title: Clinical, Radiologic, and Endoscopic Manifestations of Small Bowel Malignancies: a First Report from Thailand.
abstract: BACKGROUND
  The symptoms of small bowel malignancies are mild and frequently nonspecific, thus patients are often not diagnosed until the disease is at an advanced stage. Moreover, the lack of sufficient studies and available data on small bowel cancer makes diagnosis difficult, further delaying proper treatment for these patients. In fact, only a small number of published studies exist, and there are no studies specific to Thailand. Radiologic and endoscopic studies and findings may allow physicians to better understand the disease, leading to earlier diagnosis and improved patient outcomes.
  
  
  OBJECTIVE
  To retrospectively analyze the clinical, radiologic, and endoscopic characteristics of small bowel cancer patients in Thailand's Siriraj Hospital.
  
  
  METHODS
  This retrospective analysis included 185 adult patients (97 men, 88 women; mean age = 57.6±14.9) with pathologically confirmed small bowel cancer diagnosed between January 2006 and December 2013. Clinical, radiologic, and endoscopic findings were collected and compared between each subtype of small bowel cancer.
  
  
  RESULTS
  Of the 185 patients analyzed, gastrointestinal stromal tumor (GIST) was the most common diagnosis (39.5%, n=73). Adenocarcinoma was the second most common (25.9%, n = 48), while lymphoma and all other types were identified in 24.3% (n = 45) and 10.3% (n = 19) of cases, respectively. The most common symptoms were weight loss (43.2%), abdominal pain (38.4%), and upper gastrointestinal bleeding (23.8%).
  
  
  CONCLUSIONS
  Based on radiology and endoscopy, this study revealed upper gastrointestinal bleeding, an intra-abdominal mass, and a sub-epithelial mass as common symptoms of GIST. Obstruction and ulcerating/circumferential masses were findicative of adenocarcinoma, as revealed by radiology and endoscopy, respectively. Finally, no specific symptoms were related to lymphoma.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand E-mail : kaiyjr@gmail.com.
authors.forename: Natthakan
authors.initials: N
authors.lastname: Tangkittikasem
authors.forename: Thiraphon
authors.initials: T
authors.lastname: Boonyaarunnate
authors.forename: Pitulak
authors.initials: P
authors.lastname: Aswakul
authors.forename: Udom
authors.initials: U
authors.lastname: Kachintorn
authors.forename: Varayu
authors.initials: V
authors.lastname: Prachayakul
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000473:pathology*; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000473:pathology*; D046152:Gastrointestinal Stromal Tumors / Q000150:complications / Q000473:pathology*; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D008223:Lymphoma / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D013785:Thailand; D055815:Young Adult