Neoplasms of the Small Intestine
Despite its anatomical location between the stomach and the colon, two regions with high cancer risk, malignancies rarely occur in the small bowel. Careful follow-up is mainly indicated for patients with medical conditions carrying an increased risk for small bowel malignancy, in particular for patients with celiac disease, Crohn’s disease, inherited disorders such as familial adenomatous polyposis (FAP) and immunodeficiency. Four main histological subtypes of small bowel cancer can be distinguished: adenocarcinoma, carcinoid, malignant lymphoma and malignant gastro-intestinal stromal tumors (GIST). The incidence of these tumors is increasing, especially for the first three types and various medical conditions are now recognized to be associated with an increased cancer risk. The clinical presentation and symptoms of small bowel tumors are non-specific and therefore the diagnosis is made late in the course of the disease. Small bowel tumors are often in an advanced stage at diagnosis and the overall 5-year survival rate is rather poor (approximately 50%). Except for lymphoma where the treatment of choice is chemotherapy, treatment is essentially surgical. The role of adjuvant or palliative chemotherapy for adenocarcinoma, carcinoid and malignant GIST is unclear. Recently good results have been obtained with the introduction of new therapeutic modalities.
KeywordsSmall Bowel Celiac Disease Familial Adenomatous Polyposis Carcinoid Tumor Mantle Cell Lymphoma
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