Primary tumors of the small intestine

In our department of surgery 28 patients with malignant and 10 with benign tumors of the small intestine were treated from 1940 to 1974. Fifteen patients with malignant and 7 with benign tumors underwent surgery with the intention to cure. Palliative operations or explorations were carried out on 13 patients with malignant tumors. Three patients with benign tumors were not operated on. The initial symptoms were vague: abdominal pain, nausea, anemia or bleeding in 75 and 80 percent of patients with malignant and benign tumors, respectively. The indication for operation in the malignant cases was, however, stenosis of the intestine or biliary tract or a palpable mass in 60 percent of the cases. At operation the tumors were thus in an advanced stage. Because the initial symptoms are vague, early diagnosis is difficult.The overall 5 year survival rate was 21 percent after surgery for malignant tumors. Among the patients considered by the surgeons to have had radical operations excluding cancer patients, 40 percent survived 5 years. The surgeon's opinion regarding “radical” operation as well as the presence or absence of metastases at microscopy were of limited prognostic value.     

Primary tumors of the small intestine

Seventy-two malignant and 19 benign tumors were seen at the Veterans Administration Hospital, Hines, Illinois, from 1950 to 1976. Of these, 44 malignant and 14 benign tumors were seen in the clinical setting--the remainder were found at autopsy. Carcinoid tumors were the most common malignant tumors, followed by adenocarcinoma, lymphoma and leiomyosarcoma. Patients with malignant tumors usually presented with abdominal pain, vomiting and weight loss. The most common clinical signs were anemia, abdominal tenderness and abdominal distention. The most useful diagnostic tests were upper GI series and plain x-ray of the abdomen. Twenty-one (50%) five year survivals and 14 (33%) ten year survivals were obtained with small bowel malignancies. The majority of the five and ten year survivals were patients who had carcinoid tumors and lymphoma. Various theories on the causation of small bowel malignancies are discussed.     

Primary tumors of the small intestine

The authors had 27 patients with tumors of the small intestine. In 23 the tumors were malignant and in 4 patients--benign. Adenocarcinoma and sarcoma were encountered in 85.5% of cases. In 22 of the 27 patients the diagnosis was established only after complications (obstructive ileus, perforation, hemorrhage) developed. The difficult diagnosis of tumors of the small intestine has a negative effect on the results of surgical treatment. In the group of 23 patients with malignant tumors 15 were treated by a radical operation. All were discharged from the clinic; 8 have a survival period of less than 5 years, 7 have a survival period of over 5 years. It is concluded that only early diagnosis can improve the results of the operation.     

Primary malignant tumors of the small intestine. A clinical report

The clinical records and pathologic patterns of all the cases of primary small bowel malignancies, treated in the last 15 years, were reviewed. There were 12 patients: 8 men and 4 women ranged from 41 to 86 years old. Carcinoma was the most common (82%) followed by carcinoid and lymphoma (9%). The distribution of the malignancies showed preponderance in the proximal jejunum and duodenum. Multiple primary malignancies were found in 17% of enteric cancers. The most common presentation was pain (75%) followed by weight loss (58%), palpable mass, anemia and gastrointestinal bleeding (25%), obstruction (17%). Barium studies of the duodenum and of the small bowel, duodenal endoscopy were the most useful diagnostic tools but a correct preoperative diagnosis was made in only 42% of the patients. Curative resection was attempted in 67% of the cases. The prognosis is poor.     

Carcinoid tumors of the small intestine

Operations were performed on 15 patients for carcinoid tumours in their small intestines. Prognosis of tumour localisation in the small intestine was confirmed to be worse, as compared to other tumour sites. Only four patients were initially free of metastases. Such unfavourable point of departure supported the need for radical surgery, with a view to alleviating the locally delimited symptoms of the primary tumour and the complaints caused by the carcinoid syndrome.     

Malignant tumors of the small intestine

The four main histologic categories of malignant small intestine tumors are (1) adenocarcinoma, (2) sarcoma, (3) carcinoid, and (4) lymphoma. Signs and symptoms may be chronic or acute and include bleeding, obstruction, pain, and weight loss. When chronic, the symptoms are so vague that early diagnosis is difficult. Often the diagnosis is made only at the time of surgery. Treatment is segmental resection of intestine with adequate margin of the tumor and resection of the regional lymph nodes. Prognosis is evaluated by tumor extension through the bowel wall and lymph node metastasis. The 5-year survival rates are low except for carcinoid and lymphomatous lesions.