Clinical Features of Small Bowel Tumors

Ki, Hae Ryun; Ha, Hyun Kwon; Kim, Byung Sik; Kim, Jin Cheon; Min, Young Il; Yang, Suk Kyun; Hong, Weon Seon; Jung, Hwoon Yong; Lee, Jae Kyoon; Choe, Jae Won; Kim, Hae Kyung; Nam, Seung Woo; Oh, Sung Tae

Abstract

BACKGROUND AND AIMS: Small bowel tumors are uncommon accounting for only 3 to 6% of all gastrointestinal tumors. The diagnosis of small bowel tumors has been usually made at an advanced stage because of the infrequency and absence of symptoms specific for early diagnosis, resulting in poor prognosis. This study was conducted to investigate the clinical features of small bowel tumors in Korea.
METHODS
We reviewed and analyzed clinical manifestations, laboratory results and survivals in 63 patients with small bowel tumors diagnosed at the Asan Medical Center between June 1989 and January 1996.
RESULTS
Among 63 tuors reviewed, 58 were malignant tumors and 5 were benign tumors. The malignant tumors consisted of 25 adenocarcinomas, 15 malignant lymphomas, 12 leiomyosarcomas and 6 metastatic carcinomas. Adenocarcinomas were located mainly in the duodenum and malignant lymphomas in the ileum or duodenum, while leiomyosarcomas were evenly distributed. Clinical symptoms of these patients included abdominal pain (71.4%), palpable mass (12.7%), weight loss (10.0%) and bleeding (8.0%). Anemia and positive stool occult blood test were found in 55.0% and 46.7%, respectively. The median duration of symptoms before the diagnosis was 4 weeks in malignant tumors and 36 weeks in benign tumors. Twenty-seven of 30 patients (90.0%) with duodenal tumors were diagnosed by duodenoscopy, while small bowel series and CT scans detected 9 of 11 (82.0%) and 25 of 35 (71.4%) small bowel tumors, respectively. The incidence of metastasis to regional lymph nodes and distant organs was higher in adenocarcinoma and malignant lymphoma than leiomyosarcoma. The 2-year survival rates for patients with adenocarcinomas, malignant lymphomas, and leiomyosarcomas were 23, 57, and 60%, respectively.
CONCLUSIONS
These results suggest that small bowel tumors should be considered in patients having unexplained abdominal pain, anemia, and/or positive stool occult blood test.