Malignant Neoplasms of the Small Intestine Follow-up

  • Author: N Joseph Espat, MD, MS, FACS; Chief Editor: Jules E Harris, MD   more...
 
Updated: Dec 2, 2011
 

Further Inpatient Care

  • Patients who develop serious symptoms related to disease progression may need admission to a hospital for inpatient care (see Complications).
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Further Outpatient Care

  • Patients who have undergone surgical resection for localized disease should have a follow-up visit in the outpatient setting every 3 months to assess for symptoms or signs suggestive of recurrent disease.
  • CBC count and liver function test results may be checked periodically to identify anemia related to blood loss or abnormal liver enzymes related to hepatic metastases or biliary obstruction, respectively.
  • Abdominal CT scan images should be obtained every 6 months to identify subclinical recurrent disease early, which may be amenable to repeat surgical resection.
  • Patients with small-bowel adenocarcinoma should also undergo colorectal cancer screening (ie, colonoscopy) because of the high risk of secondary malignancies.
  • Patients with advanced metastatic disease may be treated with chemotherapy in an outpatient setting. They should also be observed for hematologic and other toxicity related to chemotherapy.
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Complications

  • Partial or complete small-bowel obstruction may occur because of an obstructing intraluminal tumor. This may be treated either conservatively (ie, nasogastric tube decompression and parenteral nutrition) or with surgery (ie, small-bowel resection or bypass).
  • Intestinal bleeding is common with small-bowel sarcomas and may require transfusion support and surgical intervention.
  • Biliary obstruction may result from compression of the extrahepatic common bile duct by a periampullary or proximal duodenal tumor. Biliary stenting via endoscopic retrograde cholangiopancreatography or transhepatic biliary drainage may be performed if feasible.
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Prognosis

  • Adenocarcinomas
    • In 1999, Howe et al reviewed 4995 patients with small-bowel adenocarcinoma from the National Cancer Data Base from 1985-1995 and found the following factors to correlate with survival: patient age, tumor site (favoring jejunum and ileum), clinical stage, and whether curative resection was performed.
    • Other smaller studies by Bakaeen et al and Ryder et al, both in 2000, also found tumor size, histologic grade, nodal metastases, and positive surgical margins to be prognostic factors.[33, 34]
  • Sarcomas
    • Tumor size greater than 4.5 cm in duodenal GIST and greater than 5 cm in jejunoileal GIST that have been reported to be malignant, patient age, and stage of disease are clinical features that have prognostic value.
    • The most important histologic feature associated with survival is the mitotic count of the tumor, with those having greater than 2 mitoses in duodenal GIST and 5 or more mitoses per 50 high-power fields in jejunoileal GIST. These indicate malignant potential of the tumor.
    • Emory et al have reported a series of 1004 GISTs. Multivariate analysis revealed that GISTs localized in the small intestine were significantly associated with worse overall survival than GISTs from the colon and stomach.[35]
    • Negative surgical margins after surgery improve prognosis.
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Patient Education

For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education article Cancer of the Small Intestine.

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Contributor Information and Disclosures
Author

N Joseph Espat, MD, MS, FACS  Harold J Wanebo Professor and Chief of Surgical Oncology, Director, Adele R Decof Cancer Center, Vice-Chair of Department of Surgery, Roger Williams Medical Center, Boston University School of Medicine

N Joseph Espat, MD, MS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Surgeons, American Hepato-Pancreato-Biliary Association, American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Clinical Oncology, Association for Academic Surgery, Central Surgical Association, Chicago Medical Society, International Hepato-Pancreato-Biliary Association, Pancreas Club, Sigma Xi, Society for Leukocyte Biology, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Surgical Oncology, Society of University Surgeons, Southeastern Surgical Congress, Southern Medical Association, and Surgical Infection Society

Disclosure: Nothing to disclose.

Coauthor(s)

Ponnandai S Somasundar, MD, FACS  Assistant Chief of Surgical Oncology, Assistant Professor of Surgery, Boston University; Hepatopancreatobiliary/Surgical Oncologist, Roger Williams Medical Center

Ponnandai S Somasundar, MD, FACS is a member of the following medical societies: American College of Surgeons, American Hepato-Pancreato-Biliary Association, Association for Academic Surgery, Association of Surgeons of India, and Society of Surgical Oncology

Disclosure: Nothing to disclose.

Piero Marco Fisichella, MD  Assistant Professor of Surgery, Stritch School of Medicine, Loyola University; Director, Esophageal Motility Center, Loyola University Medical Center

Piero Marco Fisichella, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Surgery of the Alimentary Tract, and Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Lodovico Balducci, MD  Professor of Oncology and Medicine, University of South Florida College of Medicine; Division Chief, Senior Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Benjamin Movsas, MD  Vice-Chairman, Department of Radiation Oncology, Fox Chase Cancer Center

Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, and American Society for Therapeutic Radiology and Oncology

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine; Consulting Staff, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

Additional Contributors

eMedicine extends its thanks to Alfred I Neugut, MD, PhD , Head, Cancer Prevention and Control, Herbert Irving Comprehensive Cancer Center; Professor, Department of Medicine and Public Health, Columbia University College of Physicians and Surgeons and Allen C Chen, MD, MS, Assistant Professor, Department of Medicine, Division of Medical Oncology, New York University School of Medicine for previous versions of this article.

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