İnce Barsak Kanseri
Özet
İnce barsak kanserleri tüm kanserler ve gastrointestinal kanserler içerisinde nadir görülen kanserlerdir. İnce barsak adenokanseri en fazla görülen alt tiptir. Yerleşim yeri en sık duodenumdur. Cerrahi, kemoterapi ve radyoterapinin multidisipliner yaklaşımı ile tedavisi planlanmaktadır. Tanı anından itibaren düzenli bir şekilde tüm müdahale ve tedavilerin not edilmesi, tedavi tamamlandıktan sonra aktif takip sistemi oluşturulması hastanın sağkalımını uzatmak, yaşam kalitesini artırmak anlamında önem arz etmektedir. Hem lokal tekrarları hem de uzak metastazları erken tespit etmek için programlı izlem şarttır. Nadir görülen kanserler olduğundan takip süreci ile ilgili bilgiler daha çok kolorektal kanser takip protokollerinden extrapolasyonla elde edilmiştir. Bu konuda randomize prospektif çalışmalara ihtiyaç vardır.
Özellikle en sık tekrarın ilk 2 yıl içinde olduğu düşünüldüğünde ilk 2 yıl düzenli takip esastır. Bu dönemde 3 ayda bir biyokimyasal testler, BT ve/veya MRG ile takip, CEA ve CA19.9 takibi yapılmalıdır. İkinci yıldan sonra 6 ayda bir takip önerilmektedir. Beş yıldan sonra endikasyon varsa görüntüleme yapılabilir. Endoskopik incelemeler tüm takip süresince endikasyon varsa yapılmalıdır. Yüksek riskli grupta takip protokolleri sıklaştırılmalıdır.
Small bowel cancers are rare cancers among all cancers and gastrointestinal cancers. Small bowel adenocarcinoma is the most common subtype. The most common location is the duodenum. Treatment is planned with a multidisciplinary approach of surgery, chemotherapy and radiotherapy. Regularly noting all interventions and treatments from the moment of diagnosis and establishing an active follow-up system after the completion of treatment are important in terms of extending the patient's survival and improving the quality of life. Programmed follow-up is essential for early detection of both local recurrences and distant metastases. Since they are rare cancers, information on the follow-up process has mostly been obtained by extrapolation from colorectal cancer follow-up protocols. Randomized prospective studies are needed on this subject.
Especially considering that the most frequent recurrence is in the first 2 years, regular follow-up is essential for the first 2 years. During this period, biochemical tests, follow-up with CT and/or MRI, CEA and CA19.9 should be performed every 3 months. Follow-up is recommended every 6 months after the second year. Imaging can be performed if indicated after five years. Endoscopic examinations should be performed if indicated throughout the follow-up period. Follow-up protocols should be increased in high-risk groups.
Referanslar
Vlachou, E., Koffas, A., Toumpanakis, C., & Keuchel, M. (2023). Updates in the diagnosis and management of small-bowel tumors. Best Practice & Research Clinical Gastroenterology, 101860.
Haydaroğlu, A., Yalman, D., Ersin, S., Yakut, B. D., Karabulut, B., Ünal, N., & Özütemiz, Ö. (2019). Ege Üniversitesi Hastanesinde gastrointestinal sistem kanserlerinin epidemiyolojik ve sağ kalım özellikleri. Ege Tıp Dergisi, 58-67.
Cancer Stat Facts: Small Intestine Cancer, nıh, seer database, 2024
Bass, L. M., & Wershil, B. K. (2016). Anatomy, histology, embryology, and developmental anomalies of the small and large intestine. Sleisenger and Fordtran's gastrointestinal and liver disease. 10th ed. Philadelphia, PA: Saunders, Elsevier Inc, 1649.
Fujimori, S., Hamakubo, R., Hoshimoto, A., Nishimoto, T., Omori, J., Akimoto, N., ... & Iwakiri, K. (2022). Risk factors for small intestinal adenocarcinomas that are common in the proximal small intestine. World Journal of Gastroenterology, 28(39), 5658.
Sellner, F. (1990). Investigations on the significance of the adenoma‐carcinoma sequence in the small bowel. Cancer, 66(4), 702-715.
Perzin, K. H., & Bridge, M. F. (1981). Adenomas of the small intestine: a clinicopathologic review of 51 cases and a study of their relationship to carcinoma. Cancer, 48(3), 799-819.
Neugut, A. I., & Santos, J. (1993). The association between cancers of the small and large bowel. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2(6), 551-553.
Takeda, H., Yamamoto, H., Oikawa, R., Umemoto, K., Arai, H., Mizukami, T., ... & Sunakawa, Y. (2024). Genomic Profiling of Small Intestine Cancers From a Real-World Data Set Identifies Subgroups With Actionable Alterations. JCO Precision Oncology, 8, e2300425.
Babba, T., Schischmanoff, O., Lagorce, C., Wind, P., Des Guetz, G., Aparicio, T., & Benamouzig, R. (2010). Small bowel carcinoma revealing HNPCC syndrome. Gastroentérologie clinique et biologique, 34(4-5), 325-328.
Wu, A. H., Yu, M. C., & Mack, T. M. (1997). Smoking, alcohol use, dietary factors and risk of small intestinal adenocarcinoma. International journal of cancer, 70(5), 512-517.
Canavan, C., Abrams, K. R., & Mayberry, J. (2006). Meta‐analysis: colorectal and small bowel cancer risk in patients with Crohn's disease. Alimentary pharmacology & therapeutics, 23(8), 1097-1104.
Alsakarneh, S., Ahmed, M., Azim, S., Hashash, J. G., Farraye, F. A., & Ghoz, H. (2022). Risk of small intestine cancer in inflammatory bowel disease: A propensity-matched study from a large multi-center database in the United States. Official journal of the American College of Gastroenterology| ACG, 10-14309.
Howe, J. R., Karnell, L. H., Menck, H. R., & Scott‐Conner, C. (1999). Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985–1995. Cancer: Interdisciplinary International Journal of the American Cancer Society, 86(12), 2693-2706.
Hara, A. K., Leighton, J. A., Sharma, V. K., Heigh, R. I., & Fleischer, D. E. (2005). Imaging of small bowel disease: comparison of capsule endoscopy, standard endoscopy, barium examination, and CT. Radiographics, 25(3), 697-711.
Nylund, K., Ødegaard, S., Hausken, T., Folvik, G., Lied, G. A., Viola, I., ... & Gilja, O. H. (2009). Sonography of the small intestine. World journal of gastroenterology: WJG, 15(11), 1319.
Masselli, G., Di Tola, M., Casciani, E., Polettini, E., Laghi, F., Monti, R., ... & Gualdi, G. (2016). Diagnosis of small-bowel diseases: prospective comparison of multi–detector row CT enterography with MR enterography. Radiology, 279(2), 420-431.
Cronin, C. G., Scott, J., Kambadakone, A., Catalano, O. A., Sahani, D., Blake, M. A., & McDermott, S. (2012). Utility of positron emission tomography/CT in the evaluation of small bowel pathology. The British Journal of Radiology, 85(1017), 1211-1221.
Overman, M. J., Hu, C. Y., Kopetz, S., Abbruzzese, J. L., Wolff, R. A., & Chang, G. J. (2012). A population-based comparison of adenocarcinoma of the large and small intestine: insights into a rare disease. Annals of surgical oncology, 19, 1439-1445.
Overman, M. J., Hu, C. Y., Wolff, R. A., & Chang, G. J. (2010). Prognostic value of lymph node evaluation in small bowel adenocarcinoma: analysis of the surveillance, epidemiology, and end results database. Cancer, 116(23), 5374-5382.
Onkendi, E. O., Boostrom, S. Y., Sarr, M. G., Farnell, M. B., Nagorney, D. M., Donohue, J. H., ... & Que, F. G. (2012). 15-year experience with surgical treatment of duodenal carcinoma: a comparison of periampullary and extra-ampullary duodenal carcinomas. Journal of Gastrointestinal Surgery, 16(4), 682-691.
Ecker, B. L., McMillan, M. T., Datta, J., Lee, M. K., Karakousis, G. C., Vollmer Jr, C. M., ... & Roses, R. E. (2017). Adjuvant chemotherapy versus chemoradiotherapy in the management of patients with surgically resected duodenal adenocarcinoma: A propensity score‐matched analysis of a nationwide clinical oncology database. Cancer, 123(6), 967-976.
Kelsey, C. R., Nelson, J. W., Willett, C. G., Chino, J. P., Clough, R. W., Bendell, J. C., ... & Czito, B. G. (2007). Duodenal adenocarcinoma: patterns of failure after resection and the role of chemoradiotherapy. International Journal of Radiation Oncology* Biology* Physics, 69(5), 1436-1441.
Kim K, Chie EK, Jang JY, et al. Role of adjuvant chemoradiotherapy for duodenal cancer: a single center experience. Am J Clin Oncol 2012;35:533-536.
Overman MJ, Kopetz S, Lin E, et al. Is there a role for adjuvant therapy in resected adenocarcinoma of the small intestine. Acta Oncol 2010;49:474-479.
Sakae, H., Kanzaki, H., Nasu, J., Akimoto, Y., Matsueda, K., Yoshioka, M., ... & Okada, H. (2017). The characteristics and outcomes of small bowel adenocarcinoma: a multicentre retrospective observational study. British journal of cancer, 117(11), 1607-1613.
Young, J. I., Mongoue-Tchokote, S., Wieghard, N., Mori, M., Vaccaro, G. M., Sheppard, B. C., & Tsikitis, V. L. (2016). Treatment and survival of small-bowel adenocarcinoma in the United States: a comparison with colon cancer. Diseases of the Colon & Rectum, 59(4), 306-315.
Ecker, B. L., McMillan, M. T., Datta, J., Lee, M. K., Karakousis, G. C., Vollmer Jr, C. M., ... & Roses, R. E. (2017). Adjuvant chemotherapy versus chemoradiotherapy in the management of patients with surgically resected duodenal adenocarcinoma: A propensity score‐matched analysis of a nationwide clinical oncology database. Cancer, 123(6), 967-976.
Onkendi, E. O., Boostrom, S. Y., Sarr, M. G., Farnell, M. B., Nagorney, D. M., Donohue, J. H., ... & Que, F. G. (2012). Neoadjuvant treatment of duodenal adenocarcinoma: a rescue strategy. Journal of Gastrointestinal Surgery, 16(2), 320-324.
Rompteaux, P., Gagniere, J., Gornet, J. M., Coriat, R., Baumgaertner, I., Lecomte, T., ... & Aparicio, T. (2019). Resection of small bowel adenocarcinoma metastases: Results of the ARCAD-NADEGE cohort study. European Journal of Surgical Oncology, 45(3), 331-335.
van Oudheusden, T. R., Lemmens, V. E., Braam, H. J., van Ramshorst, B., Meijerink, J., te Velde, E. A., ... & de Hingh, I. H. (2015). Peritoneal metastases from small bowel cancer: results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in The Netherlands. Surgery, 157(6), 1023-1027.
Hoshimoto, A., Tatsuguchi, A., Yamada, T., Kuriyama, S., Hamakubo, R., Nishimoto, T., ... & Iwakiri, K. (2024). Relationship Between Immunophenotypes, Genetic Profiles, and Clinicopathologic Characteristics in Small Bowel Adenocarcinoma. The American Journal of Surgical Pathology, 48(2), 127-139.
Schrock, A. B., Devoe, C. E., McWilliams, R., Sun, J., Aparicio, T., Stephens, P. J., ... & Overman, M. J. (2017). Genomic profiling of small-bowel adenocarcinoma. JAMA oncology, 3(11), 1546-1553.
Takayoshi, K., Kusaba, H., Uenomachi, M., Mitsugi, K., Makiyama, C., Makiyama, A., ... & Baba, E. (2017). Suggestion of added value by bevacizumab to chemotherapy in patients with unresectable or recurrent small bowel cancer. Cancer chemotherapy and pharmacology, 80, 333-342.
Gulhati, P., Raghav, K., Shroff, R., Varadhachary, G., Javle, M., Qiao, W., ... & Overman, M. J. (2018). Phase II study of panitumumab in RAS wild‐type metastatic adenocarcinoma of small bowel or ampulla of vater. The Oncologist, 23(3), 277-e26.
Gulhati, P., Raghav, K., Shroff, R. T., Varadhachary, G. R., Kopetz, S., Javle, M., ... & Overman, M. J. (2017). Bevacizumab combined with capecitabine and oxaliplatin in patients with advanced adenocarcinoma of the small bowel or ampulla of vater: A single‐center, open‐label, phase 2 study. Cancer, 123(6), 1011-1017.
Le, D. T., Uram, J. N., Wang, H., Bartlett, B. R., Kemberling, H., Eyring, A. D., ... & Diaz Jr, L. A. (2015). PD-1 blockade in tumors with mismatch-repair deficiency. New England Journal of Medicine, 372(26), 2509-2520.
FDA, U. (2017). FDA grants accelerated approval to pembrolizumab for first tissue/site agnostic indication. Silver Spring: US Food and Drug Administration.
Marabelle, A., Le, D. T., Ascierto, P. A., Di Giacomo, A. M., De Jesus-Acosta, A., Delord, J. P., ... & Diaz Jr, L. A. (2020). Efficacy of pembrolizumab in patients with noncolorectal high microsatellite instability/mismatch repair–deficient cancer: results from the phase II KEYNOTE-158 study. Journal of Clinical Oncology, 38(1), 1-10.
Patel, S. P., Mayerson, E., Chae, Y. K., Strosberg, J., Wang, J., Konda, B., ... & Kurzrock, R. (2021). A phase II basket trial of Dual Anti–CTLA–4 and Anti–PD–1 Blockade in Rare Tumors (DART) SWOG S1609: high‐grade neuroendocrine neoplasm cohort. Cancer, 127(17), 3194-3201.
Gouda, M. A., Nelson, B. E., Buschhorn, L., Wahida, A., & Subbiah, V. (2023). Tumor-agnostic precision medicine from the AACR GENIE database: clinical implications. Clinical Cancer Research, 29(15), 2753-2760.
Subbiah, V., Kreitman, R. J., Wainberg, Z. A., Gazzah, A., Lassen, U., Stein, A., ... & Bang, Y. J. (2023). Dabrafenib plus trametinib in BRAFV600E-mutated rare cancers: the phase 2 ROAR trial. Nature medicine, 29(5), 1103-1112.
Raghav, K. P. S., Siena, S., Takashima, A., Kato, T., Van Den Eynde, M., Di Bartolomeo, M., ... & Yoshino, T. (2023). Trastuzumab deruxtecan (T-DXd) in patients (pts) with HER2-overexpressing/amplified (HER2+) metastatic colorectal cancer (mCRC): Primary results from the multicenter, randomized, phase 2 DESTINY-CRC02 study.
Doebele, R. C., Drilon, A., Paz-Ares, L., Siena, S., Shaw, A. T., Farago, A. F., ... & Demetri, G. D. (2020). Entrectinib in patients with advanced or metastatic NTRK fusion-positive solid tumours: integrated analysis of three phase 1–2 trials. The Lancet Oncology, 21(2), 271-282.
Subbiah, V., Wolf, J., Konda, B., Kang, H., Spira, A., Weiss, J., ... & Drilon, A. (2022). Tumour-agnostic efficacy and safety of selpercatinib in patients with RET fusion-positive solid tumours other than lung or thyroid tumours (LIBRETTO-001): a phase 1/2, open-label, basket trial. The Lancet Oncology, 23(10), 1261-1273.
Dabaja, B. S., Suki, D., Pro, B., Bonnen, M., & Ajani, J. (2004). Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients. Cancer: Interdisciplinary International Journal of the American Cancer Society, 101(3), 518-526.
Aparicio, T., Henriques, J., Manfredi, S., Tougeron, D., Bouché, O., Pezet, D., ... & NADEGE Investigators. (2020). Small bowel adenocarcinoma: Results from a nationwide prospective ARCAD‐NADEGE cohort study of 347 patients. International journal of cancer, 147(4), 967-977.
Zaanan, A., Costes, L., Gauthier, M., Malka, D., Locher, C., Mitry, E., ... & Aparicio, T. (2010). Chemotherapy of advanced small-bowel adenocarcinoma: a multicenter AGEO study. Annals of Oncology, 21(9), 1786-1793.
Li, N., Shen, W., Deng, W., Yang, H., Ma, Y., Bie, L., ... & Luo, S. (2020). Clinical features and the efficacy of adjuvant chemotherapy in resectable small bowel adenocarcinoma: a single-center, long-term analysis. Annals of Translational Medicine, 8(15).
Matsuzawa, K., Itabashi, K., Matsuzawa, S., Tsutsumi, O., Hiki, Y., & Kakita, A. (1999). A case of large liver cyst with extraordinally high level of CA19-9 in the serum, CA19-9 and CEA in the cystic fluid. Nippon Shokaki Geka Gakkai Zasshi 32: 2375-2379, 1999 (in Japanese, Abstract in English).
Cahill, C., Gordon, P. H., Petrucci, A., & Boutros, M. (2014). Small bowel adenocarcinoma and Crohn's disease: any further ahead than 50 years ago?. World Journal of Gastroenterology: WJG, 20(33), 11486.
Grolleau, C., Pote, N. M., Guedj, N. S., Zappa, M., Theou-Anton, N., Bouhnik, Y., ... & Cazals-Hatem, D. L. (2017). Small bowel adenocarcinoma complicating Crohn’s disease: a single-centre experience emphasizing the importance of screening for dysplasia. Virchows Archiv, 471, 611-617.
Greenstein, A. J. (2000). Cancer in inflammatory bowel disease. The Mount Sinai journal of medicine, New York, 67(3), 227-240.
Kim, M., & Jang, H. J. (2016). The role of small bowel endoscopy in small bowel Crohn's disease: when and how?. Intestinal research, 14(3), 211-217.
Haanstra, J. F., Al-Toma, A., Dekker, E., Vanhoutvin, S. A., Nagengast, F. M., Mathus-Vliegen, E. M., ... & Koornstra, J. J. (2015). Prevalence of small-bowel neoplasia in Lynch syndrome assessed by video capsule endoscopy. Gut, 64(10), 1578-1583.
Katsinelos, P., Kountouras, J., Chatzimavroudis, G., Zavos, C., Pilpilidis, I., Fasoulas, K., & Paroutoglou, G. (2009). Wireless capsule endoscopy in detecting small-intestinal polyps in familial adenomatous polyposis. World journal of gastroenterology: WJG, 15(48), 6075.
Goverde, A., Korsse, S. E., Wagner, A., van Leerdam, M. E., Krak, N. C., Stoker, J., ... & Spaander, M. C. (2017). Small-bowel surveillance in patients with Peutz-Jeghers syndrome: comparing magnetic resonance enteroclysis and double balloon enteroscopy. Journal of Clinical Gastroenterology, 51(4), e27-e33.
Kim, J. S., Park, S. H., Hansel, S., & Fletcher, J. G. (2017). Imaging and screening of cancer of the small bowel. Radiologic Clinics, 55(6), 1273-1291.
Odat, R. M., Ibrahim, I. A., Jaffal, R., Aloqaily, M., Alshurman, S., Ja’afer Al Tarawneh, Y., & Nashwan, A. J. (2024). Understanding mortality patterns and survival outcomes in small intestine cancer: Insights from a retrospective analysis of the SEER database. Journal of Medicine, Surgery, and Public Health, 3, 100095.
Collins, J. T., Nguyen, A., & Badireddy, M. (2024). Anatomy, abdomen and pelvis, small intestine. In StatPearls [Internet]. StatPearls Publishing.
Benson, A. B., Venook, A. P., Al-Hawary, M. M., Arain, M. A., Chen, Y. J., Ciombor, K. K., ... & Gurski, L. A. (2019). Small bowel adenocarcinoma, version 1.2020, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network, 17(9), 1109-1133.
Wagner, A., Aretz, S., Auranen, A., Bruno, M. J., Cavestro, G. M., Crosbie, E. J., ... & Möslein, G. (2021). The management of Peutz–Jeghers syndrome: European hereditary tumour group (EHTG) guideline. Journal of clinical medicine, 10(3), 473.
