Small Bowel Adenocarcinoma: a Nationwide Population-Based Study

Area of Science:

• Gastroenterology
• Oncology
• Epidemiology

Background:

• Small intestinal cancers, including duodenal and jejunal adenocarcinomas, often present with non-specific symptoms, leading to diagnostic delays.
• The low prevalence and lack of cost-effective screening methods for small intestinal cancers hinder early detection.

Purpose of the Study:

• To identify distinct clinical characteristics of duodenal and jejunal adenocarcinomas to aid in early disease detection.
• To compare demographic, risk factor, clinical presentation, and treatment differences between duodenal and jejunal adenocarcinoma.

Main Methods:

• A retrospective analysis of the Explorys database from 1999-2019 was conducted.
• Demographic data, risk factors, clinical features, and treatment information were collected for patients diagnosed with duodenal or jejunal adenocarcinoma.
• Odds ratios (OR) with 95% confidence intervals were used to compare characteristics between the two cancer types.

Main Results:

• Jejunal adenocarcinoma patients were more frequently obese (OR, 1.36) and had higher rates of colon cancer (OR, 3.07), Crohn's disease (OR, 4.42), and celiac disease (OR, 2.48) compared to duodenal adenocarcinoma patients.
• Intestinal obstruction was a more common presentation in jejunal adenocarcinoma (OR, 1.99), while iron deficiency anemia was more frequent in duodenal adenocarcinoma (OR, 0.16).
• Jejunal adenocarcinoma patients were less likely to receive anti-neoplastic therapy (OR, 0.81), with no significant differences in surgical intervention rates.

Conclusions:

• Jejunal adenocarcinoma shows a stronger association with colorectal cancer, celiac disease, and Crohn's disease.
• Patients with jejunal adenocarcinoma had lower odds of requiring chemotherapy compared to those with duodenal adenocarcinoma.
• These findings highlight key differences that may assist in the earlier diagnosis and tailored treatment of small intestinal adenocarcinomas.