Small intestinal cancer in England &amp; Wales and Scotland: time trends in incidence, mortality and survival

Shack, Lorraine; Wood, H. E.; Kang, Jin Yong; Brewster, David H.; Quinn, Mike; Maxwell, J. D.; Majeed, Azeem

doi:10.1111/j.1365-2036.2006.02891.x

Cited by 27 publications

(21 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[1][2][3] According to the latest oncological records, incidence in Portugal also seems to be rising, with crude incidence rates per 100 000 population of 1.0 in 2001, 1.5 in 2005 and 1.7 in 2008. 23 It is unknown if this national increase represents a clear incidence rise, or if it may be due to the improvement in diagnostic methods or to disease underreporting in earlier years.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Malignant Small Bowel Tumors: Diagnosis, Management and Prognosis

et al. 2015

View full text Add to dashboard Cite

adenocarcinoma (n = 11), seguido do sarcoma (n = 6), linfoma (n = 6) e tumores neuroendócrinos (n = 3). A principal forma de apresentação esteve relacionada com perdas hemáticas ou obstrução intestinal. Ao diagnóstico, 46% dos doentes tinham metástases distantes/tumor irressecável. A maioria dos tumores foi diagnosticada por técnicas endoscópicas (41%) ou imagiológicas (35%). No primeiro ano após o diagnóstico, 29% dos doentes faleceram. Na análise multivariada, o adenocarcinoma permaneceu fator independente para pior sobrevida. Discussão: Os doentes com adenocarcinoma apresentaram-se em estádios tardios e com tumores irressecáveis, contribuindo para um pior prognóstico. É necessário um elevado grau de suspeita clínica para o diagnóstico de cancro do intestino delgado. Conclusão: As características dos doentes foram globalmente consistentes com o descrito na literatura. A cápsula endoscópica e a enteroscopia assistida por balão são úteis no diagnóstico, gestão e vigilância do cancro do intestino delgado. Palavras-chave: Endoscopia por Cápsula; Neoplasias Intestinais; Portugal.ABSTRACT Purpose: Despite being rare entities, the incidence of malignant small bowel tumors seems to be rising. The development of capsule endoscopy and balloon assisted enteroscopy provided an advance in the assessment of small bowel lesions. We aim to describe the clinical and pathological characteristics of patients with small bowel cancer and ascertain what roles these endoscopic techniques currently have. Material and Methods:A retrospective study of patients diagnosed with small bowel cancer, from January 2010 to October 2014, was performed. The data was submitted to statistical analysis. Results: Of the 28 diagnosed patients, 54% were female. The mean age at diagnosis was 61 years. Adenocarcinoma was the most frequent tumor (n = 11), followed by sarcoma (n = 6), lymphoma (n = 6) and neuroendocrine tumors (n = 3). The main form of presentation was related to blood loss or intestinal obstruction. By the time of diagnosis, 46% of patients had distant metastasis/ unresectable cancer. Most of the tumors were diagnosed by endoscopic (41%) or imaging techniques (35%). In the first year after diagnosis, 29% of patients died. In multivariate analysis, adenocarcinoma remained an independent factor for worse survival. Discussion: Patients with adenocarcinoma presented at late stages and with unresectable tumors, contributing to a worse outcome. A high degree of clinical suspicion for the diagnosis of small bowel cancer is necessary. Conclusion:The characteristics of the patients were generally consistent with those described in the literature. Capsule endoscopy and balloon assisted enteroscopy are useful in the diagnosis, management and surveillance of small bowel cancer.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Despite this, there is evidence of the rising incidence of small bowel cancer through the last decades, with increases as high as 1.2 to 2.3 per 100 000 population from 1973 to 2004. [1][2][3] The current 5-year survival rate in the United States is around 65%.…”

Section: Introductionmentioning

confidence: 99%

Malignant Small Bowel Tumors: Diagnosis, Management and Prognosis

et al. 2015

View full text Add to dashboard Cite

show abstract

“…1 However there is evidence of the rising incidence of small bowel malignancies through the last decades, with increases as high 2.3 per 100 000 population from 1973 to 20042. [2][3] We sought to investigate the number of small bowel malignancies diagnosed by double balloon enteroscopy (DBE) and the 1 year outcomes at our institution. Methods We retrospectively reviewed all the DBEs performed at our UK tertiary centre from 2009 to 2015.…”

mentioning

confidence: 99%

PWE-065 Small Bowel Malignancies Diagnosed at Enteroscopy: An Improved Outcome?

Sidhu

Willert

2016

Gut

View full text Add to dashboard Cite

IntroductionSmall bowel malignancies are uncommon worldwide and account for only 1–2% of all gastrointestinal malignancies.1 However there is evidence of the rising incidence of small bowel malignancies through the last decades, with increases as high 2.3 per 100 000 population from 1973 to 20042.2-3 We sought to investigate the number of small bowel malignancies diagnosed by double balloon enteroscopy (DBE) and the 1 year outcomes at our institution.MethodsWe retrospectively reviewed all the DBEs performed at our UK tertiary centre from 2009 to 2015. Demographics, indications for DBE investigation, prior investigations, DBE findings and 12 month mortality were analysed.Results294 DBEs were performed where 19 small bowel cancers were discovered. The original symptoms were anaemia (83.3%, n = 15), vomiting (11.1%, n = 2), and weight loss (5.6%, n = 1). All patients had undergone radiological imaging (76.5%, n = 13) or capsule endoscopy (58.8%, n = 10) prior to DBE. In 33.3% (n = 6) both radiological imaging and capsule endoscopy had been performed. The indication for DBE was abnormal capsule (41.2%, n = 7), abnormal imaging (52.9%, n = 9) and abnormal capsule and imaging (5.9%, n = 1). The histology findings were jejunal adenocarcinoma in 52.9% (n = 9), distal duodenal adenocarcinoma in 29.4% (n = 5), jejunal GIST in 11.8% (n = 2) and enteropathy associated T cell lymphoma in 5.9% (n = 1). 11 patients (57.9%) had capsule endoscopy prior to DBE, capsule endoscopy failed to diagnoses a malignancy in 3 patients (27.3%) who were subsequently found to have a malignancy on DBE (2 patients with Jejunal GIST and 1 patient with jejunal adenocarcinoma). In these 3 patients the capsule finding was reported as showing angiodysplasia. All the malignancies were deemed suitable for therapy by a multidisciplinary team. The treatment was surgery alone in 52.9% (n = 9), surgery and chemotherapy in 23.5% (n = 4) and chemotherapy alone in 17.6% (n = 3). The survival rate at 3 months was 88.2% and 66.7% at 1 year. In the patients with a diagnosis of adenocarcinoma the 1 year survival rate was 85.7%.ConclusionThe 1 year survival of 85.7% is significantly higher than previous reports (survival rate of 30% at 1 year from small bowel adenocarcinoma)4 and may reflect the improved outcomes from earlier diagnosis using capsule and DBE. DBE also aided in the diagnosis of tumours not seen on video capsule endoscopy, as described in literature.5References1 Chow JS, et al. Int J Epidemiol 1996;35:722–7282 Haselkorn T, et al. Cancer Causes Control. 2005;16:781–7.3 Shack LG, et al. Aliment Pharmacol Ther. 2006;23:1297–306.4 MH Fargat, A Shamseddine and K Barada. Small Bowel Tumours: Clincial presentation, prognosis and outcomes in 33 patients in a tertiary care centre. Journal of Oncology 2008.5 Chong AK, et al. Gastrointest Endosc. 2006;64:445–9.Disclosure of InterestNone Declared

show abstract

mentioning

confidence: 99%

PWE-066 Impact of A Capsule Endoscopy Service on The Management of Iron Deficiency Anaemia

Sartain

Zuhra

Lloyd

2016

Gut

View full text Add to dashboard Cite

IntroductionCapsule endoscopy (CE) is increasingly being used to investigate iron deficiency anaemia (IDA) when bi-directional endoscopy does not find a cause although current guidelines do not recommend routine small intestinal investigation unless symptoms or recurrent/refractory IDA.1 The aim of this study was to review the use of CE in the investigation of IDA over a two year period in a medium sized DGH following the creation of a new CE service.MethodsElectronic records of all patients undergoing CE between 1st April 2013 and 31st March 2015 were reviewed. Indication for CE was recorded along with the result of the investigation. Clinic letters were reviewed to assess the impact of CE on patient management.ResultsOver the study period 97 CE procedures were performed. Fifty (52%) procedures were performed to investigate IDA, 34 (35%) for investigation of possible or known Crohn’s disease; 4 (4%) for polyposis and 9 (9%) for other indications.Of the 50 CE procedures for IDA, 18 (36%) showed abnormalities in the small bowel; these included polyps (28%), vascular lesions (33%) and ulcers (28%). No malignancy was found over the 2 year period although one large (3 cm) polyp exhibited high grade dysplasia. Thirteen procedures (26%) showed gastroduodenal pathology but no small bowel abnormality. There was no difference between the mean ages of patients with normal compared to abnormal small bowel CE findings (56.9 years old vs 57.6 years old).In 8 of the 18 cases (44%) where small bowel abnormalities were found there was a subsequent change in patient management; this included surgery to remove polyps, endoscopic treatment of vascular lesions and medication changes. Thirty-eight patients (76%) were discharged from clinical follow up following CE with advice to continue long-term iron supplementation; this included 8 patients with abnormalities seen at CE.ConclusionOver a third of patients undergoing CE to investigate IDA were found to have small bowel pathology. However less than half of these findings resulted in significant management changes. In total CE findings altered clinical management in only 16% of patients although it did allow 76% of patients to be discharged from further clinical follow-up. Clincal factors such as age did not appear to predict the presence of small bowel pathology. As a result, the role and timing of CE in the investigation of IDA remains uncertain.Reference1 Guidelines for the management of iron deficiency anaemia. Goddard, et al. on behalf of the British Society of Gastroenterology 2011.Disclosure of InterestNone Declared

show abstract

Small intestinal cancer in England & Wales and Scotland: time trends in incidence, mortality and survival

Abstract: SUMMARY BackgroundTime trends in mortality from small intestinal cancer have not been studied for the 1990s.

Cited by 27 publications

References 20 publications

Malignant Small Bowel Tumors: Diagnosis, Management and Prognosis

Malignant Small Bowel Tumors: Diagnosis, Management and Prognosis

PWE-065 Small Bowel Malignancies Diagnosed at Enteroscopy: An Improved Outcome?

PWE-066 Impact of A Capsule Endoscopy Service on The Management of Iron Deficiency Anaemia

Contact Info

Product

Resources

About