Secondary bowel tumours

The gastrointestinal tract is not infrequently involved by metastatic disease. The most common tumour metastasising to the gastrointestinal tract is melanoma, with 60% of patients who die of melanoma having autopsy evidence of metastatic disease involving the gastrointestinal tract. Other less common tumours involved are the cervix, lung, breast, ovaries kidney and thyroid. Symptoms of small bowel metastases most commonly include bleeding and obstruction and, less commonly, perforation. Obstructing metastatic lesions are rarely solitary. Surgical treatment of these patients with local small bowel invasion is almost always palliative, and will be either local resection or bypass.

The outcome in patients undergoing small bowel resection for metastases is very poor with only a few long-term survivors. There are reported good results in secondary melanoma to the small bowel. The mean survival in a study was reported at 31 months in patients who underwent complete resection, compared with 10 months in patients who underwent no curative procedures109 another reported a 28% 5-year survival rate in 12 patients with no other site of metastatic melanoma who underwent complete surgical resection (110). There are also some reports of prolonged survival in patients treated for GI metastases of breast carcinoma (111,112).

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