Primary cancers of the small bowel: About 20 cases


Background: Cancers of the small bowel are rare. Diagnosis is late and difficult because of the lack of specific signs. Treatment is surgical. Prognosis is usually poor and depends on the histological type of tumor. Aim of Study: To specify the epidemiological, clinical and therapeutic characteristics of small bowel primary cancers in order to improve their prognosis. Material and Methods: This is a retrospective study about 20 cases of malignant tumors of the small bowel, collected in the department of general surgery of Habib Thameur Hospital in Tunis (Tunisia), from January 1994 through June 2011. Results: Our series involved 11 women and 9 men aged 62 on average (range: 44 - 80 years). In 45% of cases, the diagnosis was made in a patient rushed to hospital with clinical features of acute generalized peritonitis (66% of all surgical emergencies). Intestinal transit was performed in 5 patients only. Ultrasound abdominal examination was performed in 11 patients. Abdominal CT scan was performed in 7 patients, but the results were conclusive in 4 cases only (57%). Small bowel scanning was done in 5 patients only, but led to a positive diagnosis in all of them. All of our patients underwent surgery. Tumors of the small bowel were histologically divided as follows: carcinoid tumor (8 cases), leiomyosarcoma (7 cases), giant B-cell lymphoma (2 cases), malignant stromal tumor (2 cases) and malignant myxoid schwannoma (1 case). Malignant tumors of the small bowel most commonly arise in the ileum (60%) followed by the jejunum (35%). As for the long-term course, there was a recurrence at one year of a leiomyosarcoma and two recurrences of stromal tumors associated with liver metastases. Conclusion: Small bowel cancers are rare. Time to consultation is long and diagnosis is difficult and late due to the absence of typical presentation. Treatment is surgical and progression depends essentially on histological findings.

Share and Cite:

Haoues, N. , Mabrouk, M. , Zaafouri, H. , Noomene, R. , Bouhafa, A. , Maamer, A. and Cherif, A. (2014) Primary cancers of the small bowel: About 20 cases. Open Journal of Gastroenterology, 4, 81-87. doi: 10.4236/ojgas.2014.42014.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Chow, J.S., Chen, C.C., Ahsan, H. and Neugut, A.I. (1996) A population-based study of the incidence of malignant small bowel tumors: SEER, 1973-1990. International Journal of Epidemiology, 25, 722-728.
[2] Cunningham, J.D., Aleali, R., Aleali, M. and Brower, S.T. (1997) Malignant small bowel neoplasms. Histopatologic determinants of recurrence and survival. Annals of Surgery, 225, 300-306.
[3] Disario, J.A., Burt, R.W., Vargas, H. and Mc Whorter, W.P. (1994) Small bowel cancer: Epidemiological and clinical characteristics from a population-based registry. The American Journal of Gastroenterology, 89, 699-701.
[4] Naef, M., Buhlman, M. and Baer, H.U. (1999) Small bowel tumours: Diagnosis, therapy and prognostic factors. Langenbeck’s Archives of Surgery, 384, 176-180.
[5] Schmutz, G., Chapuis, F., Morel, E., Maillet, L., Peron, J.M., N’Guyen, D., Régent, D. and Bwel, J.M. (1997) Tumeurs et lymphomes du grêle. Encycl méd chir. Elseiver, Paris.
[6] Minardi, A.J., Zibari, G.B., Aultman, D.F., Mc Millan, R.W. and Mc Donald, J.C. (1998) Small bowel tumors. Journal of the American College of Surgeons, 186, 664-668.
[7] Gabos, S., Berkel, J., Band, P., Robson, D. and Whittaker, H. (1993) Small bowel cancer in Western Canada. International Journal of Epidemiology, 22, 198-206.
[8] Zollinger, R.M., Sternfeld, W.C. and Schreiber, H. (1986) Primary neoplasms of the small intestine. The American Journal of Surgery, 151, 654-658.
[9] Bonnet, J. and Lémann, M. (1997) Tumeurs de l’intestin grêle. Encycl méd chir, Elseiver, Paris, Gastroentérologie, 9-067-C-10, 8.
[10] North, J.H. and Pack, M.S. (2000) Malignant tumors of the small intestine: A review of 144 cases. The American Journal of Surgery, 66, 46-51.
[11] Zongo, N., Sanou, A., Ouédraogo, T., Koama, A., Bonkoungou, G., Kaboré, R.A.F., Zida, M. and Sano, D. (2011) Cancers primitifs de l’intestin grêle: Aspects épidémiologiques et diagnostiques au CHUYO: A propos de dix cas et revue de la littérature. Journal of African Cancer, 3, 124-127.
[12] Goumbri/Lompo, O.M., Traoré, S.S., Mendes Da Costa, P. and Beernaert, A. (1993) Benign tumor of the upper gastrointestinal tract (stomach, duodenum, small bowel): A review of 178 surgical cases. Belgian multicentric study. Acta Chirurgica Belgica, 93, 39-42.
[13] Kehila, M., Jerbi, A., Derbel, F., et al. (1990) Les tumeurs primitives du grêle (lymphomes exclus). A propos de 19 cas (1978-1988). La Tunisie Médicale (Tunis Med), 68, 425-431.
[14] Lien, G., Mori, M. and Enjoji, M. (1988) Primary carcinoma of the small intestine. A clinicopathologic and immunohistochemical study. Cancer, 61, 316-323.<316::AID-CNCR2820610222>3.0.CO;2-O
[15] Lowenfels, A.B. (1973) Why are small-bowel tumours so rare? Lancet, 1, 24-25.
[16] Fall, B., Thognon, P.H., Diop, R., et al. (1988) Les tumeurs malignes primitives du grêle. Expérience dakaroise à propos de 16 observations. Chirurgie, 114, 69-75.
[17] Turowski, G. and Abasson, D. (1995) Primary malignant lymphoma of the intestine. The American Journal of Surgery, 169, 433-441.
[18] Kitani, K., Yukawa, M., Fujiwara, Y., Tsujie, M., Hara, J. and Ikeda, M. (2013) Palliative surgery for malignant bowel obstruction in patients with advanced and recurrent gastroenterologicalcance. Gan To Kagaku Ryoho, 40, 1699-1701.
[19] Perzin, K.H. and Bridge, M.F. (1981) Adenoma of the small intestine: A clinico-pathologic review of 51 cases and a study of their relationship to carcinoma. Cancer, 48, 799-819.<799::AID-CNCR2820480324>3.0.CO;2-Q
[20] Ryan, J.C. (1996) Premalignant conditions of the small intestine. Seminars in Gastrointestinal Disease, 7, 88-93.
[21] Gore, R.M. (1997) Small bowel cancer. Clinical and pathologic features. Radiologic Clinics of North America, 35, 351-360.
[22] Spigelman, A.D., Muraday, V. and Philips, R.K.S. (1989) Cancer and the Peutz-Jeghers syndrome. Gut, 30, 1588-1590.
[23] Chen, C.C., Neugut, A.I. and Rotterdam, H. (1994) Risk factors for adenocarcinomas and malignant carcinoids of the small intestine: Preliminary findings. Cancer Epidemiology, Biomarkers & Prevention, 3, 205-207.
[24] Williamson, R.C.N., Welch, C.E. and Malt, R.A. (1983) Adenocarcinoma and lymphoma of the small intestine. Distribution and etiologic associations. Annals of Surgery, 197, 172-178.
[25] Domizio, P., Owen, R.A., shephered, N.A., Talbot, I.C. and Northon, A.J. (1993) Primary lymphoma of the small intestine. A clinicopathological study of 119 cases. The American Journal of Surgical Pathology, 17, 429-442.
[26] Greenstein, A.J., Mullin, G.E., Strauchen, J.A., et al. (1992) Lymphoma in inflammatory bowel disease. Cancer, 69, 1119-1123.
[27] Johnson, A.M., Harman, P.K. and Hankes, J.B. (1989) Primary small bowel malignancies. The American Journal of Surgery, 51, 31-36.
[28] Savoca, P.E., Ballontyne, G.H. and Cahow, C.E. (1990) Gastrointestinal malignancies in crohn’s disease: A 20 year experience. Diseases of the Colon & Rectum, 33, 7-11.
[29] Maanouni, A., Ben Mansour, A., Hamiani, O., Elaloui, M., Outarahout, O. and Souadka, A. (1980) Les tumeurs gastrointestinales d’origine musculaires à propos de 11 observations. Chir, 106, 629-635.
[30] Carbonnel, F., Grollet-Bioul, L., Brouet, J.C., et al. (1998) Are complicated forms of celiac disease cryptic T-cell lymphomas? Blood, 92, 3879-3886.
[31] Penin, F., Serot, J.M., Cristinali, P., Boissel, P. and Grosdidier, J. (1980) Circonstances de diagnostic des tumeurs primitives du grêle après 70 ans. A propos de 8 observations. Médecine et Hygiène, 38, 1802-1808.
[32] Garcia-Matcilla, J., Sanchez, F. and Parilla, P. (1994) Primary small bowel malignant tumors. European Journal of Surgical Oncology, 20, 630-634.
[33] Brophy, C. and Cahaw, E. (1989) Primary small bowel malignant tumors. Unrecognized until emergent laparatomy. The American Journal of Surgery, 55, 408-412.
[34] Ojha, A., Zachel, J., Scheuba, C., Zakez, R. and Wenzel, E. (2000) Primary small bowel malignancies. Single-center results of three decades. Journal of Clinical Gastroenterology, 30, 289-293.
[35] Trobertson, E.J., AI-Kaisi, N.K., Vareska, G.J. and Ponsky, J.L. (1986) Plasmacytoma of the ileum complicating crohn’s disease: Report of a case and review of the literature. Surgery, 100, 916-923.
[36] Auger, M.J. and Allan, N.C. (1990) Primary ileocecal lymphoma. A study of 22 patients. Cancer, 65, 358-361.<358::AID-CNCR2820650230>3.0.CO;2-0
[37] Jean, E., Gioan, J.A. and Manoli, P.H. (1980) Tumeurs du grêle. Aspect cliniques. A propos de 12 cas. Annals of Gastroenterology & Hepatology, 16, 91-96.
[38] Zollei, I. and Balogh, A. (1997) About the primary malignant tumors of small bowel. Acta Chirurgica Hungarica, 36, 406-408.
[39] Desa, L.A., Bridger, J., Grace, P.A., Krausz, T. and Spencer, J. (1991) Primary jejunoileal tumors: A review of 45 cases. World Journal of Surgery, 15, 81-86.
[40] Finet, L., Brazier, F., Allace, J., Cencerie, R., Jolly, J. and Rule, N.C.E.A. (1993) Léiomyome du grele revele par une hemorragie digestive basse isolee a propos de 2 cas. Annals of Gastroenterology & Hepatology, 29, 165-170.
[41] Herbsman, H., Wetstein, L., Rosen, Y., Orces, H., Alfonso, A.E., Iyer, S.K. and Gardner, B. (1980) Tumors of the small intestine. Current Problems in Surgery, 17, 121-182.
[42] Cervi, C. and Kanane, O. (1994) Neurosarcome de l`angle de treitz, à propos d’une observation. Journal de Chirurgie, 131, 355-357.
[43] Andrieu, G., Goldsat, D. and Chala, J. (1974) Schwannome du grele revele par des mélénas à répétition, diagnosis arteriography. CNOE, 17, 2133-2144.
[44] Lambert, P., Minghini, A., Pincus, W., Kolm, P. and Perry, R.R. (1996) Treatment and prognosis of primary malignant small bowel tumors. American Surgeon, 62, 709715.
[45] Ouriel, K. and Adams, J.T. (1984) Adenocarcinoma of the small intestine. American Journal of Surgery, 147, 66-71.
[46] Maglinte, D.T., Burney, B.T. and Miller, R.E. (1982) Lesions missed on small bowel follow through analysis and recommendations. Radiology, 144, 737-739.
[47] Fillippi dela Palavesa, M.M., Hannequin, F., Tuchman, C., Guth, S., Lahlou, D. and Roy, C. (1997) Imagerie de l’intestin grêle. Feuillets de Radiologie, 37, 91-102.
[48] Boudhiaf, M., Soyer, P., Hamzi, L. and Enteroscanner, R.R. (2006) Radiologie et imagerie médicale. Abdominale Digestive, 6, 29705-29706.
[49] Orjollet-Lecoanet, C., Ménard, Y., Martins, A., Crombé-Ternamian, A., Cotton, F. and Valette, P.J. (2000) CT enteroclysis for detection of small bowel tumors. Journal de Radiologie, 81, 618-627.
[50] Zagorowicz, E.S., Pietrzak, A.M., Wronska, E., Pachlewski, J., Rutkowski, P. and Kraszewska, E. (2013) Small bowel tumors detected and missed during capsule endoscopy: Single center experience. World Journal of Gastroenterology, 19, 9043-9048.
[51] Bhutani, M.S. and Gopalswamy, N. (1994) A multicenter experience in the United States with primary malignant tumors of the small intestine. American Journal of Gastroenterology, 89, 460.
[52] Modlin, I.M. and Sandor, A. (1997) An analysis of 8305 cases of carcinoid tumors. Cancer, 79, 813-829.
[53] Perry, R.R. and Vinik, A.I. (1996) Endocrine tumors of the gastrointestinal tract. Annual Review of Medicine, 47, 57-68.
[54] Popescu, I., Serbanescu, M., Medianuo, D. and Stancescu, M. (1987) Etude anatomo-clinique de 63 tumeurs malignes de l’intestine grêle. Chirurgie, 113, 328-335.
[55] Taleb, N., Chamseddine, N., Gergis, D.A. and Chahine, A. (1994) Lymphomes non hodgkiniens du tube digestif: Epidémiologie générale et données epidémiologiques sur 100 cas libanais recensés entre 1965 et 1991. Annales de Gastroénterologie et D’Hépatologie, 30, 283-236.
[56] Ruskoné-Fourmestraux, A. (1988) Lymphomes non hodg- kiniens primitifs du tube digestif. Encyclopédie Médico-Chirurgicale, Elsiveir, Paris, Gastroentérologie, 9-088-A-10, Hématologie, 13-018-A-10, 10.
[57] Brucher, B.L., Roder, J.D., Fink, U., Stein, H.J. and Bush, R. (1998) Prognostic factors in resected primary small bowel tumors. Digestive Surgery, 15, 42-51.
[58] Aiello Crocifoglio, V. and Flores Flores, G. (1997) Tumors of the small intestine. Revista de Gastroenterología de México, 62, 167-174.
[59] Osias, G.L., Tepper, R.E., Zanzi, I. and Katz, S. (1998) Pseudogastroparesis as a presentation of adenocarcinoma of the proximal jejunum. American Journal of Gastroenterology, 93, 994-996.
[60] Demetri, G.D. (2001) Targeting c-kit mutation in solid tumors: Scientific rational and therapeutic options. Seminars in Oncology, 28, 19-26.
[61] Miles, R., Crawford, D. and Duras, S. (1979) The small bowel tumor problem. The American Journal of Surgery, 189, 732-740.
[62] Peycelon, R. and Corread, R.F. (1970) Etude anatomo-clinique d’une serie de 29 tumeur de l’intestine grêle. Annales de Chirurgie, 24, 261-272.
[63] Abrahams, N.A., Halverson, A., Fazio, V.W., Rybicki, L.A. and Goldblum, J.R. (2002) Adenocarcinoma of the small bowel: A study of 37 cases with emphasis on histologic prognostic factors. Diseases of the Colon & Rectum, 45, 1496-1502.
[64] Emory, T.S., Sobin, L.H., Lukes, L., Lee, D.H. and O’Leary, T.J. (1999) Prognosis of gastrointestinal smooth-muscle (stromal) tumors. Dependence on anatomic site. American Journal of Surgical Pathology, 23, 82-87.
[65] Taidi, C., Soyer, P., Van Beers, B., Barge, J., Radenandrasana, A. and Levesque, M. (1994) Imagerie des tumeurs carcinoïdes. Feuill Radiology, 34, 20-29.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.