Small Bowel Cancer: Scoping Out a Rarity (+genetics eg Lynch Syndrome)

medscape


Medscape: What predisposing factors are associated with an increased risk for small bowel adenocarcinoma? 
 
Michael J. Overman, MD: There are three big factors. The first is hereditary nonpolyposis colorectal cancer (HNPCC), or Lynch syndrome, which predisposes not only to colorectal cancer but also to a number of other cancers, including small bowel adenocarcinoma.....

 Dr Overman: Screening poses several issues, given the rarity of the cancer and the challenges of imaging the small bowel. At present there are no cancer guidelines that recommend screening for small bowel adenocarcinoma. The screening modality would likely be a capsule endoscopy or enteroscopy, but these are invasive procedures for such a rare disease. For the general population, we don't have a screening test that is appropriate. For people with increased risk—the three categories I mentioned—we don't have good data, again because of the rarity of the disease. There are some data supporting screening in patients with Lynch syndrome, utilizing capsule endoscopy,^[3] but screening this population is not recommended in current guidelines. The frequency of screening is also uncertain.