Small intestine cancer is a heterogeneous group of malignant neoplasms arising in the duodenum, jejunum, or ileum. Despite the small bowel comprising the majority of the length and mucosal surface area of the gastrointestinal tract, small intestinal malignancies are rare, accounting for only a few percent of GI cancers. Proposed explanations for this relative resistance to carcinogenesis include rapid transit time limiting mucosal carcinogen exposure, dilute liquid luminal contents, low bacterial load, high mucosal IgA and lymphoid (GALT) immune surveillance, and efficient epithelial detoxification/apoptosis. Four major histological types dominate: adenocarcinoma (the predominant epithelial type, often arising on a background of chronic inflammation or a hereditary polyposis/mismatch-repair syndrome), well-differentiated neuroendocrine tumors (carcinoids, the classic midgut primary and the most common small-bowel malignancy in some series), lymphoma (usually B-cell/MALT, with enteropathy-associated T-cell lymphoma as a celiac-disease complication of the jejunoileum), and sarcoma. The mesenchymal gastrointestinal stromal tumor (GIST) is curated separately and cross-referenced here rather than duplicated. Because early tumors are typically clinically silent and the small bowel is difficult to image and endoscope, small intestinal cancers frequently present late with obstruction, occult or overt bleeding, or metastatic disease.
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Conditions with similar clinical presentations that must be differentiated from Small Intestine Cancer:
name: Small Intestine Cancer
creation_date: "2026-07-15T00:00:00Z"
description: >-
Small intestine cancer is a heterogeneous group of malignant neoplasms arising
in the duodenum, jejunum, or ileum. Despite the small bowel comprising the
majority of the length and mucosal surface area of the gastrointestinal tract,
small intestinal malignancies are rare, accounting for only a few percent of GI
cancers. Proposed explanations for this relative resistance to carcinogenesis
include rapid transit time limiting mucosal carcinogen exposure, dilute liquid
luminal contents, low bacterial load, high mucosal IgA and lymphoid (GALT)
immune surveillance, and efficient epithelial detoxification/apoptosis. Four
major histological types dominate: adenocarcinoma (the predominant epithelial
type, often arising on a background of chronic inflammation or a hereditary
polyposis/mismatch-repair syndrome), well-differentiated neuroendocrine tumors
(carcinoids, the classic midgut primary and the most common small-bowel
malignancy in some series), lymphoma (usually B-cell/MALT, with
enteropathy-associated T-cell lymphoma as a celiac-disease complication of the
jejunoileum), and sarcoma. The mesenchymal gastrointestinal stromal tumor (GIST)
is curated separately and cross-referenced here rather than duplicated. Because
early tumors are typically clinically silent and the small bowel is difficult to
image and endoscope, small intestinal cancers frequently present late with
obstruction, occult or overt bleeding, or metastatic disease.
categories:
- Gastrointestinal Cancer
- Small Intestine Neoplasm
parents:
- intestinal cancer
- digestive system neoplasm
disease_term:
preferred_term: small intestine cancer
term:
id: MONDO:0000956
label: small intestine cancer
has_subtypes:
- name: Adenocarcinoma
display_name: Small Bowel Adenocarcinoma (SBA)
description: >-
The predominant epithelial malignancy of the small intestine, most commonly
arising in the duodenum. SBA shares much of the adenoma-carcinoma / Wnt-APC,
KRAS, TP53, and SMAD4 molecular biology of colorectal cancer but at differing
frequencies (lower APC mutation, higher rates of microsatellite instability
and of the chronic-inflammation route). It arises with markedly increased
frequency on a background of Crohn disease (ileal), celiac disease, and the
hereditary predisposition syndromes Lynch syndrome, familial adenomatous
polyposis (FAP), and Peutz-Jeghers syndrome. A HER2/ERBB2-amplified molecular
subset parallels that seen in gastric and colorectal adenocarcinoma.
subtype_term:
preferred_term: small intestine adenocarcinoma
term:
id: MONDO:0003198
label: small intestine adenocarcinoma
genes:
- preferred_term: APC
term:
id: hgnc:583
label: APC
- preferred_term: KRAS
term:
id: hgnc:6407
label: KRAS
- preferred_term: TP53
term:
id: hgnc:11998
label: TP53
- preferred_term: SMAD4
term:
id: hgnc:6770
label: SMAD4
- preferred_term: ERBB2
term:
id: hgnc:3430
label: ERBB2
evidence:
- reference: PMID:35565398
reference_title: "Epidemiology, Risk Factors and Diagnosis of Small Bowel Adenocarcinoma."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Adenocarcinomas of the small intestine are rare tumors but their incidence is increasing."
explanation: Establishes small bowel adenocarcinoma as a rare but rising malignancy.
- reference: PMID:35565398
reference_title: "Epidemiology, Risk Factors and Diagnosis of Small Bowel Adenocarcinoma."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "adenocarcinomas of the small intestine are associated in almost 20% of cases with predisposing diseases (Crohn's disease, Lynch syndrome, familial adenomatous polyposis, Peutz-Jeghers syndrome and celiac disease)"
explanation: Supports the strong association of SBA with chronic inflammation and hereditary predisposition syndromes.
- reference: PMID:38141930
reference_title: "Comprehensive genomic profiling of small bowel adenocarcinoma by tissue and plasma biopsy."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "SBA had a distinct mutation spectrum from left- and right-sided colorectal carcinoma"
explanation: Supports that SBA shares but is distinct from colorectal cancer molecular biology.
- name: Neuroendocrine Tumor
display_name: Small Bowel Neuroendocrine Tumor (Carcinoid)
description: >-
Well-differentiated neuroendocrine tumor arising from serotonin-producing
enterochromaffin (EC) cells, most often in the distal ileum. The classic
"midgut carcinoid," it is the most common site for gastrointestinal NETs and a
leading cause of the carcinoid syndrome when hepatic metastases release
vasoactive amines (serotonin) into the systemic circulation. Small-bowel NETs
are frequently multifocal, are typically indolent but present late with mesenteric
fibrosis and nodal/hepatic metastases, and are characterized by chromogranin A
and serotonin (urinary 5-HIAA) secretion. Most are sporadic; a minority are
MEN1-associated. Mechanistically distinct from adenocarcinoma and cross-linked
to the existing Gastroenteropancreatic_Neuroendocrine_Neoplasm entry.
subtype_term:
preferred_term: small intestine neuroendocrine tumor
term:
id: MONDO:0002995
label: small intestine neuroendocrine tumor, well differentiated, low or intermediate grade
evidence:
- reference: PMID:40553474
reference_title: "Epidemiology of Neuroendocrine Neoplasms in the US."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "within GEP NENs, small bowel (1.4 per 100 000 persons) and pancreas (1.3 per 100 000 persons)"
explanation: SEER-based epidemiology showing the small bowel as a leading site of gastroenteropancreatic neuroendocrine neoplasms.
- name: Lymphoma
display_name: Small Intestinal Lymphoma
description: >-
Primary lymphoma of the small bowel. Most are B-cell non-Hodgkin lymphomas,
including MALT (extranodal marginal zone) lymphoma, immunoproliferative small
intestinal disease (IPSID / alpha heavy chain disease), diffuse large B-cell
lymphoma, and mantle cell lymphoma (lymphomatous polyposis). Enteropathy-associated
T-cell lymphoma (EATL) is a rare aggressive T-cell lymphoma of the jejunoileum
arising as a complication of celiac disease (cross-referenced from the
Celiac_Disease entry). The small intestine is the most common site of primary
GI lymphoma after the stomach.
subtype_term:
preferred_term: small intestine lymphoma
term:
id: MONDO:0001852
label: small intestine lymphoma
evidence:
- reference: PMID:25639480
reference_title: "Recent advances in intestinal lymphomas."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "A large variety of lymphoma types may develop as primary intestinal neoplasms in the small intestines"
explanation: Supports primary lymphoma as a small intestinal malignancy category.
- reference: PMID:25639480
reference_title: "Recent advances in intestinal lymphomas."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "enteropathy-associated T-cell lymphoma or immunoproliferative small intestinal disease that, essentially, do not arise elsewhere than in the gastrointestinal tract"
explanation: Supports EATL and IPSID as small-intestine-specific lymphoma entities, including the celiac-associated EATL noted in the subtype description.
- name: Sarcoma
display_name: Small Bowel Sarcoma
description: >-
Rare mesenchymal malignancies of the small intestine, principally leiomyosarcoma
(smooth muscle) and, less commonly, angiosarcoma or other soft-tissue sarcomas.
Note that gastrointestinal stromal tumor (GIST), historically grouped with
leiomyosarcoma, is a distinct KIT/PDGFRA-driven entity curated separately in
Gastrointestinal_Stromal_Tumor.yaml and is NOT duplicated here.
subtype_term:
preferred_term: small intestine leiomyosarcoma
term:
id: MONDO:0003360
label: small intestine leiomyosarcoma
evidence:
- reference: PMID:39199671
reference_title: "Small Bowel Cancer in Crohn's Disease."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Adenocarcinoma represents the most prevalent of these neoplasms, followed by neuroendocrine tumors and sarcomas"
explanation: Ranks sarcoma among the small-bowel cancer histologies (after adenocarcinoma and neuroendocrine tumors).
prevalence:
- population: Worldwide
measure_type: POINT_PREVALENCE
prevalence_class: RARE
notes: >-
Small intestinal malignancies are rare overall, accounting for only a few
percent of gastrointestinal cancers despite the small bowel's large mucosal
surface area.
evidence:
- reference: PMID:35565398
reference_title: "Epidemiology, Risk Factors and Diagnosis of Small Bowel Adenocarcinoma."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Adenocarcinomas of the small intestine are rare tumors but their incidence is increasing."
explanation: Documents the rarity (and rising incidence) of small bowel adenocarcinoma.
- population: United States (SEER, small bowel neuroendocrine tumors)
measure_type: ANNUAL_INCIDENCE
prevalence_class: BAND_1_9_PER_100000
rate_per_100000: 1.4
notes: >-
SEER-based incidence of small-bowel neuroendocrine neoplasms (~1.4 per 100,000),
a leading gastroenteropancreatic NET primary site.
evidence:
- reference: PMID:40553474
reference_title: "Epidemiology of Neuroendocrine Neoplasms in the US."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "within GEP NENs, small bowel (1.4 per 100 000 persons) and pancreas (1.3 per 100 000 persons)"
explanation: SEER incidence estimate for small-bowel neuroendocrine neoplasms.
pathophysiology:
- name: Chronic Mucosal Inflammation and Dysplasia
description: >-
Sustained mucosal injury and inflammation — as in ileal Crohn disease or
celiac disease — drives a chronic-inflammation carcinogenesis route with
cytokine-mediated proliferative and pro-mutagenic pressure, epithelial
regeneration, dysplasia, and progression to adenocarcinoma. This is the
dominant acquired risk pathway for small bowel adenocarcinoma.
cell_types:
- preferred_term: epithelial cell of small intestine
term:
id: CL:0002254
label: epithelial cell of small intestine
downstream:
- target: Adenoma-Carcinoma Sequence and Wnt-APC Activation
description: Chronic injury and dysplasia feed into the adenoma-carcinoma progression.
evidence:
- reference: PMID:39199671
reference_title: "Small Bowel Cancer in Crohn's Disease."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "the inflammation-dysplasia-adenocarcinoma sequence"
explanation: Supports the chronic-inflammation route from mucosal inflammation through dysplasia to adenocarcinoma in Crohn-associated small bowel cancer.
- name: Adenoma-Carcinoma Sequence and Wnt-APC Activation
description: >-
Small bowel adenocarcinoma frequently develops through an adenoma-carcinoma
sequence analogous to colorectal cancer, with activation of canonical Wnt
signaling (through APC loss or CTNNB1 stabilization), followed by KRAS
activation and TP53/SMAD4 loss. APC mutation is less frequent than in
colorectal cancer, and beta-catenin/Wnt dysregulation may arise by
alternative routes.
cell_types:
- preferred_term: epithelial cell of small intestine
term:
id: CL:0002254
label: epithelial cell of small intestine
biological_processes:
- preferred_term: canonical Wnt signaling pathway
modifier: INCREASED
term:
id: GO:0060070
label: canonical Wnt signaling pathway
downstream:
- target: Invasion and Late-Stage Presentation
description: Accumulated driver lesions produce invasive adenocarcinoma.
evidence:
- reference: PMID:38141930
reference_title: "Comprehensive genomic profiling of small bowel adenocarcinoma by tissue and plasma biopsy."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "SBA had a distinct mutation spectrum from left- and right-sided colorectal carcinoma"
explanation: Supports that the small bowel adenoma-carcinoma driver spectrum overlaps with but is distinct from colorectal cancer.
- name: Mismatch Repair Deficiency and Microsatellite Instability
description: >-
A substantial fraction of small bowel adenocarcinomas are microsatellite
unstable (MSI-high), most often in the context of Lynch syndrome (germline
MLH1/MSH2/MSH6/PMS2 defects) but also sporadically. Loss of DNA mismatch
repair produces a hypermutated genome, frameshift neoantigens, and sensitivity
to immune checkpoint blockade.
cell_types:
- preferred_term: epithelial cell of small intestine
term:
id: CL:0002254
label: epithelial cell of small intestine
biological_processes:
- preferred_term: mismatch repair
modifier: DECREASED
term:
id: GO:0006298
label: mismatch repair
downstream:
- target: Invasion and Late-Stage Presentation
description: The hypermutated MSI-high genotype contributes to malignant progression.
evidence:
- reference: PMID:40218169
reference_title: "Hereditary Colorectal Cancer Syndromes: Small Bowel Cancer Risk and Endoscopic Surveillance Strategies."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "LS patients have an increased SBC risk, warranting tailored endoscopic approaches"
explanation: Supports Lynch syndrome (mismatch repair deficiency) as a driver of increased small bowel cancer risk.
- name: Enterochromaffin Cell Neoplasia and Serotonin Hypersecretion
description: >-
Small-bowel neuroendocrine tumors arise from serotonin-producing
enterochromaffin cells of the ileal mucosa. They are characterized
genomically by recurrent loss of chromosome 18 and CDKN1B alteration rather
than the classic adenocarcinoma drivers. Clonal proliferation with
autonomous secretion of serotonin and other vasoactive amines underlies
chromogranin A elevation and, once hepatic metastases bypass first-pass
hepatic amine clearance, the carcinoid syndrome (flushing, diarrhea,
right-heart valvular fibrosis).
cell_types:
- preferred_term: enteroendocrine cell of small intestine
term:
id: CL:0009006
label: enteroendocrine cell of small intestine
biological_processes:
- preferred_term: serotonin secretion
modifier: INCREASED
term:
id: GO:0001820
label: serotonin secretion
downstream:
- target: Carcinoid Syndrome
description: >-
Autonomous serotonin and vasoactive-amine secretion, once hepatic
metastases bypass first-pass hepatic amine clearance, produces the
systemic carcinoid syndrome.
evidence:
- reference: PMID:37954063
reference_title: "Multiomic sequencing of paired primary and metastatic small bowel carcinoids."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "We confirmed a previously observed loss of chromosome 18 and CDKN1B"
explanation: Supports the characteristic chromosome 18 loss and CDKN1B involvement in small intestinal carcinoid (neuroendocrine tumor) pathogenesis.
- name: Carcinoid Syndrome
description: >-
Systemic consequence of sustained serotonin and other vasoactive-amine
release from a metastatic small-bowel neuroendocrine tumor once hepatic
metastases bypass first-pass hepatic amine clearance. It manifests as
episodic cutaneous flushing, secretory diarrhea, and bronchospasm, and,
from chronic serotonin exposure on the endocardium, right-sided
(tricuspid/pulmonary) valvular fibrosis (carcinoid heart disease).
evidence:
- reference: PMID:39594786
reference_title: "Exploring Carcinoid Syndrome in Neuroendocrine Tumors: Insights from a Multidisciplinary Narrative Review."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "including flushing, diarrhea, bronchospasm, and carcinoid heart disease"
explanation: Supports the carcinoid-syndrome clinical manifestations (flushing, diarrhea, bronchospasm, carcinoid heart disease) arising downstream of serotonin-secreting metastatic small-bowel neuroendocrine tumor.
- name: Invasion and Late-Stage Presentation
description: >-
Because early small intestinal tumors are clinically silent and the small
bowel is difficult to visualize, cancers commonly present late with transmural
invasion, obstruction, bleeding, and regional or distant metastases, a major
driver of the historically poor prognosis of small bowel adenocarcinoma.
biological_processes:
- preferred_term: epithelial to mesenchymal transition
modifier: INCREASED
term:
id: GO:0001837
label: epithelial to mesenchymal transition
evidence:
- reference: PMID:40218169
reference_title: "Hereditary Colorectal Cancer Syndromes: Small Bowel Cancer Risk and Endoscopic Surveillance Strategies."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Due to the low incidence and non-specific presentation of SBC, effective surveillance strategies are essential for early detection and management."
explanation: Supports the clinically silent, non-specific presentation of small bowel cancer that underlies its characteristically late-stage detection.
phenotypes:
- name: Abdominal pain
description: Cramping or persistent abdominal pain, often from partial obstruction or mass effect.
phenotype_term:
preferred_term: Abdominal pain
term:
id: HP:0002027
label: Abdominal pain
- name: Intestinal obstruction
description: Luminal narrowing by an annular or bulky tumor, a common presenting emergency.
phenotype_term:
preferred_term: Intestinal obstruction
term:
id: HP:0005214
label: Intestinal obstruction
- name: Gastrointestinal hemorrhage
description: Occult or overt small-bowel bleeding causing melena or iron deficiency.
phenotype_term:
preferred_term: Gastrointestinal hemorrhage
term:
id: HP:0002239
label: Gastrointestinal hemorrhage
- name: Iron deficiency anemia
description: Chronic occult blood loss from a small-bowel tumor.
phenotype_term:
preferred_term: Iron deficiency anemia
term:
id: HP:0001891
label: Iron deficiency anemia
- name: Weight loss
description: Unintentional weight loss from malabsorption, anorexia, or advanced disease.
phenotype_term:
preferred_term: Weight loss
term:
id: HP:0001824
label: Weight loss
- name: Small intestinal neoplasm
description: >-
A neoplasm arising in the small intestine; the duodenum is the most frequent
primary site for small bowel adenocarcinoma.
phenotype_term:
preferred_term: Neoplasm of the small intestine
term:
id: HP:0100833
label: Neoplasm of the small intestine
evidence:
- reference: PMID:35565398
reference_title: "Epidemiology, Risk Factors and Diagnosis of Small Bowel Adenocarcinoma."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "The most frequent primary location is the duodenum."
explanation: Supports the duodenum as the most common small-bowel adenocarcinoma primary site.
- name: Flushing
description: Paroxysmal cutaneous flushing of the carcinoid syndrome in metastatic small-bowel NET.
subtype: Neuroendocrine Tumor
phenotype_term:
preferred_term: Flushing
term:
id: HP:0031284
label: Flushing
- name: Diarrhea
description: Secretory diarrhea, a feature of the carcinoid syndrome and of extensive small-bowel involvement.
subtype: Neuroendocrine Tumor
phenotype_term:
preferred_term: Diarrhea
term:
id: HP:0002014
label: Diarrhea
biochemical:
- name: Chromogranin A
notes: >-
General neuroendocrine secretory marker elevated in small-bowel neuroendocrine
tumors; used for diagnosis and monitoring.
biomarker_term:
preferred_term: Chromogranin-A
term:
id: NCIT:C17284
label: Chromogranin-A
- name: Serotonin / urinary 5-HIAA
notes: >-
Serotonin and its urinary metabolite 5-hydroxyindoleacetic acid (5-HIAA) are
elevated in serotonin-secreting midgut carcinoids and correlate with carcinoid
syndrome.
biomarker_term:
preferred_term: Serotonin
term:
id: NCIT:C828
label: Serotonin
genetic:
- name: Lynch syndrome (mismatch repair)
gene_term:
preferred_term: MLH1
term:
id: hgnc:7127
label: MLH1
relationship_type: RISK_FACTOR
notes: >-
Germline mismatch-repair defects (Lynch syndrome) markedly increase small bowel
adenocarcinoma risk and produce MSI-high tumors.
evidence:
- reference: PMID:40218169
reference_title: "Hereditary Colorectal Cancer Syndromes: Small Bowel Cancer Risk and Endoscopic Surveillance Strategies."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "LS patients have an increased SBC risk, warranting tailored endoscopic approaches"
explanation: Supports Lynch syndrome as a germline predisposition raising small bowel cancer risk.
- name: MSH2
gene_term:
preferred_term: MSH2
term:
id: hgnc:7325
label: MSH2
relationship_type: RISK_FACTOR
- name: MSH6
gene_term:
preferred_term: MSH6
term:
id: hgnc:7329
label: MSH6
relationship_type: RISK_FACTOR
notes: >-
A Lynch syndrome mismatch-repair gene; germline defects contribute to the
MSI-high small bowel adenocarcinoma spectrum.
- name: PMS2
gene_term:
preferred_term: PMS2
term:
id: hgnc:9122
label: PMS2
relationship_type: RISK_FACTOR
notes: >-
A Lynch syndrome mismatch-repair gene; germline defects contribute to the
MSI-high small bowel adenocarcinoma spectrum.
- name: EPCAM
gene_term:
preferred_term: EPCAM
term:
id: hgnc:11529
label: EPCAM
relationship_type: RISK_FACTOR
notes: >-
Germline EPCAM deletions cause epigenetic silencing of the adjacent MSH2
gene, producing a Lynch syndrome phenotype and mismatch-repair deficiency.
- name: APC (familial adenomatous polyposis)
gene_term:
preferred_term: APC
term:
id: hgnc:583
label: APC
relationship_type: RISK_FACTOR
notes: >-
Germline APC mutation (FAP) predisposes to duodenal/periampullary adenomas and
adenocarcinoma, the leading extracolonic cancer cause of death in FAP.
evidence:
- reference: PMID:40218169
reference_title: "Hereditary Colorectal Cancer Syndromes: Small Bowel Cancer Risk and Endoscopic Surveillance Strategies."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "In FAP, duodenal surveillance follows the Spigelman classification to stratify cancer risk"
explanation: Supports elevated duodenal/small bowel cancer risk in familial adenomatous polyposis, motivating Spigelman-based surveillance.
- name: STK11 (Peutz-Jeghers syndrome)
gene_term:
preferred_term: STK11
term:
id: hgnc:11389
label: STK11
relationship_type: RISK_FACTOR
notes: >-
Germline STK11 (LKB1) mutation causes Peutz-Jeghers syndrome, with hamartomatous
small-bowel polyps and increased small intestinal cancer risk.
- name: MUTYH (MUTYH-associated polyposis)
gene_term:
preferred_term: MUTYH
term:
id: hgnc:7527
label: MUTYH
relationship_type: RISK_FACTOR
notes: >-
Biallelic germline MUTYH base-excision-repair defects (MUTYH-associated
polyposis) carry an FAP-like extracolonic risk that includes duodenal
adenomas and duodenal/small bowel adenocarcinoma.
evidence:
- reference: PMID:41214301
reference_title: "Japanese society for cancer of the colon and rectum (JSCCR) guidelines 2024 for the clinical practice of hereditary colorectal cancer."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "lifetime risks of duodenal polyposis of 17%–34%, duodenal cancer of 4%–5%"
explanation: Supports the elevated duodenal (small bowel) adenoma and cancer risk in MUTYH-associated polyposis.
treatments:
- name: Surgical resection
description: >-
Segmental small-bowel resection with lymphadenectomy (or pancreaticoduodenectomy
for duodenal/periampullary tumors) is the mainstay of curative therapy for
localized adenocarcinoma and neuroendocrine tumors.
treatment_term:
preferred_term: surgical procedure
term:
id: NCIT:C15329
label: Surgical Procedure
evidence:
- reference: PMID:39411312
reference_title: "Gastroenteropancreatic neuroendocrine neoplasms: epidemiology, genetics, and treatment."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "surgery remains the primary option for most cases"
explanation: Supports surgical resection as the primary curative modality for small-bowel neuroendocrine (and localized epithelial) tumors.
- name: Fluoropyrimidine-based chemotherapy
description: >-
Systemic fluoropyrimidine plus oxaliplatin (e.g., FOLFOX/CAPOX) is the standard
chemotherapy backbone for advanced small bowel adenocarcinoma, extrapolated from
colorectal cancer.
treatment_term:
preferred_term: chemotherapy
term:
id: NCIT:C15632
label: Chemotherapy
therapeutic_agent:
- preferred_term: 5-fluorouracil
term:
id: CHEBI:46345
label: 5-fluorouracil
- preferred_term: oxaliplatin
term:
id: CHEBI:31941
label: oxaliplatin
- name: Somatostatin analog therapy
description: >-
Somatostatin analogs (octreotide, lanreotide) control carcinoid-syndrome
symptoms and provide antiproliferative control in metastatic, somatostatin
receptor (SSTR2/SSTR5)-positive, well-differentiated small-bowel neuroendocrine
tumors.
treatment_term:
preferred_term: Pharmacotherapy
term:
id: NCIT:C15986
label: Pharmacotherapy
therapeutic_agent:
- preferred_term: octreotide
term:
id: CHEBI:7726
label: octreotide
- preferred_term: lanreotide
term:
id: CHEBI:135901
label: lanreotide
- name: Peptide receptor radionuclide therapy (PRRT)
description: >-
177Lu-DOTATATE peptide receptor radionuclide therapy delivers targeted
radiation to somatostatin-receptor-expressing metastatic/progressive
small-bowel (midgut) neuroendocrine tumors.
treatment_term:
preferred_term: peptide receptor radionuclide therapy
term:
id: NCIT:C15313
label: Radiation Therapy
therapeutic_agent:
- preferred_term: Lutetium Lu 177 dotatate
term:
id: NCIT:C95020
label: Lutetium Lu 177 Dotatate
evidence:
- reference: PMID:39411312
reference_title: "Gastroenteropancreatic neuroendocrine neoplasms: epidemiology, genetics, and treatment."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Peptide receptor radionuclide therapy (PRRT) is an effective treatment"
explanation: Supports PRRT as an effective therapy for gastroenteropancreatic (including small-bowel) neuroendocrine neoplasms.
- name: Immune checkpoint blockade (dMMR/MSI-H)
description: >-
Anti-PD-1 immune checkpoint blockade (pembrolizumab) is a tissue-agnostic option
for mismatch-repair-deficient / microsatellite-instability-high small bowel
adenocarcinoma, which is hypermutated and neoantigen-rich.
therapeutic_modality: MONOCLONAL_ANTIBODY
treatment_term:
preferred_term: Pharmacotherapy
term:
id: NCIT:C15986
label: Pharmacotherapy
therapeutic_agent:
- preferred_term: pembrolizumab
term:
id: NCIT:C106432
label: Pembrolizumab
target_mechanisms:
- target: Mismatch Repair Deficiency and Microsatellite Instability
treatment_effect: MODULATES
description: >-
The hypermutated, neoantigen-rich MSI-H/dMMR genotype confers immunogenicity
that anti-PD-1 blockade exploits; efficacy is contingent on this mechanism.
evidence:
- reference: PMID:31682550
reference_title: "Efficacy of Pembrolizumab in Patients With Noncolorectal High Microsatellite Instability/Mismatch Repair-Deficient Cancer: Results From the Phase II KEYNOTE-158 Study."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "harbor hundreds to thousands of somatic mutations that encode potential neoantigens"
explanation: Establishes the neoantigen-rich MSI-H/dMMR biology underlying checkpoint-blockade sensitivity.
evidence:
- reference: PMID:31682550
reference_title: "Efficacy of Pembrolizumab in Patients With Noncolorectal High Microsatellite Instability/Mismatch Repair-Deficient Cancer: Results From the Phase II KEYNOTE-158 Study."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "has antitumor activity against MSI-H/dMMR cancer"
explanation: KEYNOTE-158 established pembrolizumab activity across noncolorectal MSI-H/dMMR cancers, which include small bowel adenocarcinoma.
differential_diagnoses:
- name: Gastrointestinal stromal tumor
description: >-
GIST is the most common mesenchymal tumor of the GI tract and enters the
differential for a small-bowel mural mass or "sarcoma." It is a distinct
KIT/PDGFRA-driven entity, curated separately, and should be cross-referenced
rather than treated as a small intestine cancer subtype.
disease_term:
preferred_term: gastrointestinal stromal tumor
term:
id: MONDO:0011719
label: gastrointestinal stromal tumor
datasets: []
“Small bowel cancer” (SBC) is a rare malignancy of the small intestine. A recent hereditary-syndrome-focused review defines SBC as comprising four main histologic types: adenocarcinomas, neuroendocrine tumors, stromal tumors (including GIST), and lymphomas (borsotti2025hereditarycolorectalcancer pages 1-2). In the same source, adenocarcinoma and neuroendocrine tumors are described as the most common subtypes, each representing approximately ~40% of SBC, emphasizing that SBC is better treated as a group of diseases rather than a single entity (borsotti2025hereditarycolorectalcancer pages 1-2).
Across SBC broadly, the duodenum is the most frequently affected site (55–82%), followed by the jejunum (11–25%) and ileum (7–17%) (borsotti2025hereditarycolorectalcancer pages 1-2). In Lynch syndrome–associated small bowel cancers, nearly 50% occur in the duodenum (borsotti2025hereditarycolorectalcancer pages 12-14).
Commonly used synonyms in the clinical literature include: - Small bowel cancer, small intestine cancer, small-bowel tumor(s) (in diagnostic guideline contexts) (pennazio2023smallbowelcapsuleendoscopy pages 8-9, pennazio2023smallbowelcapsuleendoscopy pages 21-21) - Histology-specific entities: small bowel adenocarcinoma (SBA), small intestinal neuroendocrine tumor (SiNET; “midgut NET”), small intestine GIST (borsotti2025hereditarycolorectalcancer pages 1-2, strosberg2024sequencingofsomatostatinreceptor–based pages 1-2, serrano20232023geisguidelines pages 1-3)
The information assembled here derives from aggregated disease-level resources (guidelines/reviews) and population-level registry analyses (SEER-based studies) rather than individual EHR case series (pennazio2023smallbowelcapsuleendoscopy pages 8-9, dasari2025epidemiologyofneuroendocrine pages 5-7, alvarez2024incidenceandsurvival pages 1-2).
SBC etiology is heterogeneous and histology-dependent: - Hereditary cancer predisposition syndromes (e.g., Lynch syndrome, FAP, Peutz–Jeghers syndrome) substantially elevate risk and motivate surveillance strategies (borsotti2025hereditarycolorectalcancer pages 1-2, borsotti2025hereditarycolorectalcancer pages 12-14, macfarland2024pediatriccancerscreening pages 5-6). - Molecularly driven mesenchymal oncogenesis in GIST is dominated by gain-of-function KIT or PDGFRA receptor tyrosine kinase mutations, which are described as “crucial drivers” responsible for tumor initiation and evolution across disease course (serrano20232023geisguidelines pages 1-1).
A major diagnostic guideline (ESGE small-bowel capsule endoscopy / device-assisted enteroscopy) highlights that small-bowel tumors are most often detected during evaluation of “obscure small-bowel bleeding” or “unexplained iron-deficiency anemia”, while also noting that tumors account for only ~3.5–5% of such presentations—making these symptoms weak predictors on their own (pennazio2023smallbowelcapsuleendoscopy pages 21-21).
Additional “increased risk” contexts for underlying small-bowel tumors in that guideline include liver metastases from occult neuroendocrine tumors, advanced melanoma (stage IV), stage III melanoma with positive FOBT, and nonresponsive/complicated celiac disease (pennazio2023smallbowelcapsuleendoscopy pages 21-21).
Based on the documented presentations (bleeding/IDA) and typical small-bowel tumor consequences, useful HPO mappings include: - Iron deficiency anemia (HP:0001891) - Gastrointestinal hemorrhage / intestinal bleeding (e.g., HP:0002239) - Occult gastrointestinal bleeding (no single canonical HPO term; may map to GI hemorrhage + laboratory evidence)
Evidence for bleeding/IDA as key presentations is supported by guideline text (pennazio2023smallbowelcapsuleendoscopy pages 21-21).
High-confidence germline predisposition genes for SBC include: - MLH1, MSH2, MSH6, PMS2, EPCAM (Lynch syndrome) (borsotti2025hereditarycolorectalcancer pages 12-14) - APC (FAP) (macfarland2024pediatriccancerscreening pages 4-4) - MUTYH (MAP) (borsotti2025hereditarycolorectalcancer pages 19-21)
SBC is described as accounting for ~2.3% of all digestive cancers in the general population (borsotti2025hereditarycolorectalcancer pages 1-2).
A 2025 SEER-based analysis reports a small intestine NET incidence of approximately 1.2 per 100,000, with mean age at diagnosis ~64 years and long median survival compared with many other metastatic cancers (dasari2025epidemiologyofneuroendocrine pages 5-7). The broader SEER-based analysis reports small intestine NET incidence ~1.41 per 100,000, and provides additional prevalence context for NETs overall (dasari2025epidemiologyofneuroendocrine pages 4-5).
A 2024 SEER-based cohort study reports that incidence rates for small intestine GIST increased 2.7% annually (2000–2019), with the increase mainly in localized-stage tumors (alvarez2024incidenceandsurvival pages 1-2).
A key ESGE guideline update (published 2023; “Update 2022”) provides an evidence-based framework for small-bowel tumor evaluation: - SBCE is recommended as an initial diagnostic tool in suspected small-bowel tumors in the absence of stenosis or prior resection (pennazio2023smallbowelcapsuleendoscopy pages 8-9). - If imaging already demonstrates tumor suspicion, ESGE recommends device-assisted enteroscopy (DAE) over capsule endoscopy (pennazio2023smallbowelcapsuleendoscopy pages 8-9). - Biopsy sampling via DAE is required to resolve uncertain capsule endoscopy diagnoses (pennazio2023smallbowelcapsuleendoscopy pages 8-9). - For subepithelial masses, confirmation should be obtained using DAE and/or cross-sectional imaging, and cross-sectional imaging is recommended for staging and operability when diagnostic certainty is high (pennazio2023smallbowelcapsuleendoscopy pages 8-9).
| Modality | When to use | Typical presentations prompting workup | Advantages | Limitations / risks | Key guideline or review points | Citations |
|---|---|---|---|---|---|---|
| Small-bowel capsule endoscopy (SBCE/CE) | First-line luminal evaluation when a small-bowel tumor is suspected and there is no evidence of stenosis or prior resection; also recommended in patients at increased risk of small-bowel tumors; preferred first-line method for hereditary-syndrome surveillance programs | Obscure small-bowel bleeding, unexplained iron-deficiency anemia, suspected small-bowel tumor, surveillance in hereditary syndromes such as PJS/FAP/selected LS settings | Noninvasive, outpatient, visualizes entire mucosa, high sensitivity, excellent safety profile; reported diagnostic yield up to 91% in hereditary surveillance settings | Cannot biopsy or treat; may miss solitary proximal/protruding lesions; capsule retention about 1-2%; lesion size/location can be imprecise | ESGE recommends SBCE as an initial diagnostic tool in suspected small-bowel tumors without stenosis; not recommended for follow-up of treated tumors due to insufficient data; in hereditary settings it is commonly the primary surveillance test | (pennazio2023smallbowelcapsuleendoscopy pages 8-9, pennazio2023smallbowelcapsuleendoscopy pages 21-21, borsotti2025hereditarycolorectalcancer pages 2-4, pennazio2023smallbowelcapsuleendoscopy pages 4-5, borsotti2025hereditarycolorectalcancer pages 1-2) |
| Device-assisted enteroscopy (DAE; DBE/SBE/spiral) | Use when imaging already suggests tumor, when tissue diagnosis is needed after SBCE, when therapeutic intervention is likely, or to confirm subepithelial lesions | Positive SBCE, suspected mass needing biopsy, high polyp burden/polyps needing resection, obstructive symptoms, hereditary syndrome surveillance with actionable lesions | Direct visualization, biopsy, tattooing, endoscopic therapy/polypectomy, route can be guided by prior SBCE | More invasive, time-consuming, requires sedation/deep sedation, lower complete small-bowel examination rate than SBCE | ESGE prefers DAE over capsule if prior imaging has demonstrated tumor suspicion; biopsy is required for uncertain capsule findings; DBE diagnostic yield improves substantially when preceded by positive SBCE | (pennazio2023smallbowelcapsuleendoscopy pages 8-9, borsotti2025hereditarycolorectalcancer pages 1-2, borsotti2025hereditarycolorectalcancer pages 2-4, borsotti2025hereditarycolorectalcancer pages 4-5, pennazio2023smallbowelcapsuleendoscopy pages 4-5) |
| CT enterography / cross-sectional CT | Complementary test when SBCE may miss protruding lesions or when extraluminal disease, staging, or operability assessment is needed; useful if tumor is suspected on symptoms or endoscopy | Bleeding/IDA with concern for mass, suspected subepithelial lesion, concern for obstruction/stenosis, preoperative staging | Evaluates mural/extramural disease, metastatic spread, operability; complements capsule limitations for masses | Radiation exposure; less sensitive than mucosal endoscopy for subtle superficial lesions; no biopsy | ESGE notes CT enterography can reasonably complement SBCE, particularly when small-bowel tumor is suspected; once diagnostic certainty is high, cross-sectional imaging is recommended for staging and operability assessment | (pennazio2023smallbowelcapsuleendoscopy pages 8-9, pennazio2023smallbowelcapsuleendoscopy pages 4-5) |
| MR enterography / MRI-based small-bowel imaging | Alternative or adjunct cross-sectional imaging, especially in surveillance programs and when repeated imaging is anticipated; used with CE in PJS and other hereditary settings | Hereditary syndrome surveillance, suspected mass/polyp burden, need to localize lesions or assess bowel beyond mucosa | No ionizing radiation; complements CE for localization and burden assessment | Less direct mucosal detail than endoscopy; no biopsy or endoscopic therapy | Reviews of hereditary SBC surveillance recommend combined approaches using CE with CT/MR enterography; PJS protocols may alternate CE and MRI-enterography every 1-3 years | (borsotti2025hereditarycolorectalcancer pages 2-4, borsotti2025hereditarycolorectalcancer pages 19-21, macfarland2024pediatriccancerscreening pages 5-6) |
| Push enteroscopy / routine upper endoscopy-colonoscopy extensions | Targeted use for proximal duodenal/jejunal lesions, especially in FAP/LS where proximal lesions may be reachable by standard upper endoscopy or push techniques | Duodenal polyposis, proximal small-bowel lesions, hereditary syndromes with duodenal risk | Allows direct inspection/biopsy of reachable proximal lesions; integrates with routine surveillance | Limited reach beyond proximal small bowel | In FAP, push enteroscopy is recommended for advanced Spigelman stage disease; in LS, duodenal/distal ileal lesions may be accessible with routine gastroscopy/colonoscopy, so routine jejunoileal screening is generally not recommended except selected high-risk groups | (borsotti2025hereditarycolorectalcancer pages 12-14) |
| Multimodal workup pathway | Best when suspicion remains despite a single negative test or when hereditary risk is present | Persistent obscure bleeding/IDA, positive occult blood with high-risk cancer history, nonresponsive/complicated celiac disease, hereditary syndrome surveillance | Improves detection, localization, histologic confirmation, and treatment planning | Requires coordination and resource availability | Reviews emphasize combining endoscopy, cross-sectional imaging, and genetic risk stratification in tertiary centers; AI-assisted CE/enterography may improve workflow in the future | (borsotti2025hereditarycolorectalcancer pages 22-24, borsotti2025hereditarycolorectalcancer pages 1-2, pennazio2023smallbowelcapsuleendoscopy pages 21-21) |
Table: This table summarizes the main diagnostic modalities used for suspected small-bowel tumors, including when each test is typically used, its strengths and limitations, and recent guideline-based recommendations. It is useful for comparing first-line luminal evaluation with confirmatory, therapeutic, and staging approaches.
The 2023 GEIS guideline states that five TKIs have regulatory approval for metastatic GIST: imatinib, sunitinib, regorafenib, ripretinib, avapritinib (serrano20232023geisguidelines pages 1-3). Molecular-genotype–response relationships include: - KIT exon 11 mutants: 72% objective response with imatinib; exon 9 mutants: 38% response, with higher-dose imatinib benefiting exon 9 disease (serrano20232023geisguidelines pages 10-11). - PDGFRA D842V: resistant to imatinib and most standard therapies (serrano20232023geisguidelines pages 10-11).
These therapies are widely implemented in modern sarcoma/GIST practice and represent one of oncology’s canonical successes of biomarker-driven treatment (serrano20232023geisguidelines pages 1-1).
The most evidence-supported “prevention” approach for SBC in current retrieved sources is surveillance in hereditary syndromes, using CE, enteroscopy, and cross-sectional imaging with gene-informed stratification (borsotti2025hereditarycolorectalcancer pages 1-2, borsotti2025hereditarycolorectalcancer pages 12-14, macfarland2024pediatriccancerscreening pages 5-6).
| Syndrome | Causal genes / inheritance | Small bowel cancer risk estimates | Suggested surveillance approach | Key citations |
|---|---|---|---|---|
| Lynch syndrome (LS/HNPCC) | Pathogenic variants in MLH1, MSH2, MSH6, PMS2 or EPCAM deletion; autosomal dominant | Lifetime small bowel cancer risk reported at 0.4%–12% overall; cumulative incidence by age 75 reported as 64.7% for MLH1, 20.1% for MSH2, 0% for MSH6/PMS2 in the cited review cohort; ~50% of LS-associated small bowel cancers arise in the duodenum (borsotti2025hereditarycolorectalcancer pages 12-14) | Routine jejunal/ileal screening is generally not recommended; duodenal/distal ileal lesions may be accessible during routine gastroscopy/colonoscopy; consider more tailored surveillance in MLH1 carriers; capsule endoscopy has low complication rates (0%–0.5%) and reported diagnostic yield up to 8.6% for asymptomatic small-bowel neoplasms (borsotti2025hereditarycolorectalcancer pages 12-14, borsotti2025hereditarycolorectalcancer pages 1-2) | (borsotti2025hereditarycolorectalcancer pages 1-2, borsotti2025hereditarycolorectalcancer pages 12-14) |
| Familial adenomatous polyposis (FAP) | APC pathogenic variants; autosomal dominant; de novo cases occur (macfarland2024pediatriccancerscreening pages 4-4) | Elevated small bowel/duodenal cancer risk; duodenal surveillance risk stratified by Spigelman classification; jejunal/ileal polyps less well studied (borsotti2025hereditarycolorectalcancer pages 1-2, borsotti2025hereditarycolorectalcancer pages 12-14) | Push enteroscopy recommended for Spigelman III–IV disease; double-balloon enteroscopy (DAE) for high polyp burden; surveillance at 3–6 month intervals for high-burden disease or 12-month intervals for minimal disease; multimodal care in tertiary centers emphasized (borsotti2025hereditarycolorectalcancer pages 12-14, borsotti2025hereditarycolorectalcancer pages 1-2) | (borsotti2025hereditarycolorectalcancer pages 1-2, borsotti2025hereditarycolorectalcancer pages 12-14, macfarland2024pediatriccancerscreening pages 4-4) |
| Peutz-Jeghers syndrome (PJS) | STK11/LKB1 pathogenic variants; typically autosomal dominant (syndrome context from screening guidance) | High small bowel polyp/cancer risk; pediatric complication burden notable, with intussusception >20% by age 10 and >50% by age 20 (macfarland2024pediatriccancerscreening pages 5-6) | Start GI screening at age 8 years with endoscopy/colonoscopy plus small bowel imaging (video capsule endoscopy or MR enterography); if polyps are found, repeat every 2–3 years; some protocols alternate CE and MRI-E every 1–3 years; significant polyps ≥15 mm should undergo enteroscopy-assisted resection (borsotti2025hereditarycolorectalcancer pages 19-21, macfarland2024pediatriccancerscreening pages 5-6) | (borsotti2025hereditarycolorectalcancer pages 1-2, borsotti2025hereditarycolorectalcancer pages 19-21, macfarland2024pediatriccancerscreening pages 5-6) |
| Constitutional mismatch repair deficiency (CMMRD) | Biallelic mismatch repair gene pathogenic variants; autosomal recessive (borsotti2025hereditarycolorectalcancer pages 19-21) | Small bowel cancer prevalence reported at 10%–16%; median diagnosis age around 28 years (borsotti2025hereditarycolorectalcancer pages 19-21) | Surveillance includes annual upper endoscopy from age 8 and capsule endoscopy from age 10; concurrent push enteroscopy is recommended because lesions are often duodenal (borsotti2025hereditarycolorectalcancer pages 19-21) | (borsotti2025hereditarycolorectalcancer pages 19-21) |
| MUTYH-associated polyposis (MAP) | MUTYH pathogenic variants; usually autosomal recessive (syndrome context reflected in guideline-style review) | Duodenal cancer risk described as comparable to FAP; risk focus is mainly proximal small bowel/duodenum (borsotti2025hereditarycolorectalcancer pages 19-21) | Surveillance limited to proximal small bowel; upper endoscopy with duodenoscopy starting at age 25–30 years in American guidance or 35 years in European guidance; polypectomy regardless of size is recommended because Spigelman staging is less reliable in MAP (borsotti2025hereditarycolorectalcancer pages 19-21) | (borsotti2025hereditarycolorectalcancer pages 19-21) |
Table: This table summarizes the major hereditary syndromes linked to small bowel cancer, highlighting causal genes, reported risk estimates, and syndrome-specific surveillance/prevention approaches. It is useful for quickly comparing how surveillance differs across Lynch syndrome, FAP, Peutz-Jeghers syndrome, CMMRD, and MAP.
Not retrieved for small intestine cancer specifically in this run (gap).
Not retrieved for small intestine cancer specifically in this run (gap).
Key 2023–2024 developments captured in the retrieved evidence include: 1. Endoscopic technology integration: ESGE guidance formalizes pathways that integrate capsule endoscopy, device-assisted enteroscopy, and cross-sectional imaging for suspected small-bowel tumors, clarifying when DAE should supersede capsule endoscopy when a tumor is already suspected on imaging (pennazio2023smallbowelcapsuleendoscopy pages 8-9). 2. Syndrome-based surveillance modernization: 2024 AACR Childhood Cancer Predisposition Working Group updates support early initiation of small bowel imaging (capsule endoscopy or MR enterography) in pediatric PJS beginning at age 8, reflecting increasing emphasis on life-course surveillance (macfarland2024pediatriccancerscreening pages 5-6). 3. Registry-based epidemiology of rare GI malignancies: 2024–2025 SEER-based analyses provide updated incidence trends and long-horizon survival estimates for small intestine NETs and small intestine GIST, highlighting increasing detection and improving survivorship in some subtypes (dasari2025epidemiologyofneuroendocrine pages 5-7, alvarez2024incidenceandsurvival pages 1-2). 4. Precision therapeutics maturity in rare tumors: 2023 GIST guideline synthesis reiterates that KIT/PDGFRA genotype dictates therapeutic selection and outcome, with multiple approved TKIs and genotype-specific resistance patterns informing sequencing (serrano20232023geisguidelines pages 10-11, serrano20232023geisguidelines pages 1-3).
| Entity | Definition/notes | Approx share or incidence (if in evidence) | Typical location | Key citations |
|---|---|---|---|---|
| SBC umbrella | Small bowel cancer is a rare malignancy of the small intestine comprising four main histologic groups: adenocarcinomas, neuroendocrine tumors, stromal tumors, and lymphomas. Reviews note adenocarcinoma and neuroendocrine tumor are the two most common categories. | Accounts for ~2.3% of digestive cancers; adenocarcinoma and neuroendocrine tumors each represent ~40% of SBC; duodenum is most commonly involved (55–82%), followed by jejunum (11–25%) and ileum (7–17%). | Duodenum most common overall; then jejunum and ileum. | (borsotti2025hereditarycolorectalcancer pages 1-2) |
| SBA | Small bowel adenocarcinoma is the epithelial adenocarcinoma subtype of SBC; prognosis is often limited by late diagnosis and management complexity. In hereditary settings, it can arise through an adenoma-carcinoma sequence, especially in Lynch syndrome. | Included within the ~40% adenocarcinoma share of SBC; SEER-based prognostic study analyzed 2,064 SBA cases diagnosed 2010–2020. | Often duodenal overall; in Lynch syndrome, nearly 50% of small bowel cancers occur in the duodenum. | (borsotti2025hereditarycolorectalcancer pages 1-2, borsotti2025hereditarycolorectalcancer pages 12-14) |
| SiNET | Small intestinal neuroendocrine tumor (midgut/small-bowel NET) is a well-differentiated neuroendocrine neoplasm of the small intestine; commonly SSTR-positive and often slow-growing but prone to mesenteric nodal/liver spread. | Small intestine NET incidence ~1.2–1.41 per 100,000 persons in recent US SEER analyses; small bowel NETs are among the most common GEP-NET sites; 10-year overall survival reported at 51.7% in one SEER-based analysis. | Frequently ileal/midgut; ileal/ileocecal primaries are emphasized in treatment reviews. | (dasari2025epidemiologyofneuroendocrine pages 5-7, dasari2025epidemiologyofneuroendocrine pages 1-2, dasari2025epidemiologyofneuroendocrine pages 4-5, strosberg2024sequencingofsomatostatinreceptor–based pages 1-2) |
| Small intestine GIST | Gastrointestinal stromal tumor is the principal mesenchymal/stromal tumor category of the small intestine, usually driven by KIT or PDGFRA alterations and characterized by KIT (CD117) expression in >95% of cases. | Small intestine is the primary site in ~31% of GISTs; global GIST incidence ~10–15 per million people; small intestine GIST incidence increased by 2.7% annually in SEER 2000–2019. | Small intestine is a major primary site after stomach; may present as multifocal disease in NF1-associated cases. | (serrano20232023geisguidelines pages 1-3, alvarez2024incidenceandsurvival pages 1-2, wang2026targetedtherapyfor pages 1-2) |
Table: This table summarizes the disease scope of small intestine cancer, highlighting the umbrella category and the major clinically important histologic subtypes. It is useful for orienting a knowledge base entry to the main entities, their approximate frequencies or incidence, and their usual anatomic distribution.
References
(borsotti2025hereditarycolorectalcancer pages 1-2): Edoardo Borsotti, Francesca Laura Nava, Felice Benedicenti, Laura Cini, Andrea Magarotto, Davide Ferrari, Paolo Cantù, Marco Vitellaro, Emanuele Rausa, and Federica Cavalcoli. Hereditary colorectal cancer syndromes: small bowel cancer risk and endoscopic surveillance strategies. Diagnostics, 15:819, Mar 2025. URL: https://doi.org/10.3390/diagnostics15070819, doi:10.3390/diagnostics15070819. This article has 5 citations.
(borsotti2025hereditarycolorectalcancer pages 12-14): Edoardo Borsotti, Francesca Laura Nava, Felice Benedicenti, Laura Cini, Andrea Magarotto, Davide Ferrari, Paolo Cantù, Marco Vitellaro, Emanuele Rausa, and Federica Cavalcoli. Hereditary colorectal cancer syndromes: small bowel cancer risk and endoscopic surveillance strategies. Diagnostics, 15:819, Mar 2025. URL: https://doi.org/10.3390/diagnostics15070819, doi:10.3390/diagnostics15070819. This article has 5 citations.
(pennazio2023smallbowelcapsuleendoscopy pages 8-9): Marco Pennazio, Emanuele Rondonotti, Edward J. Despott, Xavier Dray, Martin Keuchel, Tom Moreels, David S. Sanders, Cristiano Spada, Cristina Carretero, Pablo Cortegoso Valdivia, Luca Elli, Lorenzo Fuccio, Begona Gonzalez Suarez, Anastasios Koulaouzidis, Lumir Kunovsky, Deirdre McNamara, Helmut Neumann, Enrique Perez-Cuadrado-Martinez, Enrique Perez-Cuadrado-Robles, Stefania Piccirelli, Bruno Rosa, Jean-Christophe Saurin, Reena Sidhu, Ilja Tacheci, Erasmia Vlachou, and Konstantinos Triantafyllou. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: european society of gastrointestinal endoscopy (esge) guideline – update 2022. Endoscopy, 55:58-95, Nov 2023. URL: https://doi.org/10.1055/a-1973-3796, doi:10.1055/a-1973-3796. This article has 391 citations and is from a domain leading peer-reviewed journal.
(pennazio2023smallbowelcapsuleendoscopy pages 21-21): Marco Pennazio, Emanuele Rondonotti, Edward J. Despott, Xavier Dray, Martin Keuchel, Tom Moreels, David S. Sanders, Cristiano Spada, Cristina Carretero, Pablo Cortegoso Valdivia, Luca Elli, Lorenzo Fuccio, Begona Gonzalez Suarez, Anastasios Koulaouzidis, Lumir Kunovsky, Deirdre McNamara, Helmut Neumann, Enrique Perez-Cuadrado-Martinez, Enrique Perez-Cuadrado-Robles, Stefania Piccirelli, Bruno Rosa, Jean-Christophe Saurin, Reena Sidhu, Ilja Tacheci, Erasmia Vlachou, and Konstantinos Triantafyllou. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: european society of gastrointestinal endoscopy (esge) guideline – update 2022. Endoscopy, 55:58-95, Nov 2023. URL: https://doi.org/10.1055/a-1973-3796, doi:10.1055/a-1973-3796. This article has 391 citations and is from a domain leading peer-reviewed journal.
(strosberg2024sequencingofsomatostatinreceptor–based pages 1-2): Jonathan R. Strosberg, Taymeyah Al-Toubah, Ghassan El-Haddad, Diane Reidy Lagunes, and Lisa Bodei. Sequencing of somatostatin-receptor–based therapies in neuroendocrine tumor patients. The Journal of Nuclear Medicine, 65:340-348, Jan 2024. URL: https://doi.org/10.2967/jnumed.123.265706, doi:10.2967/jnumed.123.265706. This article has 27 citations.
(serrano20232023geisguidelines pages 1-3): César Serrano, Javier Martín-Broto, José Manuel Asencio-Pascual, José Antonio López-Guerrero, Jordi Rubió-Casadevall, Silvia Bagué, Xavier García-del-Muro, Juan Ángel Fernández-Hernández, Luís Herrero, Antonio López-Pousa, Andrés Poveda, and Virginia Martínez-Marín. 2023 geis guidelines for gastrointestinal stromal tumors. Therapeutic Advances in Medical Oncology, Jan 2023. URL: https://doi.org/10.1177/17588359231192388, doi:10.1177/17588359231192388. This article has 156 citations and is from a peer-reviewed journal.
(dasari2025epidemiologyofneuroendocrine pages 5-7): Arvind Dasari, Katrine Wallace, Daniel M. Halperin, Jessica Maxwell, Pamela Kunz, Simron Singh, Beth Chasen, and James C. Yao. Epidemiology of neuroendocrine neoplasms in the us. JAMA Network Open, 8:e2515798, Jun 2025. URL: https://doi.org/10.1001/jamanetworkopen.2025.15798, doi:10.1001/jamanetworkopen.2025.15798. This article has 98 citations and is from a peer-reviewed journal.
(alvarez2024incidenceandsurvival pages 1-2): Christian S. Alvarez, M. Blanca Piazuelo, Tania Fleitas-Kanonnikoff, Jennifer Ruhl, J. Alejandro Pérez-Fidalgo, and M. Constanza Camargo. Incidence and survival outcomes of gastrointestinal stromal tumors. Aug 2024. URL: https://doi.org/10.1001/jamanetworkopen.2024.28828, doi:10.1001/jamanetworkopen.2024.28828. This article has 54 citations and is from a peer-reviewed journal.
(macfarland2024pediatriccancerscreening pages 5-6): Suzanne P. MacFarland, Kerri Becktell, Kami Wolfe Schneider, Roland P. Kuiper, Harry Lesmana, Julia Meade, Kim E. Nichols, Christopher C. Porter, Sharon A. Savage, Kris Ann Schultz, Hamish Scott, Lisa States, Uri Tabori, Chieko Tamura, Gail Tomlinson, Kristin Zelley, Carol Durno, Andrew Bauer, and Sharon E. Plon. Pediatric cancer screening in hereditary gastrointestinal cancer risk syndromes: an update from the aacr childhood cancer predisposition working group. Clinical cancer research : an official journal of the American Association for Cancer Research, 30:4566-4571, Aug 2024. URL: https://doi.org/10.1158/1078-0432.ccr-24-0953, doi:10.1158/1078-0432.ccr-24-0953. This article has 25 citations.
(serrano20232023geisguidelines pages 1-1): César Serrano, Javier Martín-Broto, José Manuel Asencio-Pascual, José Antonio López-Guerrero, Jordi Rubió-Casadevall, Silvia Bagué, Xavier García-del-Muro, Juan Ángel Fernández-Hernández, Luís Herrero, Antonio López-Pousa, Andrés Poveda, and Virginia Martínez-Marín. 2023 geis guidelines for gastrointestinal stromal tumors. Therapeutic Advances in Medical Oncology, Jan 2023. URL: https://doi.org/10.1177/17588359231192388, doi:10.1177/17588359231192388. This article has 156 citations and is from a peer-reviewed journal.
(macfarland2024pediatriccancerscreening pages 4-4): Suzanne P. MacFarland, Kerri Becktell, Kami Wolfe Schneider, Roland P. Kuiper, Harry Lesmana, Julia Meade, Kim E. Nichols, Christopher C. Porter, Sharon A. Savage, Kris Ann Schultz, Hamish Scott, Lisa States, Uri Tabori, Chieko Tamura, Gail Tomlinson, Kristin Zelley, Carol Durno, Andrew Bauer, and Sharon E. Plon. Pediatric cancer screening in hereditary gastrointestinal cancer risk syndromes: an update from the aacr childhood cancer predisposition working group. Clinical cancer research : an official journal of the American Association for Cancer Research, 30:4566-4571, Aug 2024. URL: https://doi.org/10.1158/1078-0432.ccr-24-0953, doi:10.1158/1078-0432.ccr-24-0953. This article has 25 citations.
(borsotti2025hereditarycolorectalcancer pages 19-21): Edoardo Borsotti, Francesca Laura Nava, Felice Benedicenti, Laura Cini, Andrea Magarotto, Davide Ferrari, Paolo Cantù, Marco Vitellaro, Emanuele Rausa, and Federica Cavalcoli. Hereditary colorectal cancer syndromes: small bowel cancer risk and endoscopic surveillance strategies. Diagnostics, 15:819, Mar 2025. URL: https://doi.org/10.3390/diagnostics15070819, doi:10.3390/diagnostics15070819. This article has 5 citations.
(tan2024gastroenteropancreaticneuroendocrineneoplasms pages 8-9): Baizhou Tan, Beiyu Zhang, and Hongping Chen. Gastroenteropancreatic neuroendocrine neoplasms: epidemiology, genetics, and treatment. Frontiers in Endocrinology, Sep 2024. URL: https://doi.org/10.3389/fendo.2024.1424839, doi:10.3389/fendo.2024.1424839. This article has 32 citations.
(dasari2025epidemiologyofneuroendocrine pages 4-5): Arvind Dasari, Katrine Wallace, Daniel M. Halperin, Jessica Maxwell, Pamela Kunz, Simron Singh, Beth Chasen, and James C. Yao. Epidemiology of neuroendocrine neoplasms in the us. JAMA Network Open, 8:e2515798, Jun 2025. URL: https://doi.org/10.1001/jamanetworkopen.2025.15798, doi:10.1001/jamanetworkopen.2025.15798. This article has 98 citations and is from a peer-reviewed journal.
(dasari2025epidemiologyofneuroendocrine pages 1-2): Arvind Dasari, Katrine Wallace, Daniel M. Halperin, Jessica Maxwell, Pamela Kunz, Simron Singh, Beth Chasen, and James C. Yao. Epidemiology of neuroendocrine neoplasms in the us. JAMA Network Open, 8:e2515798, Jun 2025. URL: https://doi.org/10.1001/jamanetworkopen.2025.15798, doi:10.1001/jamanetworkopen.2025.15798. This article has 98 citations and is from a peer-reviewed journal.
(borsotti2025hereditarycolorectalcancer pages 2-4): Edoardo Borsotti, Francesca Laura Nava, Felice Benedicenti, Laura Cini, Andrea Magarotto, Davide Ferrari, Paolo Cantù, Marco Vitellaro, Emanuele Rausa, and Federica Cavalcoli. Hereditary colorectal cancer syndromes: small bowel cancer risk and endoscopic surveillance strategies. Diagnostics, 15:819, Mar 2025. URL: https://doi.org/10.3390/diagnostics15070819, doi:10.3390/diagnostics15070819. This article has 5 citations.
(pennazio2023smallbowelcapsuleendoscopy pages 4-5): Marco Pennazio, Emanuele Rondonotti, Edward J. Despott, Xavier Dray, Martin Keuchel, Tom Moreels, David S. Sanders, Cristiano Spada, Cristina Carretero, Pablo Cortegoso Valdivia, Luca Elli, Lorenzo Fuccio, Begona Gonzalez Suarez, Anastasios Koulaouzidis, Lumir Kunovsky, Deirdre McNamara, Helmut Neumann, Enrique Perez-Cuadrado-Martinez, Enrique Perez-Cuadrado-Robles, Stefania Piccirelli, Bruno Rosa, Jean-Christophe Saurin, Reena Sidhu, Ilja Tacheci, Erasmia Vlachou, and Konstantinos Triantafyllou. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: european society of gastrointestinal endoscopy (esge) guideline – update 2022. Endoscopy, 55:58-95, Nov 2023. URL: https://doi.org/10.1055/a-1973-3796, doi:10.1055/a-1973-3796. This article has 391 citations and is from a domain leading peer-reviewed journal.
(borsotti2025hereditarycolorectalcancer pages 4-5): Edoardo Borsotti, Francesca Laura Nava, Felice Benedicenti, Laura Cini, Andrea Magarotto, Davide Ferrari, Paolo Cantù, Marco Vitellaro, Emanuele Rausa, and Federica Cavalcoli. Hereditary colorectal cancer syndromes: small bowel cancer risk and endoscopic surveillance strategies. Diagnostics, 15:819, Mar 2025. URL: https://doi.org/10.3390/diagnostics15070819, doi:10.3390/diagnostics15070819. This article has 5 citations.
(borsotti2025hereditarycolorectalcancer pages 22-24): Edoardo Borsotti, Francesca Laura Nava, Felice Benedicenti, Laura Cini, Andrea Magarotto, Davide Ferrari, Paolo Cantù, Marco Vitellaro, Emanuele Rausa, and Federica Cavalcoli. Hereditary colorectal cancer syndromes: small bowel cancer risk and endoscopic surveillance strategies. Diagnostics, 15:819, Mar 2025. URL: https://doi.org/10.3390/diagnostics15070819, doi:10.3390/diagnostics15070819. This article has 5 citations.
(strosberg2024sequencingofsomatostatinreceptor–based pages 4-5): Jonathan R. Strosberg, Taymeyah Al-Toubah, Ghassan El-Haddad, Diane Reidy Lagunes, and Lisa Bodei. Sequencing of somatostatin-receptor–based therapies in neuroendocrine tumor patients. The Journal of Nuclear Medicine, 65:340-348, Jan 2024. URL: https://doi.org/10.2967/jnumed.123.265706, doi:10.2967/jnumed.123.265706. This article has 27 citations.
(serrano20232023geisguidelines pages 10-11): César Serrano, Javier Martín-Broto, José Manuel Asencio-Pascual, José Antonio López-Guerrero, Jordi Rubió-Casadevall, Silvia Bagué, Xavier García-del-Muro, Juan Ángel Fernández-Hernández, Luís Herrero, Antonio López-Pousa, Andrés Poveda, and Virginia Martínez-Marín. 2023 geis guidelines for gastrointestinal stromal tumors. Therapeutic Advances in Medical Oncology, Jan 2023. URL: https://doi.org/10.1177/17588359231192388, doi:10.1177/17588359231192388. This article has 156 citations and is from a peer-reviewed journal.
(wang2026targetedtherapyfor pages 1-2): Xiao-Dong Wang, Chun-Hui Shou, Sheng-Chuan Chen, Yan-Yun Hong, Kan-Kai Zhu, Wei-Li Yang, and Ji-Ren Yu. Targeted therapy for advanced gastrointestinal stromal tumors: evolution and future directions. Drug Design, Development and Therapy, Volume 20:1-23, Mar 2026. URL: https://doi.org/10.2147/dddt.s594043, doi:10.2147/dddt.s594043. This article has 1 citations.