Study results enables prediction of survival for small bowel cancer for the first time

An innovative UK study is helping cancer specialists for the first time to predict survival of people with cancer of the small intestine (bowel), and understand how best to treat them.

In the largest study of its kind ever conducted, between 2000-2013 researchers from six UK hospitals* looked at the long and short-term survival of patients following surgical removal of part of the intestine - the only chance of a cure.

The findings will have implications for future surgery, helping medics to understand why some people respond to surgical treatment, while others do not.

Symptoms of duodenal cancer include intense abdominal pain, weight loss as food cannot get to where it is meant to, nausea, vomiting, and chronic gastrointestinal bleeding.

The study was led by Professor Hemant Kocher, Professor of Liver and Pancreas Surgery at Barts Health NHS Trust and Barts Cancer Institute, Queen Mary University of London. Specialists from six UK hospitals came together to pool information and clinical experience about the disease; The Royal London Hospital, Glasgow Royal Infirmary, Royal Free Hospital (London), Churchill Hospital (Oxford), University Hospital Southampton and Leicester General Hospital.

Little is known about duodenal cancer (cancer of the small intestine or bowel), a rare disease affecting just 0.2-0.5 people per 100,000 population in England. It is a difficult cancer to diagnose, and the number of people affected is increasing. Most patients are unfortunately diagnosed at advanced stage.

During the study, a curative resection (operation) was performed in 150 (84.3 per cent) of the 178 patients included in the study.

Of those who underwent the procedure, 80.8 per cent of people were free of the disease one year on, with 56.5 per cent remaining clear three years later.

Unlike in previous studies about duodenal cancer, this research found that cancer in lymph nodes is crucial to predicting survival. Lymphovascular invasion was a significant factor, with people living for three times longer when their lymph nodes were not affected**.

The study also showed that all types of surgery extended the life of people as long as enough lymph nodes were removed from the affected area - regardless of whether they had only part of their small intestine removed or had a larger operation that also involved removing part of their pancreas.

Doctors will now create a tissue repository to determine molecular markers for the rare disease and help doctors to identify those most at risk, as well as the most effective treatment for them. They are also calling for all patients to be treated in specialist centres to access the most appropriate care, and also provide health professionals with the opportunity to design further clinical trials to increase their understanding of how the disease progresses.

Professor Kocher explained: "This is an exciting time for advancements in a rare cancer with a high death rate. This new information will enable medics across the UK and the world to more accurately predict the course of duodenal cancer and determine which type of surgery to perform, which is vital to giving people the most beneficial treatment and improving their chance of survival.

"Due to the rarity of duodenal cancer we simply do not know enough about it, and too many people each year are dying. This study provides a clue to how the disease most commonly travels through the body, which is key to our knowing how to beat it."

Ajit Abraham, Consultant HPB Surgeon and Group Director for Surgery and Cancer, Barts Health NHS Trust said: "This important study improves on our understanding of forecasting and survival predication for patients with duodenal cancer, and points a way towards developing future clinical trials."

Mohammed Abu Hilal, a consultant hepatobiliary surgeon at Southampton General Hospital, added: "I am glad that by working together we could analyse a large common database to offer stronger and statistically more sound results.

"I am sure this work will be of great importance for clinicians in their understanding and decision-making when dealing with this type of cancer but more collaborative studies are needed, especially for rare cancers such as duodenal, pancreatic and liver."