PDF herunterladen
Clin Colon Rectal Surg 2018; 31(05): 267-277
DOI: 10.1055/s-0038-1660482
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Small Bowel Adenocarcinoma

Emerson Y. Chen
1   Division of Hematology and Medical Oncology, Department of Medicine, Knight Cancer Institute, Oregon Health & Sciences University, Portland, Oregon
,
Gina M. Vaccaro
1   Division of Hematology and Medical Oncology, Department of Medicine, Knight Cancer Institute, Oregon Health & Sciences University, Portland, Oregon
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
04. September 2018 (online)

    Lizenzen und Reprints

Abstract

Small bowel adenocarcinoma is a clinically and anatomically distinct gastrointestinal cancer that lacks prospective data to support its optimal management. Patients with inflammatory bowel disease and inherited conditions that cause gastrointestinal polyps are at especially high risk. Due to a lack of effective surveillance programs resulting in missed or delayed diagnoses only when symptoms develop, this disease is generally discovered at an advanced stage. Surgical resection is the only treatment modality with a chance of cure. Currently accepted treatment considerations are often generalized from large bowel and pancreatic–biliary cancers, due to some anatomic and clinical parallels. Additional research, however, is desperately needed to characterize the unique molecular differences of this disease to better prognosticate patients and establish rational clinical trials that would improve their outcomes.

Keywords

small bowel adenocarcinoma - small intestinal adenocarcinoma - small intestinal cancer - small bowel malignancies - small bowel cancer
 

  • References

  • 1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016; 66 (01) 7-30
    CrossrefPubMedGoogle Scholar
  • 2 Bilimoria KY, Bentrem DJ, Wayne JD, Ko CY, Bennett CL, Talamonti MS. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg 2009; 249 (01) 63-71
    CrossrefPubMedGoogle Scholar
  • 3 Halfdanarson TR, McWilliams RR, Donohue JH, Quevedo JF. A single-institution experience with 491 cases of small bowel adenocarcinoma. Am J Surg 2010; 199 (06) 797-803
    CrossrefPubMedGoogle Scholar
  • 4 Dabaja BS, Suki D, Pro B, Bonnen M, Ajani J. Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients. Cancer 2004; 101 (03) 518-526
    CrossrefPubMedGoogle Scholar
  • 5 Haselkorn T, Whittemore AS, Lilienfeld DE. Incidence of small bowel cancer in the United States and worldwide: geographic, temporal, and racial differences. Cancer Causes Control 2005; 16 (07) 781-787
    CrossrefPubMedGoogle Scholar
  • 6 Legué LM, Bernards N, Gerritse SL. , et al. Trends in incidence, treatment and survival of small bowel adenocarcinomas between 1999 and 2013: a population-based study in The Netherlands. Acta Oncol 2016; 55 (9-10): 1183-1189
    CrossrefPubMedGoogle Scholar
  • 7 Wu TJ, Yeh CN, Chao TC, Jan YY, Chen MF. Prognostic factors of primary small bowel adenocarcinoma: univariate and multivariate analysis. World J Surg 2006; 30 (03) 391-398 , discussion 399
    CrossrefPubMedGoogle Scholar
  • 8 Zaaimi Y, Aparicio T, Laurent-Puig P, Taieb J, Zaanan A. Advanced small bowel adenocarcinoma: molecular characteristics and therapeutic perspectives. Clin Res Hepatol Gastroenterol 2016; 40 (02) 154-160
    CrossrefPubMedGoogle Scholar
  • 9 Cross AJ, Hollenbeck AR, Park Y. A large prospective study of risk factors for adenocarcinomas and malignant carcinoid tumors of the small intestine. Cancer Causes Control 2013; 24 (09) 1737-1746
    CrossrefPubMedGoogle Scholar
  • 10 Shenoy S. Genetic risks and familial associations of small bowel carcinoma. World J Gastrointest Oncol 2016; 8 (06) 509-519
    CrossrefPubMedGoogle Scholar
  • 11 Aparicio T, Zaanan A, Svrcek M. , et al. Small bowel adenocarcinoma: epidemiology, risk factors, diagnosis and treatment. Dig Liver Dis 2014; 46 (02) 97-104
    CrossrefPubMedGoogle Scholar
  • 12 Syngal S, Brand RE, Church JM, Giardiello FM, Hampel HL, Burt RW. ; American College of Gastroenterology. ACG clinical guideline: Genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol 2015; 110 (02) 223-262 , quiz 263
    CrossrefPubMedGoogle Scholar
  • 13 Haanstra JF, Al-Toma A, Dekker E. , et al. Prevalence of small-bowel neoplasia in Lynch syndrome assessed by video capsule endoscopy. Gut 2015; 64 (10) 1578-1583
    CrossrefPubMedGoogle Scholar
  • 14 Giardiello FM, Brensinger JD, Tersmette AC. , et al. Very high risk of cancer in familial Peutz-Jeghers syndrome. Gastroenterology 2000; 119 (06) 1447-1453
    CrossrefPubMedGoogle Scholar
  • 15 Peters U, Askling J, Gridley G, Ekbom A, Linet M. Causes of death in patients with celiac disease in a population-based Swedish cohort. Arch Intern Med 2003; 163 (13) 1566-1572
    CrossrefPubMedGoogle Scholar
  • 16 Elriz K, Carrat F, Carbonnel F, Marthey L, Bouvier AM, Beaugerie L. ; CESAME study group. Incidence, presentation, and prognosis of small bowel adenocarcinoma in patients with small bowel Crohn's disease: a prospective observational study. Inflamm Bowel Dis 2013; 19 (09) 1823-1826
    PubMedGoogle Scholar
  • 17 Wieghard N, Mongoue-Tchokote S, Isaac Young J, Sheppard BC, Liana Tsikitis V. Prognosis of small bowel adenocarcinoma in crohn's disease compares favourably with de novo small bowel adenocarcinoma. Colorectal Dis 2012017; 19 (05) 446-455
    PubMedGoogle Scholar
  • 18 Boffetta P, Hazelton WD, Chen Y. , et al. Body mass, tobacco smoking, alcohol drinking and risk of cancer of the small intestine--a pooled analysis of over 500,000 subjects in the Asia Cohort Consortium. Ann Oncol 2012; 23 (07) 1894-1898
    CrossrefPubMedGoogle Scholar
  • 19 Kaerlev L, Teglbjaerg PS, Sabroe S. , et al. Is there an association between alcohol intake or smoking and small bowel adenocarcinoma? Results from a European multi-center case-control study. Cancer Causes Control 2000; 11 (09) 791-797
    CrossrefPubMedGoogle Scholar
  • 20 Cross AJ, Leitzmann MF, Subar AF, Thompson FE, Hollenbeck AR, Schatzkin A. A prospective study of meat and fat intake in relation to small intestinal cancer. Cancer Res 2008; 68 (22) 9274-9279
    CrossrefPubMedGoogle Scholar
  • 21 Schatzkin A, Park Y, Leitzmann MF, Hollenbeck AR, Cross AJ. Prospective study of dietary fiber, whole grain foods, and small intestinal cancer. Gastroenterology 2008; 135 (04) 1163-1167
    CrossrefPubMedGoogle Scholar
  • 22 Lu Y, Cross AJ, Murphy N. , et al. Comparison of abdominal adiposity and overall obesity in relation to risk of small intestinal cancer in a European Prospective Cohort. Cancer Causes Control 2016; 27 (07) 919-927
    CrossrefPubMedGoogle Scholar
  • 23 Young JI, Mongoue-Tchokote S, Wieghard N. , et al. Treatment and survival of small-bowel adenocarcinoma in the united states: a comparison with colon cancer. Dis Colon Rectum 2016; 59 (04) 306-315
    CrossrefPubMedGoogle Scholar
  • 24 Cloyd JM, Norton JA, Visser BC, Poultsides GA. Does the extent of resection impact survival for duodenal adenocarcinoma? Analysis of 1,611 cases. Ann Surg Oncol 2015; 22 (02) 573-580
    PubMedGoogle Scholar
  • 25 Solaini L, Jamieson NB, Metcalfe M. , et al; UK Duodenal Cancer Study Group. Outcome after surgical resection for duodenal adenocarcinoma in the UK. Br J Surg 2015; 102 (06) 676-681
    CrossrefPubMedGoogle Scholar
  • 26 Sellner F. Investigations on the significance of the adenoma-carcinoma sequence in the small bowel. Cancer 1990; 66 (04) 702-715
    CrossrefPubMedGoogle Scholar
  • 27 Nakano Y, Adachi Y, Okamoto H. , et al. Adenocarcinoma with adenoma in the jejunum suggesting an adenoma-carcinoma sequence in the small bowel: a case report. Oncol Lett 2014; 8 (02) 633-636
    CrossrefPubMedGoogle Scholar
  • 28 Zhang MQ, Chen ZM, Wang HL. Immunohistochemical investigation of tumorigenic pathways in small intestinal adenocarcinoma: a comparison with colorectal adenocarcinoma. Mod Pathol 2006; 19 (04) 573-580
    PubMedGoogle Scholar
  • 29 Laforest A, Aparicio T, Zaanan A. , et al. ERBB2 gene as a potential therapeutic target in small bowel adenocarcinoma. Eur J Cancer 2014; 50 (10) 1740-1746
    CrossrefPubMedGoogle Scholar
  • 30 Xia M, Singhi AD, Dudley B, Brand R, Nikiforova M, Pai RK. Small bowel adenocarcinoma frequently exhibits Lynch syndrome-associated mismatch repair protein deficiency but does not harbor sporadic MLH1 deficiency. Appl Immunohistochem Mol Morphol 2017; 25 (06) 399-406
    PubMedGoogle Scholar
  • 31 Warth A, Kloor M, Schirmacher P, Bläker H. Genetics and epigenetics of small bowel adenocarcinoma: the interactions of CIN, MSI, and CIMP. Mod Pathol 2011; 24 (04) 564-570
    PubMedGoogle Scholar
  • 32 Bläker H, von Herbay A, Penzel R, Gross S, Otto HF. Genetics of adenocarcinomas of the small intestine: frequent deletions at chromosome 18q and mutations of the SMAD4 gene. Oncogene 2002; 21 (01) 158-164
    CrossrefPubMedGoogle Scholar
  • 33 Alvi MA, McArt DG, Kelly P. , et al. Comprehensive molecular pathology analysis of small bowel adenocarcinoma reveals novel targets with potential for clinical utility. Oncotarget 2015; 6 (25) 20863-20874
    PubMedGoogle Scholar
  • 34 Arber N, Hibshoosh H, Yasui W. , et al. Abnormalities in the expression of cell cycle-related proteins in tumors of the small bowel. Cancer Epidemiol Biomarkers Prev 1999; 8 (12) 1101-1105
    PubMedGoogle Scholar
  • 35 Aparicio T, Svrcek M, Zaanan A. , et al. Small bowel adenocarcinoma phenotyping, a clinicobiological prognostic study. Br J Cancer 2013; 109 (12) 3057-3066
    CrossrefPubMedGoogle Scholar
  • 36 Wang Y, Jiang CQ, Guan J. , et al. Molecular alterations of EGFR in small intestinal adenocarcinoma. Int J Colorectal Dis 2013; 28 (10) 1329-1335
    CrossrefPubMedGoogle Scholar
  • 37 Rashid A, Hamilton SR. Genetic alterations in sporadic and Crohn's-associated adenocarcinomas of the small intestine. Gastroenterology 1997; 113 (01) 127-135
    CrossrefPubMedGoogle Scholar
  • 38 Svrcek M, Piton G, Cosnes J. , et al. Small bowel adenocarcinomas complicating Crohn's disease are associated with dysplasia: a pathological and molecular study. Inflamm Bowel Dis 2014; 20 (09) 1584-1592
    CrossrefPubMedGoogle Scholar
  • 39 Green PH, Cellier C. Celiac disease. N Engl J Med 2007; 357 (17) 1731-1743
    CrossrefPubMedGoogle Scholar
  • 40 Neugut AI, Jacobson JS, Suh S, Mukherjee R, Arber N. The epidemiology of cancer of the small bowel. Cancer Epidemiol Biomarkers Prev 1998; 7 (03) 243-251
    PubMedGoogle Scholar
  • 41 Zhang S, Cui Y, Zhong B. , et al. Clinicopathological characteristics and survival analysis of primary duodenal cancers: a 14-year experience in a tertiary centre in South China. Int J Colorectal Dis 2011; 26 (02) 219-226
    CrossrefPubMedGoogle Scholar
  • 42 Overman MJ, Kopetz S, Wen S. , et al. Chemotherapy with 5-fluorouracil and a platinum compound improves outcomes in metastatic small bowel adenocarcinoma. Cancer 2008; 113 (08) 2038-2045
    CrossrefPubMedGoogle Scholar
  • 43 Overman MJ, Pozadzides J, Kopetz S. , et al. Immunophenotype and molecular characterisation of adenocarcinoma of the small intestine. Br J Cancer 2010; 102 (01) 144-150
    CrossrefPubMedGoogle Scholar
  • 44 Poultsides GA, Huang LC, Cameron JL. , et al. Duodenal adenocarcinoma: clinicopathologic analysis and implications for treatment. Ann Surg Oncol 2012; 19 (06) 1928-1935
    CrossrefPubMedGoogle Scholar
  • 45 Cloyd JM, George E, Visser BC. Duodenal adenocarcinoma: advances in diagnosis and surgical management. World J Gastrointest Surg 2016; 8 (03) 212-221
    PubMedGoogle Scholar
  • 46 Bakaeen FG, Murr MM, Sarr MG. , et al. What prognostic factors are important in duodenal adenocarcinoma?. Arch Surg 2000; 135 (06) 635-641 , discussion 641–642
    PubMedGoogle Scholar
  • 47 Sohn TA, Lillemoe KD, Cameron JL. , et al. Adenocarcinoma of the duodenum: factors influencing long-term survival. J Gastrointest Surg 1998; 2 (01) 79-87
    CrossrefPubMedGoogle Scholar
  • 48 Overman MJ, Hu CY, Wolff RA, Chang GJ. Prognostic value of lymph node evaluation in small bowel adenocarcinoma: analysis of the surveillance, epidemiology, and end results database. Cancer 2010; 116 (23) 5374-5382
    CrossrefPubMedGoogle Scholar
  • 49 Sarela AI, Brennan MF, Karpeh MS, Klimstra D, Conlon KC. Adenocarcinoma of the duodenum: importance of accurate lymph node staging and similarity in outcome to gastric cancer. Ann Surg Oncol 2004; 11 (04) 380-386
    CrossrefPubMedGoogle Scholar
  • 50 Ecker BL, McMillan MT, Datta J. , et al. Lymph node evaluation and survival after curative-intent resection of duodenal adenocarcinoma: a matched cohort study. Eur J Cancer 2016; 69: 135-141
    CrossrefPubMedGoogle Scholar
  • 51 Koo DH, Yun SC, Hong YS. , et al. Adjuvant chemotherapy for small bowel adenocarcinoma after curative surgery. Oncology 2011; 80 (3-4): 208-213
    CrossrefPubMedGoogle Scholar
  • 52 Liu Y, Ishibashi H, Takeshita K. , et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal dissemination from small bowel malignancy: results from a single specialized center. Ann Surg Oncol 2016; 23 (05) 1625-1631
    CrossrefPubMedGoogle Scholar
  • 53 van Oudheusden TR, Lemmens VE, Braam HJ. , et al. Peritoneal metastases from small bowel cancer: results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in The Netherlands. Surgery 2015; 157 (06) 1023-1027
    CrossrefPubMedGoogle Scholar
  • 54 Neoptolemos JP, Moore MJ, Cox TF. , et al; European Study Group for Pancreatic Cancer. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA 2012; 308 (02) 147-156
    CrossrefPubMedGoogle Scholar
  • 55 Swartz MJ, Hughes MA, Frassica DA. , et al. Adjuvant concurrent chemoradiation for node-positive adenocarcinoma of the duodenum. Arch Surg 2007; 142 (03) 285-288
    PubMedGoogle Scholar
  • 56 Kelsey CR, Nelson JW, Willett CG. , et al. Duodenal adenocarcinoma: patterns of failure after resection and the role of chemoradiotherapy. Int J Radiat Oncol Biol Phys 2007; 69 (05) 1436-1441
    CrossrefPubMedGoogle Scholar
  • 57 Ecker BL, McMillan MT, Datta J. , et al. Efficacy of adjuvant chemotherapy for small bowel adenocarcinoma: a propensity score-matched analysis. Cancer 2016; 122 (05) 693-701
    CrossrefPubMedGoogle Scholar
  • 58 Overman MJ, Kopetz S, Lin E, Abbruzzese JL, Wolff RA. Is there a role for adjuvant therapy in resected adenocarcinoma of the small intestine. Acta Oncol 2010; 49 (04) 474-479
    CrossrefPubMedGoogle Scholar
  • 59 Aydin D, Sendur MA, Kefeli U. , et al. Evaluation of prognostic factors and adjuvant chemotherapy in patients with small bowel adenocarcinoma who underwent curative resection. Clin Colorectal Cancer 2017; 16 (03) 220-227
    CrossrefPubMedGoogle Scholar
  • 60 Xiang XJ, Liu YW, Zhang L. , et al. A phase II study of modified FOLFOX as first-line chemotherapy in advanced small bowel adenocarcinoma. Anticancer Drugs 2012; 23 (05) 561-566
    CrossrefPubMedGoogle Scholar
  • 61 Tsushima T, Taguri M, Honma Y. , et al. Multicenter retrospective study of 132 patients with unresectable small bowel adenocarcinoma treated with chemotherapy. Oncologist 2012; 17 (09) 1163-1170
    CrossrefPubMedGoogle Scholar
  • 62 Overman MJ, Varadhachary GR, Kopetz S. , et al. Phase II study of capecitabine and oxaliplatin for advanced adenocarcinoma of the small bowel and ampulla of Vater. J Clin Oncol 2009; 27 (16) 2598-2603
    CrossrefPubMedGoogle Scholar
  • 63 Zaanan A, Costes L, Gauthier M. , et al. Chemotherapy of advanced small-bowel adenocarcinoma: a multicenter AGEO study. Ann Oncol 2010; 21 (09) 1786-1793
    CrossrefPubMedGoogle Scholar
  • 64 Gibson MK, Holcroft CA, Kvols LK, Haller D. Phase II study of 5-fluorouracil, doxorubicin, and mitomycin C for metastatic small bowel adenocarcinoma. Oncologist 2005; 10 (02) 132-137
    CrossrefPubMedGoogle Scholar
  • 65 Aydin D, Sendur MA, Kefeli U. , et al. Evaluation of bevacizumab in advanced small bowel adenocarcinoma. Clin Colorectal Cancer 2017; 16 (01) 78-83
    CrossrefPubMedGoogle Scholar
  • 66 Zaanan A, Gauthier M, Malka D. , et al; Association des Gastro Entérologues Oncologues. Second-line chemotherapy with fluorouracil, leucovorin, and irinotecan (FOLFIRI regimen) in patients with advanced small bowel adenocarcinoma after failure of first-line platinum-based chemotherapy: a multicenter AGEO study. Cancer 2011; 117 (07) 1422-1428
    CrossrefPubMedGoogle Scholar
  • 67 Santini D, Fratto ME, Spoto C. , et al. Cetuximab in small bowel adenocarcinoma: a new friend?. Br J Cancer 2010; 103 (08) 1305 , author reply 1306
    CrossrefPubMedGoogle Scholar
  • 68 Aparicio T, Zaanan A, Mary F, Afchain P, Manfredi S, Evans TR. Small bowel adenocarcinoma. Gastroenterol Clin North Am 2016; 45 (03) 447-457
    CrossrefPubMedGoogle Scholar
  • 69 Hampel H, de la Chapelle A. The search for unaffected individuals with Lynch syndrome: do the ends justify the means?. Cancer Prev Res (Phila) 2011; 4 (01) 1-5
    CrossrefPubMedGoogle Scholar
  • 70 Kappelman MD, Rifas-Shiman SL, Kleinman K. , et al. The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol 2007; 5 (12) 1424-1429
    CrossrefPubMedGoogle Scholar
  • 71 Fishman PN, Pond GR, Moore MJ. , et al. Natural history and chemotherapy effectiveness for advanced adenocarcinoma of the small bowel: a retrospective review of 113 cases. Am J Clin Oncol 2006; 29 (03) 225-231
    CrossrefPubMedGoogle Scholar
  • 72 Zhang L, Wang LY, Deng YM. , et al. Efficacy of the FOLFOX/CAPOX regimen for advanced small bowel adenocarcinoma: a three-center study from China. J BUON 2011; 16 (04) 689-696
    PubMedGoogle Scholar
  • 73 Koo DH, Yun SC, Hong YS. , et al. Systemic chemotherapy for treatment of advanced small bowel adenocarcinoma with prognostic factor analysis: retrospective study. BMC Cancer 2011; 11: 205
    CrossrefPubMedGoogle Scholar
  • 74 Czaykowski P, Hui D. Chemotherapy in small bowel adenocarcinoma: 10-year experience of the British Columbia Cancer Agency. Clin Oncol (R Coll Radiol) 2007; 19 (02) 143-149
    CrossrefPubMedGoogle Scholar
  • 75 Locher C, Malka D, Boige V. , et al. Combination chemotherapy in advanced small bowel adenocarcinoma. Oncology 2005; 69 (04) 290-294
    CrossrefPubMedGoogle Scholar