Distribution of small bowel tumors
Summary
We have studied the anatomic distribution of 784 small bowel carcinomas and have analyzed available epidemiologic data to determine the relation of these rare cancers to other gastrointestinal tumors and to diet. The anatomic distribution of small bowel cancer is unusual: most tumors occur in the duodenum or proximal jejunum, relatively few tumors occur in the central bowel, and only in the lower ileum do the expected number of tumors appear. Review of available epidemiologic data shows a correlation between small bowel cancer and lower, but not upper gastrointestinal cancer. The incidence of small bowel cancer is positively correlated with protein and fat consumption.
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Cited by (27)
Incidence, Risk Factors, and Temporal Trends of Small Intestinal Cancer: A Global Analysis of Cancer Registries
2023, GastroenterologySmall intestinal cancer is a rare cancer, with limited studies exploring its epidemiology. To our knowledge, this study is the first effort to comprehensively analyze the incidence, risk factors, and trends for small intestinal cancer by sex, age, and country.
Global Cancer Observatory, Cancer Incidence in Five Continents Plus, and Global Burden of Disease were accessed to estimate the age-standardized rates of small intestinal cancer incidence (International Classification of Diseases, 10th Revision, Clinical Modification: C17) and prevalence of lifestyle risk factors, metabolic risk factors, and inflammatory bowel disease (IBD). Risk factor associations were assessed by linear and logistic regressions. Average annual percent change was calculated using joinpoint regression.
A total of 64,477 small intestinal cancer cases (age-standardized rate, 0.60 per 100,000) were estimated globally in 2020, with a higher disease burden found in North America (1.4). Higher small intestinal cancer incidence was associated with higher human development index; gross domestic product; and prevalence of smoking, alcohol drinking, physical inactivity, obesity, diabetes, lipid disorder, and IBD (β = 0.008–0.198; odds ratios, 1.07–10.01). There was an overall increasing trend of small intestinal cancer incidence (average annual percent change, 2.20–21.67), and the increasing trend was comparable among the 2 sexes but more evident in the older population aged 50–74 years than in the younger population aged 15–49 years.
There was a substantial geographic disparity in the burden of small intestinal cancer, with higher incidence observed in countries with higher human development index; gross domestic product; and prevalence of unhealthy lifestyle habits, metabolic disorders, and IBD. There was an overall increasing trend in small intestinal cancer incidence, calling for the development of preventive strategies.
Dietary whey protein lowers serum C-peptide concentration and duodenal SREBP-1c mRNA abundance, and reduces occurrence of duodenal tumors and colon aberrant crypt foci in azoxymethane-treated male rats
2006, Journal of Nutritional BiochemistryWe evaluated partially hydrolyzed whey protein (WPH) for inhibitory effects on the development of colon aberrant crypt foci (ACF) and intestinal tumors in azoxymethane (AOM)-treated rats. Pregnant Sprague–Dawley rats and their progeny were fed AIN-93G diets containing casein (CAS, control diet) or WPH as the sole protein source. Colons and small intestines from the male progeny were obtained at 6, 12, 20 and 23 weeks after AOM treatment. At 6 and 23 weeks, post-AOM, WPH-fed rats had fewer ACF than did CAS-fed rats. Intestinal tumors were most frequent at 23 weeks, post-AOM. At this time point, differences in colon tumor incidence with diet were not observed; however, WPH-fed rats had fewer tumors in the small intestine (7.6% vs. 26% incidence, P=.004). Partially hydrolized whey protein suppressed circulating C-peptide concentration (a stable indicator of steady-state insulin secretion) at all four time points relative to the corresponding CAS-fed animals. The relative mRNA abundance for the insulin-responsive, transcription factor gene, SREBP-1c, was reduced by WPH in the duodenum but not colon. Results indicate potential physiological linkages of dietary protein type with circulating C-peptide (and by inference insulin), local expression of SREBP-1c gene and propensity for small intestine tumorigenesis.
Malignant tumours of the small bowel
1994, Surgical OncologyEarly diagnosis of small intestinal cancers provides the best probability of cure. The astute clinician will include these tumours in the differential diagnosis when vague or non-specific abdominal complaints occur and a more common cause is not discovered. Failure to evaluate the small bowel, which is a blind spot to routine endoscopic and radiological diagnostic tests, constitutes a common error when confronted with occult gastrointestinal blood loss and normal upper and lower gastrointestinal examination. Surgical resection remains the cornerstone of therapy for these malignancies. Advances in effective chemotherapy for large bowel carcinoma may have an impact on the management of small intestinal adenocarcinomas. Substantial palliation can be offered to the patient with metastatic carcinoid tumour, but the long-term outlook for these patients remains poor. Early stage lymphomas of the intestine are readily treated by combined modality therapy while advanced stage disease remains resistant to curative management. The patient prognosis for a small bowel sarcoma is largely dependent on the tumour grade. A high index of suspicion to improve tumour detection and better treatments of tumours with the same histology at other anatomic sites should enhance the management and outcome of patients with small intestinal malignancies.
Bile as a source of potential reactive metabolites
1982, ToxicologyMany toxic substances are excreted via the bile as chemically inert metabolites. In some cases, however, highly toxic, mutagenic and carcinogenic products can be derived from bile, either directly or after further metabolism by intestinal microflora or intestinal cells. Potential reactive substances may thus reach biliary tract and intestinal cells via this route and may undergo subsequent enterohepatic circulation. The possible role of biliary reactants in carcinogenesis of the biliary tract and intestine is discussed.
Experimental intestinal cancer research with special reference to human pathology
1979, Advances in Cancer ResearchThis chapter systematizes the data available in the literature on experimental intestinal neoplasms and compares them with the findings on colonic and rectal tumors in man. Considerable advances have occurred in the study of morphology and morphogenesis of intestinal cancer, which contribute to the elucidation of the mechanisms of human colon carcinogenesis. Experimental intestinal tumors are finding a wide application in the studies of the immunology and kinetics of tumor cell populations, opening up new vistas in the explorations of the nature of tumor growth. Such animal models are being used for the improvement of X-ray and clinical diagnosis of intestinal tumors. The available data show that the pathogenesis of experimental intestinal tumors is a complex of processes, taking place at all levels-from the molecule to the body including multistage metabolism of the carcinogen involved. The morphology, morphogenesis, kinetics, and factors modifying intestinal tumors are discussed in the chapter. The morbidity of malignant tumors of the colon and rectum leads the cancer patient registries in many countries. Progress made in experimental tumor induction has led to the development of transplantable strains of intestinal tumors of mice and rats.
DOES BILE PROMOTE EXTRA-COLONIC CANCER?
1978, The LancetThe incidence of biliary-tract cancer and of several other gastrointestinal tumours is increased when conditions favour conversion of bile acids to more active substances. This may indicate that bacterial degradation of bile salts is related to the pathogenesis of cancer in parts of the alimentary tract other than the large bowel.