THE SMALL bowel has a high cellular turnover and one of the largest epithelial surfaces in the body; it is 6 meters (20 feet) long, with a huge surface area, numerous microvilli, columnar cells, goblet cells, argentaffin cells, and aggregations of lymphoid tissue in Peyer patches. Despite this cell activity and mitosis, fewer than 1,000 deaths annually result from small bowel tumors; in contrast, it is estimated that in 1973 alone, 37,000 persons died from colon and rectal cancer, 14,700 from stomach cancer, and 6,400 from esophageal cancer.1 The incongruity of a theoretically optimal setting for neoplastic formation and the surprisingly uncommon occurrence of small bowel tumors defies explanation.
Small-bowel tumors are seldom suspected in the patient whose symptoms may include intestinal obstruction, bleeding, palpable mass, or perforation. Usually, the process of diagnosis is one of exclusion; often, repeated gastrointestinal studies are required to identify a lesion. Since primary
Rubin P. Cancer of the Gastrointestinal Tract: E. Small Intestine: Diagnosis and Treatment: Introduction. JAMA. 1974;229(6):699. doi:10.1001/jama.1974.03230440057039
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