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Upper Gastrointestinal (lips to ileocecal valve, including esophagus and stomach)

E468: Small bowel cancers: a population-based analysis of epidemiology, treatment and outcomes in Ontario, Canada from 2005-2020

Introduction: Small bowel cancers are uncommon malignancies comprised of several histologies with variable treatments and prognoses. The current study describes the epidemiology, treatment, and outcomes of a large, population-based cohort of patients with small bowel cancers.

Methods: We performed a retrospective cohort study using linked administrative healthcare data from Ontario, Canada. Patients diagnosed with a small bowel cancer between 2005-2020 were included. Trends in incidence, treatments, and survival were explored by histology (adenocarcinoma, neuroendocrine tumors (NET), gastrointestinal stromal tumors (GIST), and lymphoma).

Results:

A total of 5306 patients with small bowel cancers were identified. The most common histologies were NET (40.5%) and adenocarcinoma (31.6%). From 2005 to 2020, the annual incidence of small bowel cancers increased from 1.54 to 2.78 per 100 000. Over the study period, the likelihoods of receiving surgery and systemic therapy within one year of diagnosis both increased for all histologic subtypes except lymphoma. Cancer stage data is missing for 66% of the cohort. Median overall survival from diagnosis was 1.0 year for adenocarcinoma, 13.2 years for NET, 14.2 years for GIST, and 10.1 years for lymphoma. There was no trend towards improved median survival for adenocarcinoma by year of diagnosis; 0.94 years (2005-2010), 1.07 years (2011-2015), and 0.98 years (2016-2020).

Conclusions:

Small bowel cancers are increasing in incidence, with increasing use of surgery and systemic therapies. While survival is favourable for many small bowel cancers, it remains poor for adenocarcinoma. Better availability of cancer stage data within the database would facilitate future research. 

Learning Objectives:

  • list the most commonly diagnosed malignancies of the small bowel.
  • describe the trends in incidence between the various histologies of small bowel cancer.
  • describe the trends in the treatments of small bowel cancers.