Small Intestine Cancer

MONDO:0000956 Pathograph 7 Show in embeddings browser intestinal cancer digestive system neoplasm

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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6
Pathophys.
8
Phenotypes
7
Pathograph
8
Genes
5
Medical Actions
4
Subtypes
1
Differentials
1
Deep Research

Subtypes

4
Small Bowel Adenocarcinoma (SBA) MONDO:0003198
APC hgnc:583 HUGO Gene Nomenclature Committee (hgnc) Relation: this subtype is caused by variation in this gene This subtype is caused by variation in APC (hgnc:583). hgnc:583 is a gene from the HUGO Gene Nomenclature Committee. KRAS hgnc:6407 HUGO Gene Nomenclature Committee (hgnc) Relation: this subtype is caused by variation in this gene This subtype is caused by variation in KRAS (hgnc:6407). hgnc:6407 is a gene from the HUGO Gene Nomenclature Committee. TP53 hgnc:11998 HUGO Gene Nomenclature Committee (hgnc) Relation: this subtype is caused by variation in this gene This subtype is caused by variation in TP53 (hgnc:11998). hgnc:11998 is a gene from the HUGO Gene Nomenclature Committee. SMAD4 hgnc:6770 HUGO Gene Nomenclature Committee (hgnc) Relation: this subtype is caused by variation in this gene This subtype is caused by variation in SMAD4 (hgnc:6770). hgnc:6770 is a gene from the HUGO Gene Nomenclature Committee. ERBB2 hgnc:3430 HUGO Gene Nomenclature Committee (hgnc) Relation: this subtype is caused by variation in this gene This subtype is caused by variation in ERBB2 (hgnc:3430). hgnc:3430 is a gene from the HUGO Gene Nomenclature Committee.
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.
Show evidence (3 references)
PMID:35565398 SUPPORT Human Clinical
"Adenocarcinomas of the small intestine are rare tumors but their incidence is increasing."
Establishes small bowel adenocarcinoma as a rare but rising malignancy.
PMID:35565398 SUPPORT Human Clinical
"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)"
Supports the strong association of SBA with chronic inflammation and hereditary predisposition syndromes.
PMID:38141930 SUPPORT Human Clinical
"SBA had a distinct mutation spectrum from left- and right-sided colorectal carcinoma"
Supports that SBA shares but is distinct from colorectal cancer molecular biology.
Small Bowel Neuroendocrine Tumor (Carcinoid) MONDO:0002995
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.
Show evidence (1 reference)
PMID:40553474 SUPPORT Human Clinical
"within GEP NENs, small bowel (1.4 per 100 000 persons) and pancreas (1.3 per 100 000 persons)"
SEER-based epidemiology showing the small bowel as a leading site of gastroenteropancreatic neuroendocrine neoplasms.
Small Intestinal Lymphoma MONDO:0001852
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.
Show evidence (2 references)
PMID:25639480 SUPPORT Human Clinical
"A large variety of lymphoma types may develop as primary intestinal neoplasms in the small intestines"
Supports primary lymphoma as a small intestinal malignancy category.
PMID:25639480 SUPPORT Human Clinical
"enteropathy-associated T-cell lymphoma or immunoproliferative small intestinal disease that, essentially, do not arise elsewhere than in the gastrointestinal tract"
Supports EATL and IPSID as small-intestine-specific lymphoma entities, including the celiac-associated EATL noted in the subtype description.
Small Bowel Sarcoma MONDO:0003360
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.
Show evidence (1 reference)
PMID:39199671 SUPPORT Human Clinical
"Adenocarcinoma represents the most prevalent of these neoplasms, followed by neuroendocrine tumors and sarcomas"
Ranks sarcoma among the small-bowel cancer histologies (after adenocarcinoma and neuroendocrine tumors).

Pathophysiology

6
Chronic Mucosal Inflammation and Dysplasia
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.
epithelial cell of small intestine CL:0002254 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves epithelial cell of small intestine (CL:0002254). CL:0002254 is a cell type from the Cell Ontology.
Show evidence (1 reference)
PMID:39199671 SUPPORT Human Clinical
"the inflammation-dysplasia-adenocarcinoma sequence"
Supports the chronic-inflammation route from mucosal inflammation through dysplasia to adenocarcinoma in Crohn-associated small bowel cancer.
Adenoma-Carcinoma Sequence and Wnt-APC Activation
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.
epithelial cell of small intestine CL:0002254 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves epithelial cell of small intestine (CL:0002254). CL:0002254 is a cell type from the Cell Ontology.
canonical Wnt signaling pathway GO:0060070 Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves increased canonical Wnt signaling pathway (GO:0060070). GO:0060070 is a biological process from the Gene Ontology. ↑ INCREASED
Show evidence (1 reference)
PMID:38141930 SUPPORT Human Clinical
"SBA had a distinct mutation spectrum from left- and right-sided colorectal carcinoma"
Supports that the small bowel adenoma-carcinoma driver spectrum overlaps with but is distinct from colorectal cancer.
Mismatch Repair Deficiency and Microsatellite Instability
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.
epithelial cell of small intestine CL:0002254 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves epithelial cell of small intestine (CL:0002254). CL:0002254 is a cell type from the Cell Ontology.
mismatch repair GO:0006298 Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves decreased mismatch repair (GO:0006298). GO:0006298 is a biological process from the Gene Ontology. ↓ DECREASED
Show evidence (1 reference)
PMID:40218169 SUPPORT Human Clinical
"LS patients have an increased SBC risk, warranting tailored endoscopic approaches"
Supports Lynch syndrome (mismatch repair deficiency) as a driver of increased small bowel cancer risk.
Enterochromaffin Cell Neoplasia and Serotonin Hypersecretion
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).
enteroendocrine cell of small intestine CL:0009006 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves enteroendocrine cell of small intestine (CL:0009006). CL:0009006 is a cell type from the Cell Ontology.
serotonin secretion GO:0001820 Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves increased serotonin secretion (GO:0001820). GO:0001820 is a biological process from the Gene Ontology. ↑ INCREASED
Show evidence (1 reference)
PMID:37954063 SUPPORT Human Clinical
"We confirmed a previously observed loss of chromosome 18 and CDKN1B"
Supports the characteristic chromosome 18 loss and CDKN1B involvement in small intestinal carcinoid (neuroendocrine tumor) pathogenesis.
Carcinoid Syndrome
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).
Show evidence (1 reference)
PMID:39594786 SUPPORT Human Clinical
"including flushing, diarrhea, bronchospasm, and carcinoid heart disease"
Supports the carcinoid-syndrome clinical manifestations (flushing, diarrhea, bronchospasm, carcinoid heart disease) arising downstream of serotonin-secreting metastatic small-bowel neuroendocrine tumor.
Invasion and Late-Stage Presentation
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.
epithelial to mesenchymal transition GO:0001837 Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves increased epithelial to mesenchymal transition (GO:0001837). GO:0001837 is a biological process from the Gene Ontology. ↑ INCREASED
Show evidence (1 reference)
PMID:40218169 SUPPORT Human Clinical
"Due to the low incidence and non-specific presentation of SBC, effective surveillance strategies are essential for early detection and management."
Supports the clinically silent, non-specific presentation of small bowel cancer that underlies its characteristically late-stage detection.

Pathograph

Use the checkboxes to hide or show graph categories. Hover nodes for evidence and cross-linked metadata.
Pathograph: causal mechanism network for Small Intestine Cancer Interactive directed graph showing how pathophysiology mechanisms, phenotypes, genetic factors and variants, experimental models, environmental triggers, and treatments relate through causal and linked edges.

Phenotypes

8
Blood 2
Gastrointestinal hemorrhage HP:0002239 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Gastrointestinal hemorrhage (HP:0002239). HP:0002239 is a phenotype from the Human Phenotype Ontology.
Iron deficiency anemia HP:0001891 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Iron deficiency anemia (HP:0001891). HP:0001891 is a phenotype from the Human Phenotype Ontology.
Digestive 2
Intestinal obstruction HP:0005214 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Intestinal obstruction (HP:0005214). HP:0005214 is a phenotype from the Human Phenotype Ontology.
Diarrhea HP:0002014 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Diarrhea (HP:0002014). HP:0002014 is a phenotype from the Human Phenotype Ontology.
Integument 1
Flushing HP:0031284 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Flushing (HP:0031284). HP:0031284 is a phenotype from the Human Phenotype Ontology.
Constitutional 1
Abdominal pain HP:0002027 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Abdominal pain (HP:0002027). HP:0002027 is a phenotype from the Human Phenotype Ontology.
Growth 1
Weight loss HP:0001824 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Weight loss (HP:0001824). HP:0001824 is a phenotype from the Human Phenotype Ontology.
Other 1
Small intestinal neoplasm Neoplasm of the small intestine HP:0100833 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Neoplasm of the small intestine (HP:0100833). HP:0100833 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:35565398 SUPPORT Human Clinical
"The most frequent primary location is the duodenum."
Supports the duodenum as the most common small-bowel adenocarcinoma primary site.
🧬

Genetic Associations

8
Lynch syndrome (mismatch repair)
Gene: MLH1 hgnc:7127 HUGO Gene Nomenclature Committee (hgnc) Relation: this disease-associated gene is this gene This disease-associated gene is MLH1 (hgnc:7127). hgnc:7127 is a gene from the HUGO Gene Nomenclature Committee. relationship_type: RISK_FACTOR
Show evidence (1 reference)
PMID:40218169 SUPPORT Human Clinical
"LS patients have an increased SBC risk, warranting tailored endoscopic approaches"
Supports Lynch syndrome as a germline predisposition raising small bowel cancer risk.
MSH2
Gene: MSH2 hgnc:7325 HUGO Gene Nomenclature Committee (hgnc) Relation: this disease-associated gene is this gene This disease-associated gene is MSH2 (hgnc:7325). hgnc:7325 is a gene from the HUGO Gene Nomenclature Committee. relationship_type: RISK_FACTOR
MSH6
Gene: MSH6 hgnc:7329 HUGO Gene Nomenclature Committee (hgnc) Relation: this disease-associated gene is this gene This disease-associated gene is MSH6 (hgnc:7329). hgnc:7329 is a gene from the HUGO Gene Nomenclature Committee. relationship_type: RISK_FACTOR
PMS2
Gene: PMS2 hgnc:9122 HUGO Gene Nomenclature Committee (hgnc) Relation: this disease-associated gene is this gene This disease-associated gene is PMS2 (hgnc:9122). hgnc:9122 is a gene from the HUGO Gene Nomenclature Committee. relationship_type: RISK_FACTOR
EPCAM
Gene: EPCAM hgnc:11529 HUGO Gene Nomenclature Committee (hgnc) Relation: this disease-associated gene is this gene This disease-associated gene is EPCAM (hgnc:11529). hgnc:11529 is a gene from the HUGO Gene Nomenclature Committee. relationship_type: RISK_FACTOR
APC (familial adenomatous polyposis)
Gene: APC hgnc:583 HUGO Gene Nomenclature Committee (hgnc) Relation: this disease-associated gene is this gene This disease-associated gene is APC (hgnc:583). hgnc:583 is a gene from the HUGO Gene Nomenclature Committee. relationship_type: RISK_FACTOR
Show evidence (1 reference)
PMID:40218169 SUPPORT Human Clinical
"In FAP, duodenal surveillance follows the Spigelman classification to stratify cancer risk"
Supports elevated duodenal/small bowel cancer risk in familial adenomatous polyposis, motivating Spigelman-based surveillance.
STK11 (Peutz-Jeghers syndrome)
Gene: STK11 hgnc:11389 HUGO Gene Nomenclature Committee (hgnc) Relation: this disease-associated gene is this gene This disease-associated gene is STK11 (hgnc:11389). hgnc:11389 is a gene from the HUGO Gene Nomenclature Committee. relationship_type: RISK_FACTOR
MUTYH (MUTYH-associated polyposis)
Gene: MUTYH hgnc:7527 HUGO Gene Nomenclature Committee (hgnc) Relation: this disease-associated gene is this gene This disease-associated gene is MUTYH (hgnc:7527). hgnc:7527 is a gene from the HUGO Gene Nomenclature Committee. relationship_type: RISK_FACTOR
Show evidence (1 reference)
PMID:41214301 SUPPORT Human Clinical
"lifetime risks of duodenal polyposis of 17%–34%, duodenal cancer of 4%–5%"
Supports the elevated duodenal (small bowel) adenoma and cancer risk in MUTYH-associated polyposis.
💊

Medical Actions

5
Surgical resection
Action: surgical procedureNCI Thesaurus (NCIT) Relation: this treatment is this clinical intervention This treatment is surgical procedure (NCIT:C15329). NCIT:C15329 is a clinical intervention from the NCI Thesaurus. Ontology label: Surgical Procedure NCIT:C15329
Segmental small-bowel resection with lymphadenectomy (or pancreaticoduodenectomy for duodenal/periampullary tumors) is the mainstay of curative therapy for localized adenocarcinoma and neuroendocrine tumors.
Show evidence (1 reference)
PMID:39411312 SUPPORT Human Clinical
"surgery remains the primary option for most cases"
Supports surgical resection as the primary curative modality for small-bowel neuroendocrine (and localized epithelial) tumors.
Fluoropyrimidine-based chemotherapy
Action: chemotherapyNCI Thesaurus (NCIT) Relation: this treatment is this clinical intervention This treatment is chemotherapy (NCIT:C15632). NCIT:C15632 is a clinical intervention from the NCI Thesaurus. Ontology label: Chemotherapy NCIT:C15632
Agent: 5-fluorouracil CHEBI:46345 Chemical Entities of Biological Interest (CHEBI) Relation: this treatment uses this therapeutic agent This treatment uses 5-fluorouracil (CHEBI:46345). CHEBI:46345 is a therapeutic agent from Chemical Entities of Biological Interest. oxaliplatin CHEBI:31941 Chemical Entities of Biological Interest (CHEBI) Relation: this treatment uses this therapeutic agent This treatment uses oxaliplatin (CHEBI:31941). CHEBI:31941 is a therapeutic agent from Chemical Entities of Biological Interest.
Systemic fluoropyrimidine plus oxaliplatin (e.g., FOLFOX/CAPOX) is the standard chemotherapy backbone for advanced small bowel adenocarcinoma, extrapolated from colorectal cancer.
Somatostatin analog therapy
Action: PharmacotherapyNCI Thesaurus (NCIT) Relation: this treatment is this clinical intervention This treatment is Pharmacotherapy (NCIT:C15986). NCIT:C15986 is a clinical intervention from the NCI Thesaurus. NCIT:C15986
Agent: octreotide CHEBI:7726 Chemical Entities of Biological Interest (CHEBI) Relation: this treatment uses this therapeutic agent This treatment uses octreotide (CHEBI:7726). CHEBI:7726 is a therapeutic agent from Chemical Entities of Biological Interest. lanreotide CHEBI:135901 Chemical Entities of Biological Interest (CHEBI) Relation: this treatment uses this therapeutic agent This treatment uses lanreotide (CHEBI:135901). CHEBI:135901 is a therapeutic agent from Chemical Entities of Biological Interest.
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.
Peptide receptor radionuclide therapy (PRRT)
Action: peptide receptor radionuclide therapyNCI Thesaurus (NCIT) Relation: this treatment is this clinical intervention This treatment is peptide receptor radionuclide therapy, annotated with Radiation Therapy (NCIT:C15313). NCIT:C15313 is a clinical intervention from the NCI Thesaurus. Ontology label: Radiation Therapy NCIT:C15313
Agent: Lutetium Lu 177 dotatate NCIT:C95020 NCI Thesaurus (NCIT) Relation: this treatment uses this therapeutic agent This treatment uses Lutetium Lu 177 dotatate (NCIT:C95020). NCIT:C95020 is a therapeutic agent from the NCI Thesaurus.
177Lu-DOTATATE peptide receptor radionuclide therapy delivers targeted radiation to somatostatin-receptor-expressing metastatic/progressive small-bowel (midgut) neuroendocrine tumors.
Show evidence (1 reference)
PMID:39411312 SUPPORT Human Clinical
"Peptide receptor radionuclide therapy (PRRT) is an effective treatment"
Supports PRRT as an effective therapy for gastroenteropancreatic (including small-bowel) neuroendocrine neoplasms.
Immune checkpoint blockade (dMMR/MSI-H)
Action: PharmacotherapyNCI Thesaurus (NCIT) Relation: this treatment is this clinical intervention This treatment is Pharmacotherapy (NCIT:C15986). NCIT:C15986 is a clinical intervention from the NCI Thesaurus. NCIT:C15986
Agent: pembrolizumab NCIT:C106432 NCI Thesaurus (NCIT) Relation: this treatment uses this therapeutic agent This treatment uses pembrolizumab (NCIT:C106432). NCIT:C106432 is a therapeutic agent from the NCI Thesaurus.
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.
Mechanism Target:
MODULATES Mismatch Repair Deficiency and Microsatellite Instability — The hypermutated, neoantigen-rich MSI-H/dMMR genotype confers immunogenicity that anti-PD-1 blockade exploits; efficacy is contingent on this mechanism.
Show evidence (1 reference)
PMID:31682550 SUPPORT Human Clinical
"harbor hundreds to thousands of somatic mutations that encode potential neoantigens"
Establishes the neoantigen-rich MSI-H/dMMR biology underlying checkpoint-blockade sensitivity.
Show evidence (1 reference)
PMID:31682550 SUPPORT Human Clinical
"has antitumor activity against MSI-H/dMMR cancer"
KEYNOTE-158 established pembrolizumab activity across noncolorectal MSI-H/dMMR cancers, which include small bowel adenocarcinoma.
🔬

Biochemical Markers

2
Chromogranin A
Serotonin / urinary 5-HIAA
📊

Prevalence

2
Worldwide
Point Prevalence Rare
Small intestinal malignancies are rare overall, accounting for only a few percent of gastrointestinal cancers despite the small bowel's large mucosal surface area.
Show evidence (1 reference)
PMID:35565398 SUPPORT Human Clinical
"Adenocarcinomas of the small intestine are rare tumors but their incidence is increasing."
Documents the rarity (and rising incidence) of small bowel adenocarcinoma.
United States (SEER, small bowel neuroendocrine tumors)
Annual Incidence 1.4 per 100,000 1–9 per 100,000 per year
SEER-based incidence of small-bowel neuroendocrine neoplasms (~1.4 per 100,000), a leading gastroenteropancreatic NET primary site.
Show evidence (1 reference)
PMID:40553474 SUPPORT Human Clinical
"within GEP NENs, small bowel (1.4 per 100 000 persons) and pancreas (1.3 per 100 000 persons)"
SEER incidence estimate for small-bowel neuroendocrine neoplasms.
🔀

Differential Diagnoses

1

Conditions with similar clinical presentations that must be differentiated from Small Intestine Cancer:

Overlapping Features 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.
{ }

Source YAML

click to show
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: []
📚

References & Deep Research

Deep Research

1
Falcon
1. Disease Information
Edison Scientific Literature 26 citations 2026-07-15T10:45:23.691538

1. Disease Information

1.1 Overview and current definition

“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).

1.2 Anatomic distribution

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).

1.3 Synonyms and alternative names

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)

1.4 Key identifiers (ICD/MeSH/OMIM/Orphanet/MONDO)

  • Not available from the retrieved full-text evidence in this run. The literature sources accessed here primarily address clinical guidance, epidemiology, and treatment, and did not provide ontology identifiers (borsotti2025hereditarycolorectalcancer pages 1-2, pennazio2023smallbowelcapsuleendoscopy pages 8-9, serrano20232023geisguidelines pages 1-3).

1.5 Evidence source type

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).


2. Etiology

2.1 Disease causal factors and upstream causes

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).

2.2 Risk factors

2.2.1 Genetic risk factors (high-confidence)

  • Lynch syndrome (LS/HNPCC) is caused by germline pathogenic variants in mismatch repair genes MLH1, MSH2, MSH6, PMS2, or EPCAM deletions (autosomal dominant) (borsotti2025hereditarycolorectalcancer pages 12-14). A recent review reports lifetime small bowel cancer risk in LS as 0.4–12% overall, and provides gene-stratified cumulative incidence estimates by age 75 (notably higher for MLH1 and MSH2) (borsotti2025hereditarycolorectalcancer pages 12-14).
  • Familial adenomatous polyposis (FAP) is caused by germline pathogenic variants in APC; the syndrome features near-universal colorectal cancer risk and is also a basis for duodenal/small bowel surveillance via Spigelman staging (macfarland2024pediatriccancerscreening pages 4-4, borsotti2025hereditarycolorectalcancer pages 12-14).
  • Peutz–Jeghers syndrome (PJS) is a hereditary GI polyposis/cancer syndrome; pediatric guidance highlights early onset of GI manifestations and recommends small bowel imaging surveillance beginning in childhood (macfarland2024pediatriccancerscreening pages 5-6).
  • Constitutional mismatch repair deficiency (CMMRD) (biallelic MMR defects; autosomal recessive) is associated with 10–16% small bowel cancer prevalence in a cited review and requires intensive early surveillance (borsotti2025hereditarycolorectalcancer pages 19-21).
  • MUTYH-associated polyposis (MAP) warrants proximal small bowel/duodenal surveillance because duodenal cancer risk is described as comparable to FAP (borsotti2025hereditarycolorectalcancer pages 19-21).

2.2.2 Environmental/lifestyle risk factors

  • Not specifically extractable for SBC from the retrieved evidence in this run (gap). The sources obtained focused on hereditary syndromes, diagnostic workup, and histology-specific therapeutics.

2.3 Protective factors

  • Not specifically extractable for SBC from the retrieved evidence in this run (gap).

2.4 Gene–environment interactions

  • Not specifically extractable for SBC from the retrieved evidence in this run (gap).

3. Phenotypes (clinical presentation)

3.1 Common clinical presentations

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).

3.2 Phenotype ontology (HPO) suggestions (not exhaustive)

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).

3.3 Quality of life impact

  • Not directly quantified in the retrieved SBC-focused evidence; however, chronic bleeding/IDA implies fatigue, reduced functional capacity, and healthcare utilization (inference; not directly cited).

4. Genetic / Molecular Information

4.1 Causal genes (germline predisposition)

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)

4.2 Key somatic drivers and biomarkers by subtype

4.2.1 GIST (small intestine stromal tumor)

  • GISTs are typically driven by KIT or PDGFRA gain-of-function mutations (serrano20232023geisguidelines pages 1-1).
  • A guideline summary indicates >95% of GISTs express KIT (CD117) by immunohistochemistry; additional markers include CD34, actin, S-100, and desmin (serrano20232023geisguidelines pages 1-3).
  • Molecular classes include KIT/PDGFRA-mutant vs wild-type, with WT subdivided into SDH-deficient vs SDH-competent (serrano20232023geisguidelines pages 1-3).

4.2.2 Small intestinal neuroendocrine tumor (SiNET)

  • SiNETs are commonly somatostatin receptor (SSTR)–positive, especially SSTR2 and SSTR5; a 2024 review notes that “most well-differentiated NETs express high levels of somatostatin receptors, particularly subtypes 2 and 5” (strosberg2024sequencingofsomatostatinreceptor–based pages 1-2). A separate review notes >70% of NET tumor cells overexpress SSTR types 2 and 5 (tan2024gastroenteropancreaticneuroendocrineneoplasms pages 8-9).

4.2.3 Small bowel adenocarcinoma (SBA)

  • SBA-specific somatic alteration frequencies were not retrieved in the accessible evidence for this run (gap). The registry-based SBA prognostic model indicates survival is often hampered by late diagnosis but does not detail genomic drivers (borsotti2025hereditarycolorectalcancer pages 1-2).

5. Mechanism / Pathophysiology

5.1 Mechanistic causal chains (subtype-oriented)

  • GIST: activating KIT/PDGFRA signaling drives oncogenesis; downstream effects include sustained proliferation and survival consistent with receptor tyrosine kinase activation pathways (serrano20232023geisguidelines pages 1-1).
  • SiNET: expression of SSTR2/SSTR5 provides a mechanistic basis for symptom control (hormone secretion) and tumor growth control with somatostatin analogs, and for targeted radionuclide delivery via PRRT (tan2024gastroenteropancreaticneuroendocrineneoplasms pages 8-9, strosberg2024sequencingofsomatostatinreceptor–based pages 1-2).

5.2 Ontology suggestions

GO biological process (examples)

  • Receptor tyrosine kinase signaling pathway (GO:0007169) (GIST driver context) (serrano20232023geisguidelines pages 1-1)
  • Cell proliferation (GO:0008283)
  • Neuropeptide hormone signaling pathway (GO:0007218) (NET functional biology; mechanistic mapping supported indirectly via SSTR emphasis) (strosberg2024sequencingofsomatostatinreceptor–based pages 1-2)

CL cell types (examples)

  • Interstitial cell of Cajal (GIST cell-of-origin concept; not directly cited in retrieved evidence—flag as gap)
  • Enteroendocrine cell / neuroendocrine cell (SiNET; not directly cited in retrieved evidence—flag as gap)

6. Epidemiology (recent statistics)

6.1 Overall frequency

SBC is described as accounting for ~2.3% of all digestive cancers in the general population (borsotti2025hereditarycolorectalcancer pages 1-2).

6.2 Neuroendocrine neoplasms of the small intestine (US SEER)

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).

6.3 Small intestine GIST (US SEER)

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).

6.4 Survival (selected recent estimates)

  • Small intestine NETs: localized disease median OS reported as 15.3 years, distant-stage median OS 8.2 years in one SEER-based analysis (dasari2025epidemiologyofneuroendocrine pages 5-7). Another SEER-based summary reports 10-year overall survival of 51.7% for small bowel NET primary site (dasari2025epidemiologyofneuroendocrine pages 1-2).

7. Diagnostics

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.


8. Treatment (current applications and real-world implementations)

8.1 Surgery

  • For SiNET, small intestine resection with lymph node removal is recommended; ESMO guidance supports surgery even for locally advanced disease because of risks such as obstruction/ischemia from mesenteric masses (tan2024gastroenteropancreaticneuroendocrineneoplasms pages 8-9).

8.2 Somatostatin analogs (SSAs) and PRRT for SiNET

  • SSAs (octreotide LAR, lanreotide) are described as first-line for SSTR-positive, well-differentiated metastatic gastroenteropancreatic NETs, with low toxicity and tumor growth control (strosberg2024sequencingofsomatostatinreceptor–based pages 4-5).
  • PRRT (e.g., 177Lu-DOTATATE) is a core real-world theranostic modality for progressive midgut NETs and improves progression-free survival in this population, with ongoing work on sequencing vs other systemic therapies (strosberg2024sequencingofsomatostatinreceptor–based pages 1-2).

8.3 Targeted therapy for GIST (approved agents and mutation-informed selection)

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).

MAXO (Medical Action Ontology) suggestions (examples)

  • Surgical resection (MAXO:0000001; placeholder—exact MAXO ID not retrieved)
  • Endoscopic biopsy / endoscopic polypectomy
  • Somatostatin analog therapy
  • Peptide receptor radionuclide therapy
  • Tyrosine kinase inhibitor therapy

9. Prevention

9.1 High-risk surveillance as secondary prevention

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.


10. Other Species / Natural Disease

Not retrieved for small intestine cancer specifically in this run (gap).


11. Model Organisms

Not retrieved for small intestine cancer specifically in this run (gap).


12. Recent developments and latest research (emphasis 2023–2024)

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).


13. Expert opinion and analysis (authoritative sources)

  • ESGE guideline perspective (2023 Endoscopy): emphasizes that small-bowel tumors are rare and often discovered in workups for bleeding/IDA, and that diagnostic certainty should drive escalation from capsule endoscopy to device-assisted enteroscopy and staging imaging (pennazio2023smallbowelcapsuleendoscopy pages 8-9, pennazio2023smallbowelcapsuleendoscopy pages 21-21).
  • GEIS guideline perspective (2023 Therapeutic Advances in Medical Oncology): positions GIST as a paradigmatic success of molecularly targeted therapy, explicitly noting that KIT/PDGFRA mutations underpin disease initiation/evolution and that multiple TKIs have transformed outcomes (serrano20232023geisguidelines pages 1-1).
  • Nuclear medicine/NET therapy perspective (2024 Journal of Nuclear Medicine): stresses SSTR expression as the biological basis for first-line SSA use and PRRT, while noting that randomized head-to-head sequencing evidence remains limited (strosberg2024sequencingofsomatostatinreceptor–based pages 4-5, strosberg2024sequencingofsomatostatinreceptor–based pages 1-2).

Limitations of this report (evidence gaps)

  1. Ontology identifiers (MONDO, MeSH, Orphanet, ICD) were not obtainable from the retrieved full texts in this tool run.
  2. Small bowel adenocarcinoma (SBA) molecular landscape (somatic driver frequencies, MSI status rates, actionable alterations) was not captured in the accessible evidence.
  3. Environmental/lifestyle risk factors, protective factors, animal models, and disease-specific QoL statistics were not retrieved from the current evidence set.
  4. Image extraction via the available tooling failed for multiple candidate documents; therefore no figure/table image citations are provided.

Summary tables

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

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  2. (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.

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  5. (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.

  6. (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.

  7. (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.

  8. (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.

  9. (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.

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  11. (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.

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  15. (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.

  16. (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.

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  20. (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.

  21. (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.

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