title: Small bowel adenocarcinoma (SBA) three years after colonic adenocarcinoma in an elderly patient: Case report in a National Institute of Health and Aging (INRCA) and review of the literature.
abstract: BACKGROUND
  Adenocarcinoma of the small intestine is a rare malignancy (the annual incidence in the USA is approximately 3.9 cases per million persons with median age between 60 and 70 years) with limited data available to guide therapeutic decisions. Nonspecific signs and symptoms associated with difficulty in performing small bowel examination is the cause of delayed diagnosis made between 6 and 9 months after appearance of symptoms with the majority of patients presenting with late stage disease and either lymph node involvement or distant metastatic disease.
  
  
  METHODS
  An 87-year-old man treated 3 years previously for colonic adenocarcinoma with left colectomy, was brought to our attention with a 4.5cm×3.5cm mass in the proximal jejunum associated with another abdominal wall enhancing mass of 5cm in diameter in the rectus muscle. Diagnosis on gross examination after surgical resection was adenocarcinoma stage III (T4N1M0) with involvement of lymph nodes.
  
  
  CONCLUSIONS
  According to an analysis of the Surveillance, Epidemiology and End Results (SEER) database, patients who develop either a small or large intestine adenocarcinoma are at increased risk for a second cancer at both intestinal sites. The role of adjuvant therapy in patients who undergo curative resection is unclear. Recent retrospective and prospective studies have helped to clarify the optimal chemotherapy approach for advanced small bowel adenocarcinoma.
  
  
  CONCLUSIONS
  With our work, we present our personal case of metachronous primary carcinoma of small bowel following resected colorectal carcinoma and review the literature.
authors.affiliation: Department of General Surgery and Surgical Pathology, I.N.R.C.A. (Italian National Institute for Research and Care of Aging), Via della Montagnola 81, 60127 Ancona, Italy. Electronic address: webcostruction@msn.com.
authors.forename: Danilo
authors.initials: D
authors.lastname: Coco
authors.affiliation: Department of General Surgery and Surgical Pathology, I.N.R.C.A. (Italian National Institute for Research and Care of Aging), Via della Montagnola 81, 60127 Ancona, Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Leanza
authors.affiliation: Department of General Surgery and Surgical Pathology, I.N.R.C.A. (Italian National Institute for Research and Care of Aging), Via della Montagnola 81, 60127 Ancona, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Boccoli
keywords: Gastrointestinal tumor; Intestinal oncological surgery; Intestinal surgery; Small bowel adenocarcinoma; Small bowel resection