Key Points
-
Small bowel tumours are rare cancers and their incidence worldwide is increasing
-
Clinical presentation is nonspecific and specialized diagnostic modalities, such as enteroclysis, enterography, enteroscopy and video-capsule endoscopy are needed for early diagnosis
-
Surgery is the mainstay treatment for locoregional disease and the benefit from adjuvant chemotherapy is unclear
-
Systemic fluoropyrimidine and oxaliplatin-based chemotherapy has shown clinical benefit in metastatic disease
-
Recent molecular characterization efforts have revealed distinct molecular biology and pathogenesis compared to colorectal cancers
-
Large-scale collaborative research efforts are necessary to improving our knowledge regarding the management of these uncommon tumours
Abstract
Small bowel cancers account for 3% of all gastrointestinal malignancies and small bowel adenocarcinomas represent a third of all small bowel cancers. Rarity of small bowel adenocarcinomas restricts molecular understanding and presents unique diagnostic and therapeutic challenges. Better cross-sectional imaging techniques and development of enteroscopy and capsule endoscopy have facilitated earlier and more-accurate diagnosis. Surgical resection remains the mainstay of therapy for locoregional disease. In the metastatic setting, fluoropyrimidine and oxaliplatin-based chemotherapy has shown clinical benefit in prospective non-randomized trials. Although frequently grouped under the same therapeutic umbrella as large bowel adenocarcinomas, small bowel adenocarcinomas are distinct clinical and molecular entities. Recent progress in molecular characterization has aided our understanding of the pathogenesis of these tumours and holds potential for prospective development of novel targeted therapies. Multi-institutional collaborative efforts directed towards cogent understanding of tumour biology and designing sensible clinical trials are essential for developing improved therapeutic strategies. In this Review, we endeavour to outline an evidence-based approach to present-day management of small bowel adenocarcinoma, describe contemporary challenges and uncover evolving paradigms in the management of these rare 'orphan' neoplasias.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Hatzaras, I. et al. Small-bowel tumours: epidemiologic and clinical characteristics of 1260 cases from the connecticut tumour registry. Arch. Surg. 142, 229–235 (2007).
Schottenfeld, D., Beebe-Dimmer, J. L. & Vigneau, F. D. The epidemiology and pathogenesis of neoplasia in the small intestine. Ann. Epidemiol. 19, 58–69 (2009).
Chow, J. S., Chen, C. C., Ahsan, H. & Neugut, A. I. A population-based study of the incidence of malignant small bowel tumours: SEER, 1973–1990. Int. J. Epidemiol. 25, 722–728 (1996).
Siegel, R., Naishadham, D. & Jemal, A. Cancer statistics, 2013. CA Cancer J. Clin. 63, 11–30 (2013).
Bilimoria, K. Y. et al. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann. Surg. 249, 63–71 (2009).
Lu, Y., Frobom, R. & Lagergren, J. Incidence patterns of small bowel cancer in a population-based study in Sweden: increase in duodenal adenocarcinoma. Cancer Epidemiol. 36, e158–e163 (2012).
Haselkorn, T., Whittemore, A. S. & Lilienfeld, D. E. Incidence of small bowel cancer in the United States and worldwide: geographic, temporal, and racial differences. Cancer Causes Control 16, 781–787 (2005).
Howe, J. R., Karnell, L. H., Menck, H. R. & Scott-Conner, C. The American College of Surgeons Commission on Cancer and the American Cancer Society. Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985–1995. Cancer 86, 2693–2706 (1999).
Halfdanarson, T. R., McWilliams, R. R., Donohue, J. H. & Quevedo, J. F. A single-institution experience with 491 cases of small bowel adenocarcinoma. Am. J. Surg. 199, 797–803 (2010).
Chang, H. K. et al. Adenocarcinoma of the small intestine: a multi-institutional study of 197 surgically resected cases. Hum. Pathol. 41, 1087–1096 (2010).
Goodman, M. T., Matsuno, R. K. & Shvetsov, Y. B. Racial and ethnic variation in the incidence of small-bowel cancer subtypes in the United States, 1995–2008. Dis. Colon Rectum 56, 441–448 (2013).
Overman, M. J. et al. A population-based comparison of adenocarcinoma of the large and small intestine: insights into a rare disease. Ann. Surg. Oncol. 19, 1439–1445 (2012).
Rodriguez-Bigas, M. A. et al. Characteristics of small bowel carcinoma in hereditary nonpolyposis colorectal carcinoma. International Collaborative Group on HNPCC. Cancer 83, 240–244 (1998).
Giardiello, F. M. et al. Very high risk of cancer in familial Peutz-Jeghers syndrome. Gastroenterology 119, 1447–1453 (2000).
Koornstra, J. J. et al. Management of extracolonic tumours in patients with Lynch syndrome. Lancet Oncol. 10, 400–408 (2009).
ten Kate, G. L. et al. Is surveillance of the small bowel indicated for Lynch syndrome families? Gut 56, 1198–1201 (2007).
Galiatsatos, P. & Foulkes, W. D. Familial adenomatous polyposis. Am. J. Gastroenterol. 101, 385–398 (2006).
Centre, M. M., Jemal, A. & Ward, E. International trends in colorectal cancer incidence rates. Cancer Epidemiol. Biomarkers Prev. 18, 1688–1694 (2009).
Dabaja, B. S., Suki, D., Pro, B., Bonnen, M. & Ajani, J. Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients. Cancer 101, 518–526 (2004).
Sellner, F. Investigations on the significance of the adenoma-carcinoma sequence in the small bowel. Cancer 66, 702–715 (1990).
Perzin, K. H. & Bridge, M. F. Adenomas of the small intestine: a clinicopathologic review of 51 cases and a study of their relationship to carcinoma. Cancer 48, 799–819 (1981).
Vogelstein, B. et al. Genetic alterations during colorectal-tumour development. N. Engl. J. Med. 319, 525–532 (1988).
Haan, J. C. et al. Small bowel adenocarcinoma copy number profiles are more closely related to colorectal than to gastric cancers. Ann. Oncol. 23, 367–374 (2012).
Chan, O. T. et al. Lack of HER2 overexpression and amplification in small intestinal adenocarcinoma. Am. J. Clin. Pathol. 134, 880–885 (2010).
Kountourakis, P. et al. Clinicopathologic significance of EGFR and Her-2/neu in colorectal adenocarcinomas. Cancer J. 12, 229–236 (2006).
Shitara, K. et al. Prognosis of patients with advanced gastric cancer by HER2 status and trastuzumab treatment. Gastric Cancer 16, 261–267 (2012).
DeSesso, J. M. & Jacobson, C. F. Anatomical and physiological parameters affecting gastrointestinal absorption in humans and rats. Food Chem. Toxicol. 39, 209–228 (2001).
Lowenfels, A. B. Why are small-bowel tumours so rare? Lancet 1, 24–26 (1973).
Calman, K. C. Why are small bowel tumours rare? An experimental model. Gut 15, 552–554 (1974).
Blaker, H. et al. Mutational activation of the RAS-RAF-MAPK and the Wnt pathway in small intestinal adenocarcinomas. Scand. J. Gastroenterol. 39, 748–753 (2004).
Miyaki, M. et al. Characteristics of somatic mutation of the adenomatous polyposis coli gene in colorectal tumours. Cancer Res. 54, 3011–3020 (1994).
Pan, S. Y. & Morrison, H. Epidemiology of cancer of the small intestine. World J. Gastrointest. Oncol. 3, 33–42 (2011).
Green, P. H. & Cellier, C. Celiac disease. N. Engl. J. Med. 357, 1731–1743 (2007).
Jess, T., Winther, K. V., Munkholm, P., Langholz, E. & Binder, V. Intestinal and extra-intestinal cancer in Crohn's disease: follow-up of a population-based cohort in Copenhagen County, Denmark. Aliment. Pharmacol. Ther. 19, 287–293 (2004).
Jess, T., Gamborg, M., Matzen, P., Munkholm, P. & Sorensen, T. I. Increased risk of intestinal cancer in Crohn's disease: a meta-analysis of population-based cohort studies. Am. J. Gastroenterol. 100, 2724–2729 (2005).
Green, P. H. et al. Risk of malignancy in patients with celiac disease. Am. J. Med. 115, 191–195 (2003).
Wu, A. H., Yu, M. C. & Mack, T. M. Smoking, alcohol use, dietary factors and risk of small intestinal adenocarcinoma. Int. J. Cancer 70, 512–517 (1997).
Negri, E. et al. Risk factors for adenocarcinoma of the small intestine. Int. J. Cancer 82, 171–174 (1999).
Kaerlev, L. et al. Is there an association between alcohol intake or smoking and small bowel adenocarcinoma? Results from a European multi-centre case-control study. Cancer Causes Control 11, 791–797 (2000).
Boffetta, P. 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. 23, 1894–1898 (2012).
Chen, C. C., Neugut, A. I. & Rotterdam, H. Risk factors for adenocarcinomas and malignant carcinoids of the small intestine: preliminary findings. Cancer Epidemiol. Biomarkers Prev. 3, 205–207 (1994).
Chow, W. H. et al. Risk factors for small intestine cancer. Cancer Causes Control 4, 163–169 (1993).
Cross, A. J. et al. A prospective study of meat and fat intake in relation to small intestinal cancer. Cancer Res. 68, 9274–9279 (2008).
Schatzkin, A., Park, Y., Leitzmann, M. F., Hollenbeck, A. R. & Cross, A. J. Prospective study of dietary fibre, whole grain foods, and small intestinal cancer. Gastroenterology 135, 1163–1167 (2008).
Wolk, A. et al. A prospective study of obesity and cancer risk (Sweden). Cancer Causes Control 12, 13–21 (2001).
Samanic, C. et al. Obesity and cancer risk among white and black United States veterans. Cancer Causes Control 15, 35–43 (2004).
Bjørge, T., Tretli, S. & Engeland, A. Height and body mass index in relation to cancer of the small intestine in two million Norwegian men and women. Br. J. Cancer 93, 807–810 (2005).
Jagelman, D. G., DeCosse, J. J. & Bussey, H. J. Upper gastrointestinal cancer in familial adenomatous polyposis. Lancet 1, 1149–1151 (1988).
Saurin, J. C. et al. Surveillance of duodenal adenomas in familial adenomatous polyposis reveals high cumulative risk of advanced disease. J. Clin. Oncol. 22, 493–498 (2004).
Fu, T. et al. CpG island methylator phenotype-positive tumours in the absence of MLH1 methylation constitute a distinct subset of duodenal adenocarcinomas and are associated with poor prognosis. Clin. Cancer Res. 18, 4743–4752 (2012).
Rashid, A. & Hamilton, S. R. Genetic alterations in sporadic and Crohn's-associated adenocarcinomas of the small intestine. Gastroenterology 113, 127–135 (1997).
Wheeler, J. M. et al. An insight into the genetic pathway of adenocarcinoma of the small intestine. Gut 50, 218–223 (2002).
Miyoshi, Y. et al. Somatic mutations of the APC gene in colorectal tumours: mutation cluster region in the APC gene. Hum. Mol. Genet. 1, 229–233 (1992).
Diosdado, B. et al. High-resolution array comparative genomic hybridization in sporadic and celiac disease-related small bowel adenocarcinomas. Clin. Cancer Res. 16, 1391–1401 (2010).
Lee, H. J. et al. Combined loss of E-cadherin and aberrant beta-catenin protein expression correlates with a poor prognosis for small intestinal adenocarcinomas. Am. J. Clin. Pathol. 139, 167–176 (2013).
Murata, M. et al. Molecular and biological analysis of carcinoma of the small intestine: beta-catenin gene mutation by interstitial deletion involving exon 3 and replication error phenotype. Am. J. Gastroenterol. 95, 1576–1580 (2000).
Bläker, H., von Herbay, A., Penzel, R., Gross, S. & Otto, H. F. Genetics of adenocarcinomas of the small intestine: frequent deletions at chromosome 18q and mutations of the SMAD4 gene. Oncogene 21, 158–164 (2002).
Breuhahn, K., Singh, S., Schirmacher, P. & Blaker, H. Large-scale N-terminal deletions but not point mutations stabilize beta-catenin in small bowel carcinomas, suggesting divergent molecular pathways of small and large intestinal carcinogenesis. J. Pathol. 215, 300–307 (2008).
Ilyas, M., Tomlinson, I. P., Rowan, A., Pignatelli, M. & Bodmer, W. F. Beta-catenin mutations in cell lines established from human colorectal cancers. Proc. Natl Acad. Sci. USA 94, 10330–10334 (1997).
Cho, K. R. et al. The DCC gene: structural analysis and mutations in colorectal carcinomas. Genomics 19, 525–531 (1994).
Reiss, M., Santoro, V., de Jonge, R. R. & Vellucci, V. F. Transfer of chromosome 18 into human head and neck squamous carcinoma cells: evidence for tumour suppression by Smad4/DPC4. Cell Growth Differ. 8, 407–415 (1997).
Thiagalingam, S. et al. Evaluation of candidate tumour suppressor genes on chromosome 18 in colorectal cancers. Nat. Genet. 13, 343–346 (1996).
Svrcek, M. et al. Immunohistochemical analysis of adenocarcinoma of the small intestine: a tissue microarray study. J. Clin. Pathol. 56, 898–903 (2003).
Blaker, H. et al. Loss of SMAD4 function in small intestinal adenocarcinomas: comparison of genetic and immunohistochemical findings. Pathol. Res. Pract. 200, 1–7 (2004).
Nishiyama, K. et al. Overexpression of p53 protein and point mutation of K-ras genes in primary carcinoma of the small intestine. Oncol. Rep. 9, 293–300 (2002).
Boland, C. R. et al. A National Cancer Institute Workshop on Microsatellite Instability for cancer detection and familial predisposition: development of international criteria for the determination of microsatellite instability in colorectal cancer. Cancer Res. 58, 5248–5257 (1998).
Overman, M. J. et al. Immunophenotype and molecular characterisation of adenocarcinoma of the small intestine. Br. J. Cancer 102, 144–150 (2010).
Planck, M. et al. Microsatellite instability and expression of MLH1 and MSH2 in carcinomas of the small intestine. Cancer 97, 1551–1557 (2003).
Potter, D. D. et al. The role of defective mismatch repair in small bowel adenocarcinoma in celiac disease. Cancer Res. 64, 7073–7077 (2004).
Minardi, A. J. Jr, Zibari, G. B., Aultman, D. F., McMillan, R. W. & McDonald, J. C. Small-bowel tumours. J. Am. Coll. Surg. 186, 664–668 (1998).
Talamonti, M. S., Goetz, L. H., Rao, S. & Joehl, R. J. Primary cancers of the small bowel: analysis of prognostic factors and results of surgical management. Arch. Surg. 137, 564–570 (2002).
Zaanan, A. et al. Chemotherapy of advanced small-bowel adenocarcinoma: a multicenter AGEO study. Ann. Oncol. 21, 1786–1793 (2010).
Maglinte, D. D., O'Connor, K., Bessette, J., Chernish, S. M. & Kelvin, F. M. The role of the physician in the late diagnosis of primary malignant tumours of the small intestine. Am. J. Gastroenterol. 86, 304–308 (1991).
Bessette, J. R., Maglinte, D. D., Kelvin, F. M. & Chernish, S. M. Primary malignant tumors in the small bowel: a comparison of the small-bowel enema and conventional follow-through examination. AJR Am. J. Roentgenol. 153, 741–744 (1989).
Dudiak, K. M., Johnson, C. D. & Stephens, D. H. Primary tumors of the small intestine: CT evaluation. AJR Am. J. Roentgenol. 152, 995–998 (1989).
Pilleul, F. et al. Possible small-bowel neoplasms: contrast-enhanced and water-enhanced multidetector CT enteroclysis. Radiology 241, 796–801 (2006).
Van Weyenberg, S. J. et al. MR enteroclysis in the diagnosis of small-bowel neoplasms. Radiology 254, 765–773 (2010).
Minordi, L. M., Vecchioli, A., Mirk, P. & Bonomo, L. CT enterography with polyethylene glycol solution vs CT enteroclysis in small bowel disease. Br. J. Radiol. 84, 112–119 (2011).
Laurent, F. et al. Diagnosis and categorization of small bowel neoplasms: role of computed tomography. Gastrointest. Radiol. 16, 115–119 (1991).
Cronin, C. G. et al. Utility of positron emission tomography/CT in the evaluation of small bowel pathology. Br. J. Radiol. 85, 1211–1221 (2012).
Fry, L. C., Bellutti, M., Neumann, H., Malfertheiner, P. & Monkemuller, K. Incidence of bleeding lesions within reach of conventional upper and lower endoscopes in patients undergoing double-balloon enteroscopy for obscure gastrointestinal bleeding. Aliment. Pharmacol. Ther. 29, 342–349 (2009).
Lewis, B. S., Eisen, G. M. & Friedman, S. A pooled analysis to evaluate results of capsule endoscopy trials. Endoscopy 37, 960–965 (2005).
Cobrin, G. M., Pittman, R. H. & Lewis, B. S. Increased diagnostic yield of small bowel tumors with capsule endoscopy. Cancer 107, 22–27 (2006).
Wiarda, B. M. et al. Small bowel Crohn's disease: MR enteroclysis and capsule endoscopy compared to balloon-assisted enteroscopy. Abdom. Imaging 37, 397–403 (2012).
Huprich, J. E. et al. Prospective blinded comparison of wireless capsule endoscopy and multiphase CT enterography in obscure gastrointestinal bleeding. Radiology 260, 744–751 (2011).
Ross, A. et al. Double balloon enteroscopy detects small bowel mass lesions missed by capsule endoscopy. Dig. Dis. Sci. 53, 2140–2143 (2008).
Bakaeen, F. G. et al. What prognostic factors are important in duodenal adenocarcinoma? Arch. Surg. 135, 635–641 (2000).
Abrahams, N. A., Halverson, A., Fazio, V. W., Rybicki, L. A. & Goldblum, J. R. Adenocarcinoma of the small bowel: a study of 37 cases with emphasis on histologic prognostic factors. Dis. Colon Rectum 45, 1496–1502 (2002).
Sohn, T. A. et al. Adenocarcinoma of the duodenum: factors influencing long-term survival. J. Gastrointest. Surg. 2, 79–87 (1998).
Overman, M. J., Hu, C. Y., Wolff, R. A. & Chang, G. J. Prognostic value of lymph node evaluation in small bowel adenocarcinoma: analysis of the surveillance, epidemiology, and end results database. Cancer 116, 5374–5382 (2010).
Nicholl, M. B. et al. Small bowel adenocarcinoma: understaged and undertreated? Ann. Surg. Oncol. 17, 2728–2732 (2010).
Edge, S., Byrd, D. R. & Compton, C. C. in AJCC Cancer Staging Manual, 7th edn Ch. 17 (eds Edge, S. B. et al.) 181–190 (Springer, New York, 2010).
Barnes, G. Jr, Romero, L., Hess, K. R. & Curley, S. A. Primary adenocarcinoma of the duodenum: management and survival in 67 patients. Ann. Surg. Oncol. 1, 73–78 (1994).
Kaklamanos, I. G. et al. Extent of resection in the management of duodenal adenocarcinoma. Am. J. Surg. 179, 37–41 (2000).
Joesting, D. R., Beart, R. W. Jr, van Heerden, J. A. & Weiland, L. H. Improving survival in adenocarcinoma of the duodenum. Am. J. Surg. 141, 228–231 (1981).
Poultsides, G. A. et al. Duodenal adenocarcinoma: clinicopathologic analysis and implications for treatment. Ann. Surg. Oncol. 19, 1928–1935 (2012).
Lepage, C., Bouvier, A. M., Manfredi, S., Dancourt, V. & Faivre, J. Incidence and management of primary malignant small bowel cancers: a well-defined French population study. Am. J. Gastroenterol. 101, 2826–2832 (2006).
Efficacy of adjuvant fluorouracil and folinic acid in colon cancer. International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) investigators. Lancet 345, 939–944 (1995).
Overman, M. J., Kopetz, S., Lin, E., Abbruzzese, J. L. & Wolff, R. A. Is there a role for adjuvant therapy in resected adenocarcinoma of the small intestine. Acta Oncol. 49, 474–479 (2010).
Singhal, N. & Singhal, D. Adjuvant chemotherapy for small intestine adenocarcinoma. Cochrane Database Systematic Reviews, Art. No.: CD005202, http://dx.doi.org/10.1002/14651858.CD005202.pub2.
Keat, N. et al. International rare cancers initiative. Lancet Oncol. 14, 109–110 (2013).
Swartz, M. J. et al. Adjuvant concurrent chemoradiation for node-positive adenocarcinoma of the duodenum. Arch. Surg. 142, 285–288 (2007).
Kelsey, C. R. et al. Duodenal adenocarcinoma: patterns of failure after resection and the role of chemoradiotherapy. Int. J. Radiat. Oncol. Biol. Phys. 69, 1436–1441 (2007).
Onkendi, E. O. et al. Neoadjuvant treatment of duodenal adenocarcinoma: a rescue strategy. J. Gastrointest. Surg. 16, 320–324 (2012).
Fishman, P. N. et al. Natural history and chemotherapy effectiveness for advanced adenocarcinoma of the small bowel: a retrospective review of 113 cases. Am. J. Clin. Oncol. 29, 225–231 (2006).
Koo, D. H. et al. Systemic chemotherapy for treatment of advanced small bowel adenocarcinoma with prognostic factor analysis: retrospective study. BMC Cancer 11, 205 (2011).
Czaykowski, P. & Hui, D. Chemotherapy in small bowel adenocarcinoma: 10-year experience of the British Columbia Cancer Agency. Clin. Oncol. (R. Coll. Radiol.) 19, 143–149 (2007).
Ouriel, K. & Adams, J. T. Adenocarcinoma of the small intestine. Am. J. Surg. 147, 66–71 (1984).
Gibson, M. K., Holcroft, C. A., Kvols, L. K. & Haller, D. Phase II study of 5-fluorouracil, doxorubicin, and mitomycin C for metastatic small bowel adenocarcinoma. Oncologist 10, 132–137 (2005).
Overman, M. J. et al. Phase II study of capecitabine and oxaliplatin for advanced adenocarcinoma of the small bowel and ampulla of Vater. J. Clin. Oncol. 27, 2598–2603 (2009).
McWilliams, R. R. et al. Pharmacogenetic dosing by UGT1A1 genotype as first-line therapy for advanced small-bowel adenocarcinoma: A North Central Cancer Treatment Group (NCCTG) trial [abstract]. J. Clin. Oncol. 30 (Suppl. 4), a314 (2012).
Xiang, X. J. et al. A phase II study of modified FOLFOX as first-line chemotherapy in advanced small bowel adenocarcinoma. Anticancer Drugs 23, 561–566 (2012).
Locher, C. et al. Combination chemotherapy in advanced small bowel adenocarcinoma. Oncology 69, 290–294 (2005).
Zaanan, A. et al. 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 multicentre AGEO study. Cancer 117, 1422–1428 (2011).
Zhang, L. et al. Efficacy of the FOLFOX/CAPOX regimen for advanced small bowel adenocarcinoma: a three-centre study from China. J. BUON 16, 689–696 (2011).
Jigyasu, D., Bedikian, A. Y. & Stroehlein, J. R. Chemotherapy for primary adenocarcinoma of the small bowel. Cancer 53, 23–25 (1984).
Crawley, C., Ross, P., Norman, A., Hill, A. & Cunningham, D. The Royal Marsden experience of a small bowel adenocarcinoma treated with protracted venous infusion 5-fluorouracil. Br. J. Cancer 78, 508–510 (1998).
Tsushima, T. et al. Multicenter retrospective study of 132 patients with unresectable small bowel adenocarcinoma treated with chemotherapy. Oncologist 17, 1163–1170 (2012).
Overman, M. J. et al. Chemotherapy with 5-fluorouracil and a platinum compound improves outcomes in metastatic small bowel adenocarcinoma. Cancer 113, 2038–2045 (2008).
Santini, D. et al. Cetuximab in small bowel adenocarcinoma: a new friend? Br. J. Cancer 103, 1305 (2010).
De Dosso, S., Molinari, F., Martin, V., Frattini, M. & Saletti, P. Molecular characterisation and cetuximab-based treatment in a patient with refractory small bowel adenocarcinoma. Gut 59, 1587–1588 (2010).
Jeurnink, S. M., van Eijck, C. H., Steyerberg, E. W., Kuipers, E. J. & Siersema, P. D. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol. 7, 18 (2007).
Ercolani, G. et al. The role of liver resections for noncolorectal, nonneuroendocrine metastases: experience with 142 observed cases. Ann. Surg. Oncol. 12, 459–466 (2005).
Adam, R. et al. Hepatic resection for noncolorectal nonendocrine liver metastases: analysis of 1,452 patients and development of a prognostic model. Ann. Surg. 244, 524–535 (2006).
Acknowledgements
M. Overman is supported in part by the Kavanagh Family Foundation.
Author information
Authors and Affiliations
Contributions
Both authors researched data for the article, made substantial contributions to discussion of content, and wrote, reviewed and edited the manuscript before submission.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Raghav, K., Overman, M. Small bowel adenocarcinomas—existing evidence and evolving paradigms. Nat Rev Clin Oncol 10, 534–544 (2013). https://doi.org/10.1038/nrclinonc.2013.132
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrclinonc.2013.132
This article is cited by
-
Clinicopathological features and prognosis of primary small bowel adenocarcinoma: a large multicenter analysis of the JSCCR database in Japan
Journal of Gastroenterology (2024)
-
Microsatellite instability in the high-grade dysplasia component of duodenal adenoma is associated with progression to adenocarcinoma
Surgery Today (2023)
-
Impact of gastric and bowel surgery on gastrointestinal drug delivery
Drug Delivery and Translational Research (2023)
-
First case report of neoadjuvant gemcitabine and S-1 for locally advanced unresectable duodenal adenocarcinoma
Surgical Case Reports (2022)
-
OLFM4-RET fusion is an oncogenic driver in small intestine adenocarcinoma
Oncogene (2022)