Introduction to small bowel tumors

The small bowel is a relatively infrequent site of malignancy in the gastrointestinal tract. The most common primary tumors of the small bowel are adenocarcinoma, lymphoma, neuroendocrine tumors, and gastrointestinal stromal tumors. However, as many as half of all small bowel tumors are metastatic. In general, the best chance for cure in patients with localized primary small bowel malignancy is surgical resection. The incidence of primary small bowel cancer is strikingly elevated in the genetic syndromes of familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer, and Peutz–Jeghers syndrome. In the hope of prevention or early detection of cancer in patients with these disorders, experts have recommended surveillance of the small bowel in affected individuals. Historically, surveillance has been performed with small bowel radiography. However, in the past decade, video capsule endoscopy has largely replaced x-ray studies. Device-assisted enteroscopy, most notably double-balloon enteroscopy, has assumed an expanding role in the surveillance of these patients and in the endoscopic removal of premalignant lesions of the small bowel, such as adenomas and hamartomas.