NCCN Guidelines 2019 for small bowel adenorcacinoma
The main treatment for small bowel adenocarcinoma (SBA) is surgery, while the benefits of adjuvant therapy have not yet been proven. This is indicated in the latest clinical guidelines of the National Comprehensive Cancer Network (NCCN 2019).
The occurrence and progression of small bowel cancer
Compared to colorectal cancer, small bowel adenocarcinoma is not so common, and 10 590 new cases of the disease are expected in USA in 2019, including 1590 deaths. But unlike colorectal cancer and other gastrointestinal malignancies, the SBA incidence is only growing with every year.
The predisposition or risk factors for small bowel cancer are:
- Inflammatory bowel disease
- Hereditary diseases
- Adenomatous polyposis
- Peutz-Jeghers syndrome
- Lynch syndrome
Oncologists have only a handful of guidelines for small bowel adenocarcinoma. Last year France joined in with its own recommendations, when the medical association published the first-ever clinical guidelines for SBA.
At the same time, Israeli oncologists use the latest American and European technologies for the of the gastrointestinal tract malignancies treatment, including robotic operations and immunotherapy.
Most cases of small bowel cancer develop in:
- duodenum (52-57%),
- small intestine (18-29%)
- ileum (10-13%)
- non-specific areas of the small intestine (4-14%).
Complications of small bowel cancer
Tumors are usually accompanied by complications, such as the gastrointestinal obstruction or pain in the abdomen. Patients with the SBA as a rule, have a younger age compared with patients with rectum and colorectal cancer.
The classical treatment approach and adjuvant therapy for small bowel adenocarcinoma
Segmental resection is a standard surgical approach, although some tumors may require the duodenum resection, pancreas, or segmental removal of the duodenum. Clinical observations show that removal of eight lymph nodes at least significantly improves the surgery results.
In addition to surgery for local disease, radiation therapy may be important for individual patients with retroperitoneal duodenal adenocarcinoma, but this may acquire complex decision-making procedures. Studies have not yet shown clear benefits with adjuvant chemotherapy, but in some cases, therapy-based on fluoropyrimidine gives good results.
Current trials for malignant tumors of SBA
Selective studies are currently underway and this may shed light on the importance of adjuvant chemotherapy for stage I-III malignant SBA tumors. Now research groups around the world are focusing on small bowel cancer, receiving and analyzing a lot of new data on the effects of taxane family’s drugs.
Surgery is rarely performed to cure in patients with metastatic adenocarcinoma of the small intestine. Most patients receive systemic treatment, including fluoropyrimidine, taxane, or immunosuppressive therapy. Small bowel adenocarcinoma has a unique genetic profile, unlike colon and rectal cancer, and this serves as the basis for new specialized or immunosuppressive therapy.
Source: Emed, Israel