Introduction Malignant tumours involving the small intestine are among the rarest types of cancer. They present difficulties in early diagnosis and management. We analysed the records of all such patients at our hospital over the last 7 years to address the challenge in early recognition and diagnosis.
Methods We retrospectively reviewed the case notes of all patients with operated small intestine tumours identified from histopathology records from 2004 to 2011. Clinical records, discharge summaries and imaging reports were reviewed for demographics, presenting symptoms, diagnostic workup, histopathology and outcome.
Results 255 patients were identified of which 32 (13%) were malignant tumours. Mean age was 71 years (range 59 to 88). Male to female ratio was 3:5. There were 15 (47%) metastatic tumours involving the small intestine (14 adenocarcinomas). Of the 17 primary tumours, there were 4 (13%) adenocarcinomas, 5 (16%) carcinoid, 4 (13%) gastrointestinal stromal tumour (GIST), 3 (9%) lymphomas and 1 (2%) sarcoma.
Of the patients with metastases, 9 presented with bowel obstruction, 4 with perforations and 2 with chronic abdominal pain. Of the 17 patients with primary tumours, the presenting symptoms were chronic abdominal pain (5 patients), systemic symptoms (5), bowel obstruction (3), small bowel perforation (2), gastro-intestinal bleeding (1) and 1 patient was diagnosed at surgery. In the metastases group, 6 were diagnosed on computerised tomography (CT) and 1 on magnetic resonance imaging (MRI). 2 of the 6 diagnosed on CT had recent normal abdominal ultrasound (US). The remaining 8 patients were diagnosed at the time of surgery. 7 of the 8 patients had recent cross sectional imaging which did not pick up the tumour. In the primary tumour group, 1 case was diagnosed on US and 7 on CT (2 of these patients had previous US which did not reveal the tumour). The remaining 9 patients were diagnosed at the time of surgery. 7 of these 9 patients had recent imaging (including CT, Barium meal, US and MRI) which did not pick up the tumour.
In the metastases group, 9 were treated with palliative surgery, 4 had surgery with adjuvant chemotherapy and 2 had curative surgery. In the primary tumours group, 8 had curative surgery, 4 had surgery with adjuvant chemotherapy, 2 patients had neoadjuvant chemotherapy and surgery, 1 had surgery with adjuvant chemotherapy and radiotherapy and 2 were treated with palliative intent. 60% of those with metastases to the small bowel died within 2 years of diagnosis and 18% with primary tumours died within 2 years.
Conclusion Most patients with metastatic disease present as emergencies while those with primary tumours present with more non-specific symptoms. We require a high index of suspicion and various imaging and endoscopic modalities (including wireless capsule endoscopy) for early diagnosis.
Disclosure of Interest None Declared.
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