Small bowel adenocarcinoma: An overview

Abstract

Small bowel adenocarcinoma (SBA) is a rare malignancy of the gastrointestinal tract. However, these tumors are among those with worst prognosis. Vague clinical signs and symptoms and radiological diagnostic challenges often delay treatment, which negatively impacts the prognosis of the patients. However, recent advances in imaging technology, like multidetector computed tomography, magnetic resonance imaging, and capsule endoscopy, have made earlier and accurate diagnosis possible. Surgery is the treatment of choice followed by adjuvant therapy. However, there are no strict treatment guidelines available for the management of SBA. Most of the available evidence from colorectal and gastric carcinoma has been extrapolated to adequately manage SBA. Prognosis for SBA is better than gastric carcinoma but worse than colorectal carcinoma. Currently, there is not enough information on the molecular characteristics and tumor pathogenesis. Because the incidence of SBA is very low, there is a need for further studies to evaluate the possible application of newer investigative agents and strategies to obtain a better outcome within the framework of international collaborations.

Keywords: Adenocarcinoma; Chemotherapy; Prognostic factors; Small bowel; Surgery

Core Tip: Small bowel adenocarcinoma are rare malignancies with a poor prognosis. These are often diagnosed in the advanced stage owing to the non-specific nature of symptoms. The clinical presentation is varied and vague, and a high index of suspicion is required for prompt diagnosis and treatment. The most common site of presentation is the duodenum. Surgical resection with negative margins and adequate lymph node dissection remains the mainstay of treatment. Since the disease is rare, there is a paucity of prospective data. The treatment is generally extrapolated from the evidence available from colonic cancers. We have discussed all the aspects of this small bowel cancer comprehensively.