scholarly journals Small bowel adenocarcinoma: revisited

2021 ◽  
Vol 8 (3) ◽  
pp. 1010
Author(s):  
Muhammad F. Rosley ◽  
Mahanama Dissanayake
Keyword(s):  
Adjuvant Chemotherapy ◽  
Small Bowel ◽  
Metabolic Response ◽  
Advanced Disease ◽  
Tumor Staging ◽  
Delayed Diagnosis ◽  
Small Bowel Resection ◽  
Anatomical Location ◽  
Small Bowel Adenocarcinoma ◽  
Presenting Symptoms

Small bowel malignancies are rare despite it representing 75% of the gastro intestinal (GI) length and 90% of the mucosal surface area. Even then small bowel adenocarcinoma (SBA) accounts for only 30-40% of all small intestine malignancies. Etiology is multifactorial and risk factors include hereditary mutations, inflammatory bowel diseases, coeliac disease. Presenting symptoms are vague and nonspecific and cannot usually be diagnosed by conventional upper and lower GI endoscopy as it is in an inaccessible location. This leads to delayed diagnosis and hence poor prognosis. Mainstay of treatment is surgical resection with adjuvant chemotherapy in advanced disease. We present a case study of a 74 years old woman who presented to the emergency department with small bowel obstruction and radiological features suggestive of underlying small bowel malignancy. She underwent urgent laparotomy with segmental small bowel resection and had intraoperative evidence of wide spread metastasis which was confirmed on subsequent tumor staging scans. She received adjuvant chemotherapy with complete metabolic response at one year post resection. SBA is generally diagnosed at advanced stage due to its anatomical location. Complete surgical resections should always be targeted. However, adjuvant chemotherapy plays a role in advanced disease even though clinical data of evidence is scarce.

scholarly journals Efficacy of adjuvant chemotherapy for small bowel adenocarcinoma: A propensity score-matched analysis

Cancer ◽  
2015 ◽  
Vol 122 (5) ◽  
pp. 693-701 ◽  
Author(s):  
Brett L. Ecker ◽  
Matthew T. McMillan ◽  
Jashodeep Datta ◽  
Ronac Mamtani ◽  
Bruce J. Giantonio ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Small Bowel ◽  
Propensity Score ◽  
Small Bowel Adenocarcinoma

GLOBAL BALLAD: An International Rare Cancers Initiative trial to evaluate the potential benefit of adjuvant chemotherapy for small bowel adenocarcinoma (IRCI 002).

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. TPS4154-TPS4154 ◽  
Author(s):  
T.R. Jeffry Evans ◽  
Thomas Aparicio ◽  
Karine Le Malicot ◽  
Kenichi Nakamura ◽  
Yoshitaka Honma ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Small Bowel ◽  
Potential Benefit ◽  
Small Bowel Adenocarcinoma ◽  
Rare Cancers

Clinical outcomes of resectable small bowel adenocarcinoma treated by surgery alone: Case series in a Japanese single institution.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 372-372
Author(s):  
Shoko Noda ◽  
Yoshitaka Honma ◽  
Hiroshi Moro ◽  
Shoko Nakamura ◽  
Yusuke Sasaki ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Small Bowel ◽  
Clinical Outcomes ◽  
Univariate Analysis ◽  
Case Series ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Cancer Center ◽  
Significant Prognostic Factor ◽  
Small Bowel Adenocarcinoma

372 Background: Small bowel adenocarcinoma (SBA) is known as a poor prognostic cancer even in surgically resected cases. Its five-year survival rates were reported as 65%, 48%, and 35% in stage I, II, and III SBA, respectively. However, clinical outcomes of curatively resected SBA, especially without peri-operative adjuvant chemotherapy, are still unknown in Japanese population. Methods: We retrospectively reviewed medical records of patients who were diagnosed as Stage I, II, and III SBA after curative surgery between July 1994 and June 2014 at National Cancer Center Hospital. Overall survival (OS) and relapse-free survival (RFS) were calculated by Kaplan-Meier method. Cox proportional-hazards analysis was performed to identify the prognostic factors. Results: From a total of 76 patients with SBA received surgical resection, 56 were selected in this study who underwent curative resection with histological confirmation and did not receive adjuvant chemotherapy. The median age was 64 years (range: 20-85). Thirty-five patients (61%) were male. Forty-five patients (80%) had tumors in duodenum, 6 (11%) in jejunum and 5 (9%) in ileum. Pathological T stage were pT1a/T1b/T2/T3/T4 in 9/2/4/14/27 patients, and pathological N stage (pN) were pN0/N1/N2 in 29/16/11. The 1/3/5-year OS in all patients were 92.5/77.5/71.6%, and 1/3/5-year RFS were 76.5/68.9/61.6%. The 5-year RFS of pN0 (stage I/IIA/IIB) / N1 (stage IIIA) /N2 (stage IIIB) were 81.2/51.6/20.8%, and 5-year OS were 88.2/71.6/26.7%, respectively. Univariate analysis demonstrated that pN, presence of lymphatic and venous invasion were associated with poor OS. In multivariate analysis, pN was a significant predictor of poor OS (HR: 5.39 [N0 vs N1], 21.74 [N0 vs N2], 4.03 [N1 vs N2], p = 0.042). These findings were also seen in RFS. Conclusions: This study showed survival outcome of curatively resected SBA was better compared with previous reports, and pN was a significant prognostic factor of RFS and OS.

Delayed diagnosis of rheumatoid arthritis in an elderly patient presenting with weakness and desolation

2021 ◽  
Vol 14 (2) ◽  
pp. e237251
Author(s):  
Sebastian Stiebitz ◽  
Tasslem von Streng ◽  
Moritz Strickler
Keyword(s):  
Rheumatoid Arthritis ◽  
Elderly Patient ◽  
Advanced Disease ◽  
Diagnostic Testing ◽  
Delayed Diagnosis ◽  
Previous Treatment ◽  
Signs And Symptoms ◽  
Presenting Symptoms ◽  
General Weakness ◽  
Oral Glucocorticoids

We describe the case of an 81-year-old man who presented with unspecific symptoms of desolation and general weakness, which led to a delayed diagnosis of rheumatoid arthritis (RA). The patient had not received any previous treatment as he had not been in contact with medical services for several years prior to hospital admission. This enabled advanced disease manifestations to develop, including peripheral neuropathy with distal paraparesis, lethargy and weight loss. These signs and symptoms were later recognised as extra-articular manifestations of RA and classical features of RA were less pronounced. Following extensive diagnostic testing ruling out other possible causes for the presenting symptoms, an anti-inflammatory therapy with oral glucocorticoids and methotrexate was started.

Adjuvant chemotherapy impact on the overall survival of completely resected small bowel adenocarcinoma: An updated meta-analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16806-e16806
Author(s):  
Philip A. Haddad ◽  
Dalia A. Hammoud ◽  
Kevin M. Gallagher
Keyword(s):  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Small Bowel ◽  
Survival Benefit ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Adjuvant Chemoradiotherapy ◽  
Small Bowel Adenocarcinoma ◽  
The Impact ◽  
Resected Small Bowel

e16806 Background: While the small intestine represents around 75% of the length and more than 90% of the gastrointestinal tract mucosal surface, it contributes around 2% of gastrointestinal tumors. Adenocarcinoma which constitutes 40% of all small bowel tumors is the most common histology. Complete surgical resection of early-stage small bowel adenocarcinoma (SBAC) is the only proven potentially curative therapy. Due to the rarity of this disease and the absence of randomized trials, the benefit of postoperative adjuvant chemotherapy (ACT) in patients with completely resected localized SBAC has been controversial. A meta-analysis conducted in 2018 found no survival benefit for adjuvant therapies in SBAC. However, this meta-analysis combined studies that used adjuvant chemotherapy and chemoradiotherapy and included studies contaminated by other less chemosensitive histologies and more advanced and sometimes metastatic disease. The purpose of this meta-analysis is to evaluate the impact of ACT on the overall survival (OS) of patients with completely resected SBAC incorporating more recent studies. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of resected small bowel adenocarcinoma, English language, publications from 2000 to the present, and comparative studies reporting OS with hazard ratios (HR) or Kaplan-Meier curves of patients that underwent ACT versus those that did not. Adjuvant chemoradiotherapy studies and those that reported aggregate OS for a cohort with mixed histologies were excluded. A meta-analysis was conducted using an inverse variance method with a random-effects model. Results: Nine retrospective series which included 2082 patients were selected and analyzed. The majority of SBAC patients that received ACT belonged to stages II & III. ACT was found to be significantly associated with better OS in patients with completely resected SBAC (HR 0.66, 95%CI: 0.56-0.78, p < 0.001). Conclusions: This is the first meta-analysis to show that adjuvant chemotherapy is associated with a survival benefit in patients with completely resected small bowel adenocarcinoma. In the absence of randomized clinical trials, this meta-analysis represents the most compelling data supporting the use of ACT in this patient population.

scholarly journals Small Bowel Adenocarcinoma: Etiology, Presentation, and Molecular Alterations

2019 ◽  
Vol 17 (9) ◽  
pp. 1135-1141 ◽  
Author(s):  
Katrina S. Pedersen ◽  
Kanwal Raghav ◽  
Michael J. Overman
Keyword(s):  
Colorectal Cancer ◽  
Small Bowel ◽  
Patient Outcomes ◽  
Delayed Diagnosis ◽  
Small Bowel Adenocarcinoma ◽  
Rare Cancer ◽  
Molecular Alterations ◽  
Molecular Studies

Small bowel adenocarcinoma (SBA) is a rare cancer that has been treated similarly to colorectal cancer (CRC) in the advanced setting. Incidence has been increasing as detection efforts have been improving for these challenging-to-diagnose tumors, but patients frequently experience prolonged nonspecific symptoms due to delayed diagnosis. As a result of such delays and likely due to variant biology, patient outcomes for SBA are inferior to those for CRC at all stages of diagnosis. Recent molecular studies highlight the genomic differences underpinning these tumors and suggest new future pathways for treatment, distinct from CRC.

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