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Risk of second primary malignancies and causes of death in patients with adenocarcinoma and carcinoid of the small intestine
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
2008 (English)In: European Journal of Cancer, ISSN 0959-8049, Vol. 44, no 5, 718-25 p.Article in journal (Refereed) Published
Abstract [en]

We studied risk of second malignancies and causes of death in 1829 cases of adenocarcinoma and 3055 cases of carcinoid tumours in the small bowel reported to the Swedish Cancer Registry from 1960 through to 2000. Data on causes of death were analysed as from 1966 whereas data on second tumours was available during the whole registry-period. Follow-up was available until 2001.

Standard mortality ratio (SMR) and standard incidence ratio (SIR) were calculated.

Female patients with adenocarcinoma had increased risk of acquiring cancer in the female genital organs (SIR 3.2; 95% confidence intervals (CI) 1.9–5.0) and breasts (SIR 2.7; 95% CI 1.1–5.4). Both sexes combined had increased risk of second tumours in the gastrointestinal tract (SIR 1.5; 95% CI 1.1–2.1) and skin (SIR 4.6; 95% CI 1.2–12). Men with carcinoid tumour had increased risk of prostate cancer (SIR 2.8; 95% CI 1.6–4.6). Increased risk was seen for both sexes with carcinoid for malignant melanoma (SIR 6.3; 95% CI 2.7–12), malignant skin tumours (SIR 3.6; 95% CI 1.7–6.7) and malignancies of endocrine organs (SIR 2.3 95% CI 1.3–3.8). Patients with adenocarcinoma had increased risk of dying from malignant diseases other than the primary cancer (SMR 9.5; 95% CI 8.6–10) and gastrointestinal disease (SMR 2.6 95% CI 1.6–4.2). The cohort with carcinoid had higher than expected risk of dying from malignant disease (SMR 4.3; 95% CI 4.0–4.6), gastrointestinal disease (SMR 2.8; 95% CI 2.1–3.6) and cardiovascular disease (SMR 1.1; 95% CI 1.0–1.3).

The increased risk of second malignant tumours is an indication of common aetiology, or possibly, a general vulnerability to malignant disease for these patients. A detailed analysis of causes of death in a population-based cohort of small intestinal malignancies has not been presented before in the literature.

Place, publisher, year, edition, pages
2008. Vol. 44, no 5, 718-25 p.
Keyword [en]
Adenocarcinoma, Carcinoid, Small intestine, Standardised incidence ratio, Standardised mortality ratio
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-97256DOI: 10.1016/j.ejca.2007.12.003ISI: 000255225200019PubMedID: 18207733OAI: oai:DiVA.org:uu-97256DiVA: diva2:172114
Available from: 2008-05-09 Created: 2008-05-09 Last updated: 2010-02-23Bibliographically approved
In thesis
1. Epidemiological Studies of Small Intestinal Tumours
Open this publication in new window or tab >>Epidemiological Studies of Small Intestinal Tumours
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Malignant tumours of the small intestine are rare. Age-standardised incidence in Europe is between 0.5-1.5 per 100 000. As the small intestine represents more than 90 % of the gastrointestinal mucosal surface, it is surprising that it gives rise to less than 2 % of gastrointestinal malignancies. The dominating histological subtypes are carcinoids and adenocarcinomas.

We used three population-based registries in Sweden to study survival, second malignant tumours, causes of death, and Crohn’s disease as a risk factor for small intestinal adenocarcinoma and carcinoid.

We evaluated tumour site, sex, age, and year of diagnosis as prognostic factors. For adenocarcinomas there was no difference in survival between duodenal and jejunal/ileal tumours. Women with jejunal/ileal adenocarcinomas showed higher probabilities of survival than men, while no such relation was found for duodenal tumours. Old age correlated with poor survival for duodenal tumours, and prognosis has improved in later years. For carcinoids, duodenal tumours had a more favourable prognosis than jejunal/ileal tumours. There was no difference in survival between sexes. Old age correlated with poor survival, and survival has improved in recent years.

Female patients with adenocarcinoma had increased risk of acquiring cancer in the genital organs and breasts, and both sexes had increased risks of second tumours in the gastrointestinal tract and skin. Men with carcinoid tumours had increased risk of prostate cancer. Both sexes had increased risk of malignant melanoma and malignancies of endocrine organs.

Patients with adenocarcinoma had increased risk of dying from malignant diseases other than the primary small intestinal cancer and from gastrointestinal disease. The cohort with carcinoid had higher than expected risk of dying from malignant disease, gastrointestinal disease, and cardiovascular disease.

Patients with Crohn’s disease had increased risk of small intestinal adenocarcinoma and carcinoid, and the risk has increased for patients diagnosed in recent years.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 104 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 357
Keyword
Surgery, small intestine, adenocarcinoma, carcinoid, epidemiology, survival, second malignancies, causes of death, Crohn's disease, Kirurgi
Identifiers
urn:nbn:se:uu:diva-8842 (URN)
Public defence
2008-05-31, Enghoffsalen, bv ing 50, Akademiska sjukhuset,, Uppsala, 09:15
Opponent
Supervisors
Available from: 2008-05-09 Created: 2008-05-09Bibliographically approved

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