A population-based study of the incidence of malignant small bowel tumours: SEER, 1973-1990.

BACKGROUND

Little is known about the incidence of cancers of the small bowel.

METHODS

Data from cancer registries participating in the Surveillance, Epidemiology, and End-Results (SEER) Program from 1973 to 1990 were analysed to determine the incidence of the four major histological types of cancer occurring in the small intestine: adenocarcinomas, malignant carcinoid tumours, lymphomas and sarcomas. In addition, the incidence rate of lymphomas arising from the small intestine and stomach and adenocarcinomas from the small intestine, stomach and colon were compared over time.

RESULTS

Small bowel tumours occurred rarely, with an average annual incidence rate of 9.9 per million people. Carcinoid tumours and adenocarcinomas were the most common histological subtypes, with average annual incidence rates of 3.8 and 3.7 per million people respectively, followed by lymphomas (1.1 per million people) and sarcomas (1.3 per million people). For all histological subtypes, men had higher rates than women. Most tumours occurred in older adults; over 90% of cases occurred in people over the age of 40. During the 18-year study period, the incidence of small bowel tumours has risen slowly. In white men, black men and black women, rises in the incidence of adenocarcinomas, malignant carcinoids and lymphomas contributed to this trend. In white women, the incidence of adenocarcinomas, was stable while malignant carcinoids and lymphomas rose. The incidence of sarcomas was steady for all groups except black women, for which it fell. The histological types were distributed by anatomical subsite: adenocarcinomas were distributed more proximally on average whereas lymphomas were more common distally. In addition, there was an association between the incidence trends of adenocarcinomas occurring in the duodenum and colon suggesting similar risk factors for cancers in these regions. There was no similar correlation for tumours in the jejunum and ileum. The incidence of lymphomas over time rose in all areas of the small intestine, paralleling a similar rise in lymphomas of the stomach.

CONCLUSIONS

Cancers of the small bowel are rare despite a slow increase over the past two decades, especially among lymphomas. Higher rates in males and whites deserve further investigation.