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Adenocarcinoma of Small Bowel.

Fadavi P, Zare M - Rare Tumors (2015)

Bottom Line: The diagnosis is usually late and most patients presented with the advanced stage.Because of this rarity, there is limited data when making decisions for treatment and biological behavior.Like other duodenal cancers, the metastasis decreased her survival and she died about 13 months after diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Hafte Tir Hospital, Iran University of Medical Science , Tehran, Iran.

ABSTRACT
Small bowel cancer is one of the rarest cancers in the gastrointestinal tract. The diagnosis is usually late and most patients presented with the advanced stage. Because of this rarity, there is limited data when making decisions for treatment and biological behavior. Most forms of the cancer occur in the duodenum with surgery being the treatment of choice if the cancer is operable. Chemotherapy has an accepted role in duodenal cancer, with the best form being regimen, which yields the best result in combination with capecitabin and oxaliplatin. Our case patient was present with liver metastasis and a huge mass in her first duodenal region so we were required to use chemotherapy and radiotherapy. Like other duodenal cancers, the metastasis decreased her survival and she died about 13 months after diagnosis.

No MeSH data available.


Related in: MedlinePlus

Computed tomography images before (A) and after (B) radiation therapy show the reduction of the liver metastasis.
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fig001: Computed tomography images before (A) and after (B) radiation therapy show the reduction of the liver metastasis.

Mentions: The patient was a 41 years old, non-smoking female who suffered from chronic dyespia, recently complaining of weight loss, nausea, and vomiting. In the physical exam, however, there were no other signs and symptoms recognized except for weight loss. Upper GI endoscopy was done and there was a huge necrotic mass in the first duodenal section which had obliterated the lumen. A biopsy was taken and the result was a poorly differentiated adenocarcinoma with vascular invasion. A CT scan revealed that there was a mass measuring 10.12 cm and multiple liver metastasis yet lab tests showed that renal and liver functions were normal: carcinoembryonic antigen (CEA)=0.34 and hemoglobin=8.5. Because of the liver metastasis, neoadjuvant chemotherapy was done with capecitabine and oxaliplatin and we decided to refer her to surgery if the response to chemotherapy was good. After 4 courses of chemotherapy, we evaluated her with a CT scan with the results showing that the size of the duodenal mass and liver metastasis had increased (12.12) yet chest CT scans and lab tests were normal (CEA=1.46). Due to pain, mass effect, and no response to chemotherapy, we started radiation therapy (RT) with a local field with a total dose of 45 Gy in 25 fractions and there was quickly a dramatic response to radiation therapy. We have CT before and after RT (Figure 1A). Once the pain subsided, we started chemotherapy again with capecitabine and irinotecan and over a 4 course, the mass size was 4.4 cm and the liver metastasis had become smaller (Figure 1B). We referred her for radiofrequency ablation for the liver metastasis and then to the surgery department. Radiofrequency was done but yet the patient was inoperable so we continued chemotherapy with capecitabine and irinotecan for another 2 courses. After seven months of radiation therapy, ascites and peritoneal seeding were happening so we did palliative care for her. Because lab tests were normal and the patient could tolerate further treatment, she received chemotherapy with Gemcitabine along with D1 and D8 every 3 weeks until she died 13 months after the first diagnose.


Adenocarcinoma of Small Bowel.

Fadavi P, Zare M - Rare Tumors (2015)

Computed tomography images before (A) and after (B) radiation therapy show the reduction of the liver metastasis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508636&req=5

fig001: Computed tomography images before (A) and after (B) radiation therapy show the reduction of the liver metastasis.
Mentions: The patient was a 41 years old, non-smoking female who suffered from chronic dyespia, recently complaining of weight loss, nausea, and vomiting. In the physical exam, however, there were no other signs and symptoms recognized except for weight loss. Upper GI endoscopy was done and there was a huge necrotic mass in the first duodenal section which had obliterated the lumen. A biopsy was taken and the result was a poorly differentiated adenocarcinoma with vascular invasion. A CT scan revealed that there was a mass measuring 10.12 cm and multiple liver metastasis yet lab tests showed that renal and liver functions were normal: carcinoembryonic antigen (CEA)=0.34 and hemoglobin=8.5. Because of the liver metastasis, neoadjuvant chemotherapy was done with capecitabine and oxaliplatin and we decided to refer her to surgery if the response to chemotherapy was good. After 4 courses of chemotherapy, we evaluated her with a CT scan with the results showing that the size of the duodenal mass and liver metastasis had increased (12.12) yet chest CT scans and lab tests were normal (CEA=1.46). Due to pain, mass effect, and no response to chemotherapy, we started radiation therapy (RT) with a local field with a total dose of 45 Gy in 25 fractions and there was quickly a dramatic response to radiation therapy. We have CT before and after RT (Figure 1A). Once the pain subsided, we started chemotherapy again with capecitabine and irinotecan and over a 4 course, the mass size was 4.4 cm and the liver metastasis had become smaller (Figure 1B). We referred her for radiofrequency ablation for the liver metastasis and then to the surgery department. Radiofrequency was done but yet the patient was inoperable so we continued chemotherapy with capecitabine and irinotecan for another 2 courses. After seven months of radiation therapy, ascites and peritoneal seeding were happening so we did palliative care for her. Because lab tests were normal and the patient could tolerate further treatment, she received chemotherapy with Gemcitabine along with D1 and D8 every 3 weeks until she died 13 months after the first diagnose.

Bottom Line: The diagnosis is usually late and most patients presented with the advanced stage.Because of this rarity, there is limited data when making decisions for treatment and biological behavior.Like other duodenal cancers, the metastasis decreased her survival and she died about 13 months after diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Hafte Tir Hospital, Iran University of Medical Science , Tehran, Iran.

ABSTRACT
Small bowel cancer is one of the rarest cancers in the gastrointestinal tract. The diagnosis is usually late and most patients presented with the advanced stage. Because of this rarity, there is limited data when making decisions for treatment and biological behavior. Most forms of the cancer occur in the duodenum with surgery being the treatment of choice if the cancer is operable. Chemotherapy has an accepted role in duodenal cancer, with the best form being regimen, which yields the best result in combination with capecitabin and oxaliplatin. Our case patient was present with liver metastasis and a huge mass in her first duodenal region so we were required to use chemotherapy and radiotherapy. Like other duodenal cancers, the metastasis decreased her survival and she died about 13 months after diagnosis.

No MeSH data available.


Related in: MedlinePlus