cancer cases included nine cases of colorectal cancer (CRC), one case of small bowel cancer, one case of stomach cancer, three cases of acute myeloid leukemia, two cases of endometrial cancer, one case of lung cancer, one case of skin cancer, and one case of thyroid cancer. The SIR for cancers in Japan in 2003 was 0.87 (95% confidence interval [CI] 0.52-1.35) for all cancers, 2.79 (95% CI 1.28-5.29) for CRC, and 6.94 (95% CI 1.43-20.3) for leukemia. Among the cancers in CD patients in our hospital, no significant difference was seen in the risk for all cancers in comparison with the standard population. However, the risks for CRC and leukemia were significantly higher than in the standard population.

Reproductive history and risk of small bowel cancer by histologic type: a population-based study

The male predominance of the two main histologic malignancies of the small bowel cancer may reflect a role of sex hormones which will be examined in this study. This was a nationwide population-based nested case-control study, based on a cohort of subjects born between 1932 and 2008, as identified in the Swedish Multi-Generation Register. For each case of small bowel cancer, 10 age- and sex-matched controls were randomly selected. Number of children and age at having the first child were analyzed in relation to the risk of small bowel cancer using conditional logistic regression, providing odds ratios (ORs) and 95 % confidence intervals (CIs). A total of 632 female cases and 894 male cases of small bowel cancer were included. No overall increased risk of small bowel cancer was found in parous compared to non-parous women (OR = 1.02, 95 % CI 0.67-1.54). There was no association between age at first birth and small bowel cancer (>30 years of age vs <20 years; OR = 1.04, 95 % CI 0.72-1.50). No associations were detected in separate analyses of adenocarcinoma or carcinoid of the small bowel. No distinct risk patterns were discerned in men compared to women. Reproductive history does not seem to be associated with the risk of small bowel cancer, independent of histologic type.

Crohn's Disease and Small Bowel Adenocarcinoma: A Population-Based Case–Control Study

Although Crohn's disease (CD) is thought to predispose to adenocarcinomas of the small bowel, the association has not been well studied in an older population. The objective of our study was to evaluate the association of CD with small bowel cancer in a population-based case-control study. All cases of small bowel cancer in persons 67 and older in the Surveillance, Epidemiology and End Results catchment area and in the Medicare claims data base were compared with cancer-free controls residing in the same geographic area. We used multivariable logistic regression models adjusted for demographic and other factors. We identified 923 cases of small bowel cancer and 142,273 controls. Although we found a strong association between CD and small bowel cancer (OR = 12.07; 95% CI: 6.07-20.80; P < 0.001), the prevalence of CD in patients with small bowel cancer was low (1.6%). Although CD is a significant risk factor for small bowel cancers among individuals older than 67, the absolute risk is small. Older individuals with CD can be reassured that although there is an association between CD and small bowel cancer, the absolute risk remains small.

What is the Incidence of Small Bowel Cancer in Patients with Crohnʼs Disease and is There a Detection Bias?

Purpose: While Crohn's Disease (CD) is thought to predispose to adenocarcinomas of the small bowel, the prevalence and incidence of CD among patient with small bowel cancers (SBC), compared to cancer-free controls, has not been well studied at the population level. It is also not clear if this increased incidence is due to detection bias. The first objective is to estimate the prevalence of CD in persons with adenocarcinomas of the small bowel compared to cancer-free controls in a population-based, case-control study of an older population (>65 years). Our second objective is to study the incidence of SBC compared to non-GI cancers in patients with Crohn's disease to evaluate for detection bias. Methods: Cases and controls were identified from the SEER-Medicare database. Cases consisted of persons 67 and older in the SEER catchment area and in the Medicare claims data base who were diagnosed with SBC between 1994-1999. Two sets of controls were identified: one set was cancer free and a second set with non-GI cancers. CD cases were identified from ICD-9 codes on Medicare outpatient, office, and inpatient claims data during the two year window prior to the date of cancer diagnosis for cases or a randomly selected reference date for controls. Incidence was measured by comparing the number of new cases of small bowel cancer divided by the number of person-years at risk among persons with CD and those without CD. Results: The final sample consisted of 923 cases of SBC, 10,800 cases of other non-GI tract cancers, and 142,273 cancer free controls. Overall 1.6% of small bowel cancer cases carried a diagnosis of CD, which was nearly 12 times the prevalence of CD among cancer-free controls (p-value<0.001). In multivariable logistic regression analysis there was a significant association between CD and SBC (OR 11.24; 95% CI 6.07- 20.84; p-value<0.001). We found the annual incidence of SBC was 143 per 100,000 person-years (95% CI 120-168/ 100,000 person-years) among those with CD, and 1.1 per 100,000 person-years (0.25.5/ 100,000 person-years) among those without CD, yielding an incidence rate ratio of 120. Non-GI cancer controls had a nearly 1.5 fold higher prevalence of CD compared to cancer-free controls (p-value 0.03). In multivariable logistic regression analysis, there was a modest significant association of CD (OR 1.69; 95% CI 1.06-2.70; p-value 0.02) with non-GI cancer controls compared to cancer-free controls. Conclusion: The prevalence rate and incidence rate ratio for SBC among elderly persons with CD is strikingly high, even though the absolute risk remains low. There is also an increased prevalence of CD in persons with non-GI cancers suggesting either detection bias or a truly higher prevalence of CD among non-GI tract cancer controls.

Malignancy Associated with Inflammatory Bowel Disease

Purpose: As the number of patients with inflammatory bowel disease (IBD) has steadily increased in Korea, IBD-associated cancers are expected to increase in number. This study investigated the clinical features of intestinal cancer in patients with IBD. 15 cancer patients had no history of treatment for IBD of more than 3 mo before diagnosis of the cancer. Eleven cancers were located in the rectum (7 in UC, 4 in CD), including 1 case of synchronous cancer. One case of small bowel cancer was found in a patient with small bowel CD. Four cases involved a mucinous adenocarcinoma. Eight of the 12 cases of an adenocarcinoma of the colon and rectum were advanced stage. Conclusion: IBD-associated intestinal cancers were found at a relatively young age, were diagnosed at an advanced stage, and had a higher proportion of mucinous adenocarcinomas than in sporadic cancer. Considering the increasing incidence of IBD and the expected increase in the number of IBD-associated cancer in Korea, every effort should be made to prevent intestinal cancer in patients with IBD and to detect it early.

Metachronous Small Bowel Adenocarcinomas Detected by Capsule Endoscopy in a Patient with Hereditary Nonpolyposis Colorectal Cancer

Hereditary nonpolyposis colorectal carcinoma (HNPCC) is the most common colorectal cancer susceptibility syndrome, with a lifetime risk of colon cancer of 80% [1]. Affected individuals are at risk for extracolonic malignancies as well. These include (in descending order) endometrial, ovarian, gastric, and transition cell carcinoma of the uroepithelial tract. Other more rare HNPCC-associated extracolonic tumors include pancreas, hepatobiliary, brain, skin, and possibly small bowel. The significance of small bowel tumors in HNPCC remains unclear. Two large studies have assessed the risk of extracolonic cancers in HNPCC patients. Vasen et al. [2] observed a very high relative risk (>100-fold) for small bowel cancer in a cohort of 210 mutation carriers. Aarnio et al. [3], however, reviewed a larger cohort of 360 mutation carriers and found no cases of small bowel cancer. Cohort studies have reviewed the clinical pattern of small bowel cancers in HNPCC patients [4–6]. In addition to these larger series, many isolated case reports describe this association [7, 8].

Increased Incidence of Small Bowel Cancer in Females in Southeastern Kentucky

Purpose: The annual U.S. incidence of small bowel cancer is 1.7 per 100,000 of the population from the years 1998–2002, with a slight male predominance. The median age at diagnosis is 67 years. The SEER data showed that most small bowel tumors occurred in older adults; over 90% of cases occurred in people over 40 years of age. Approximately 0.3% diagnosed were under 20, 1.9% between the ages of 20 and 34, 6.0% between 35 and 44, 15.6% between 45 and 54, 20.6% between 55 and 64, 24.9% between 65 and 74, 23.0% between 75 and 84 and 7.7% in those 85 years of age and older. The most common histological types of malignant tumors of the small intestine were: Adenocarcinoma- 45%; Carcinoid-29%; Lymphoma-15%; and Sarcoma-10%. Methods: A retrospective analysis of 39 cases of small bowel cancer was performed in the Southeast Appalachian region. Data was taken from the Perry County Tumor Registry for the years 1995–2003. Results: The estimated annual incidence was 14.7 per 100,000. The gender specific estimated annual incidence rates were 4.7 per 100,000 for males and 24.3 per 100,000 for females. The median age of diagnosis was 58 years, with 84.6% females and 15.4% males. Additionally, 15% of cases were 45 years of age or younger and 20% of cases had a history of smoking. The distribution of histological types were: adenocarcinoma 64% (M-66.6%, F-63.6%), carcinoids 18% (M-16.7%, F-18.2%), lymphomas 10% (M-16.7%, F-9%) and leiomyosarcoma 8% (M-0%, F-9%). Conclusions: Our results demonstrate that the median age of diagnosis of small bowel cancer is lower in Southeastern Appalachian Kentucky than that of the US (58 years and 67 years, respectively). Interestingly there was a greater incidence of small bowel tumors in females (24.3 per 100,000) in a region with a predominantly white population (90% of population). Additionally, greater number of bowel cancers attributable to adenocarcinoma among these individuals was observed (64%) compared to the (45%) for the US. Our findings of higher incidence of small bowel tumors particularly adenocarcinomas among females in Southeast Appalachian Kentucky region deserve further investigation.

大腸全摘後の回腸嚢に小腸癌が発生したクローン病の１例

クローン病の小腸癌はその頻度が増加していると報告されているが, 本邦においては極めてまれである. 今回我々は潰瘍性大腸炎の診断で大腸全摘術, 回腸嚢肛門吻合を受け, 10年後に回腸嚢内に小腸癌を発生した44歳の女性を経験したので報告した. 患者は左臀部痛を主訴に来院し, 検査のために2003年8月入院となった. 既往症として35歳時Crohn病の診断を受け, その後5-ASA, predonisolone, azathioprinにて治療されていた. 小腸癌は, 直径10cm大で回腸嚢内に発生していた. 回腸嚢切除, 肛門切断術を行い腫瘍は治癒的に切除され, リンパ節転移は認めなかった. 現在外来にて化学療法施行中であるが再発は認めていない. 回腸嚢やクローン病の経過中には, 小腸癌の発生を念頭に入れて定期的な検査を行う必要がある.

Clinical characteristics of Peutz-Jeghers syndrome in Korean polyposis patients.

Peutz-Jeghers syndrome is an autosomal dominant inherited disorder characterized by hamartomatous polyps in the small bowel and mucocutaneous pigmentation. Patients with Peutz-Jeghers syndrome often present as surgical emergencies with complications of the polyps, such as intussusception, bowel obstruction, and bleeding. Recently an increased risk of malignancies has also been reported. This study was initiated to determine the clinical features of Peutz-Jeghers syndrome in Korean patients, with special attention to the development of malignancies. Thirty patients with Peutz-Jeghers syndrome were investigated; their median age was 23.5 years, and symptoms appeared at a median age of 12.5 years. Family history was positive in one-half of cases, and mucocutaneous pigmentation was observed in almost all patients (93%). The jejunoileum was the most frequent site of the polyps, and there were generally 10-100 polyps. Multiple laparotomies were performed in a substantial portion of the patients, due mainly to polyp-induced bowel obstruction, and the surgical interventions were begun at a relatively young age (average 21.4 years). Four cases of small-bowel cancer and one case of breast cancer were detected in probands, at a relatively young age (mean 36 years). Cancers of the small bowel, stomach, colon, breast and cervix were diagnosed in the first relatives of the probands. Close follow-up from an early age should thus be performed in patients with Peutz-Jeghers syndrome as they are at high risk of surgical emergency and development of malignancy.

Small bowel cancer: A 30-year review

Small bowel cancer is a relatively rare tumor with an incidence of 2,700 new cases and 900 deaths per year. The influence of stage on survival has been reported only once previously. Patterns of recurrence are unreported. All cases of small bowel cancer treated at our hospital over a 30-year period (1960-1989) were reviewed. The site of most cancers was the duodenum (46%), followed in frequency by the jejunum (33%) and the ileum (21%). Adenocarcinoma was the most common histology (63%), followed in frequency by lymphoma (15%), leiomyosarcoma (13%), carcinoid tumors (6%), and miscellaneous (3%). Analysis of stage distribution by site showed a decrease in stages I and II with more distal locations. Associated cancers occurred in 11%, but none were seen in the group with carcinoid tumors. Actuarial 10-year survival rates were 24% for those with adenocarcinoma (all stages) 75% for stage I, 25% for those with stage II, and 0% for stage III. A subgroup of 10 patients who underwent a pancreaticoduodenectomy (one stage I, seven stage II, two stage III) had a 30% 10-year survival rate. Those patients with lymphoma had a 12% 10-year survival rate, and those with leiomyosarcoma had a 20% 10-year survival rate. A 100% 10-year survival rate was observed in those with carcinoid tumors. Peritoneal carcinomatosis was the most common failure pattern (33%), followed in frequency by local recurrence in 23% and abdominal wall recurrence in 15%. A correlation exists between the pathologic stage and the survival rate for adenocarcinoma. The most common recurrence pattern for adenocarcinoma was carcinomatosis, followed in frequency by abdominal wall recurrence. Leiomyosarcoma preferentially metastasizes to the liver.

Abdominal Carcinoid Tumours in Sheffield

The incidence, presentation, and treatment strategies of abdominal carcinoid tumours are discussed. In the Trent Region of the UK, carcinoid tumours have an incidence of 0.7 cases/100,000 population. The small bowel is the commonest site (36%) followed by the lung (22%) and appendix (13%). Analysis of the presenting symptoms and signs in 24 cases of small bowel cancer demonstrated diarrhoea in 17, pain in 17, and flushing in 12. Treatment strategies comprise surgery and drug therapy. Sandostatin has a role in preventing the release of pharmacologically active tumour products. A long-term trial of Sandostatin in patients with carcinoid syndrome is underway. Experience to dat indicates Sandostatin is indicated: where surgery and drugs (cyproheptadine and codeine phosphate) in combination have failed to control symptoms; where the patient is unfit for surgery; and to cover anaesthesia and surgery as prophylaxis against the risks of carcinoid crisis.

Carcinoma complicating Crohn's disease: Report of seven cases and review of the literature

Seven cases of adenocarcinoma complicating Crohn's disease are reviewed. In three of the patients, small bowel cancers developed in association with regional enteritis. In four patients, carcinoma of the colon was superimposed on Crohn's colitis. In two of these, the adenocarcinoma infiltrated chronic colocutaneous fistulas. Review of the literature shows an increasing number of reports of carcinoma complicating Crohn's disease, with a total of 36 cases of small bowel cancer and 30 cases of colon cancer previously reported. The significance of these and our own cases is discussed. The possibility of carcinoma must be kept in mind by clinicians following patients with Crohn's disease. Adenocarcinoma complicating Crohn's disease occurs at a younger age, on the average, and in areas similar to the distribution of Crohn's disease rather than the usual distribution of the cancer. Preoperative diagnosis is difficult, but changes in the nature of chronic fistulas should be investigated.