Surgery is usually the first-line therapeutic modality for small bowel malignancy. A localized neoplasm is resected widely to ensure that resection margins are free of tumor. In the case of adenocarcinoma, surgery is the only possibility for cure; recurrences are more likely if the cancer has penetrated the serosa and invaded regional lymph nodes. Chemotherapy and radiation therapy can provide temporary palliation in a few patients with unresectable disease.
Radiation therapy and chemotherapy are important modalities for small bowel lymphomas as primary treatment and as adjuvant therapy after surgical resection. Perforation of the gastrointestinal tract caused by rapid lysis of lymphomatous areas has been described after radiation therapy or chemotherapy. Thus surgical resection with curative intent is widely held as preferable. Involvement of local lymph nodes is generally an indication for postoperative irradiation or chemotherapy. In widespread, unresectable disease, chemotherapy is indicated. Leiomyosarcomas are best treated with surgery. They are radioresistant, and chemotherapy has been largely ineffective.
Author: Charles J. Lightdale
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