Adenocarcinoma of the small bowel: changes in the landscape?
OBJECTIVE
Small bowel adenocarcinoma (SBA) is a rare cancer with a poor prognosis and little information to guide its management. In recent years, improved diagnostic imaging and an increase in reported experience with use of chemotherapy may alter the way we manage SBA. This review will summarize recent advances in characterization, imaging, and treatment of SBA.


RESULTS
Recent advances in less invasive imaging tools may permit earlier and increased diagnosis of SBA. Surgery remains the mainstay of treatment, and the role of adjuvant chemotherapy is still unclear. However, the use of adjuvant therapy is increasing. Chemotherapy with newer regimens may provide clinical benefit in the metastatic setting. Nearly all results are from retrospective studies. Targeted therapies have not been extensively studied.


CONCLUSIONS
The rarity of the disease and difficulty in diagnosis contribute to the lack of prospective trials evaluating therapies for SBA. Retrospective studies suggest a benefit for combination chemotherapy regimens. Prospective evaluation of newer chemotherapeutic agents and targeted therapies is needed to improve outcomes in this disease.
Speranza
Giovanna
G
Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland 20892, USA.
Doroshow
James H
JH
Kummar
Shivaani
S
D000230:Adenocarcinoma / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D007421:Intestine, Small / Q000187:drug effects* / Q000473:pathology / Q000601:surgery*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D016896:Treatment Outcome; D000093542:Gemcitabine
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000068258:Bevacizumab; D000093542:Gemcitabine