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Primary Small-Bowel Malignancy: Update in Tumor Biology, Markers, and Management Strategies

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Abstract

Purpose

Primary small-bowel malignancies (SBM) are rare tumors but their incidence is rising. An estimated 9160 new cases and 1210 deaths due to SBM may occur in the USA in 2014. We review advances made in tumor biology, immunohistochemistry, and discuss treatment strategies for these malignancies.

Methods

Relevant articles from PubMed/Medline and Embase searches were collected using the phrases “small-bowel adenocarcinoma, gastrointestinal carcinoids, gastrointestinal stromal tumors, small-bowel leiomyosarcoma, and small-bowel lymphoma”.

Results

Advances in imaging techniques such as wireless capsule endoscopy, CT and MRI enterography, and endoscopy (balloon enteroscopy) along with discovery of molecular markers such as c-kit and PDGFRA for GIST tumors have improved our ability to diagnose, localize, and treat these patients. Early detection and surgical resection offers the best chance for long-term survival in all tumors except bowel lymphoma where chemotherapy plays the main role. Adjuvant therapy with imatinib has improved overall survival for GIST tumors, somatostatin analogs have improved symptoms and also inhibited tumor growth and stabilized metastatic disease in carcinoid disease, but chemotherapy has not improved survival for adenocarcinoma.

Conclusions

Recent advances in molecular characterization holds promise in novel targeted therapies. Currently ongoing trials are exploring efficacy of targeted therapies and role of adjuvant therapy for adenocarcinoma and results are awaited. Early detection and aggressive surgical therapy for all localized tumors and lymph node sampling particularly for adenocarcinoma remains the main treatment modality.

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The author declares that he has no conflict of interest, no financial disclosures, and have no sponsors for this journal article.

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  1. Department of Surgery, KCVA, 4801 E Linwood Blvd, Kansas City, MO, 64128, USA

    Santosh Shenoy

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  1. Santosh Shenoy
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Shenoy, S. Primary Small-Bowel Malignancy: Update in Tumor Biology, Markers, and Management Strategies. J Gastrointest Canc 45, 421–430 (2014). https://doi.org/10.1007/s12029-014-9658-z

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  • DOI: https://doi.org/10.1007/s12029-014-9658-z

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