Colorectal cancer (CRC) ranks third worldwide in terms of morbidity and second in mortality. In Romania, CRC represents the second leading cause of malignancy, accounting for 13.3% of all diagnosed cancers and associated with a five-year survival rate close to 50%. Despite the availability of effective CRC screening programs proven to reduce incidence and mortality, low participation rates contribute to a high occurrence of advanced disease complications. As a result, bowel obstruction develops in approximately 25% of colorectal cancer cases, significantly worsening patient outcomes. This review aims to highlight the role of screening in reducing the incidence of such complications and to assess the outcomes associated with surgical management of malignant bowel obstruction. A comprehensive review of current literature was conducted, focusing on the incidence, clinical presentation, and management of intestinal obstructions in CRC patients. Emphasis was placed on studies evaluating screening programs, risk factors, and surgical interventions. Data indicate a continuous rise in emergency presentations due to obstructive CRC, correlating with low screening uptake. Early detection through organized screening significantly lowers the risk of obstruction and improves outcomes. Enhanced screening programs and early identification of high-risk individuals are crucial in preventing advanced CRC complications. Timely diagnosis not only reduces emergency surgical interventions but also improves prognosis and overall survival rates.
Neuroendocrine tumors (NETs) are a group of rare malignancies characterized by heterogeneous clinical and biological presentations. Their estimated annual incidence ranges from 3 to 6 cases per million inhabitants, with a notable rise in prevalence due to improved diagnostic capabilities and medical awareness. Gastrointestinal NETs predominantly affect the small intestine (~45%), followed by the rectum, appendix, colon, and stomach. Despite advancements in imaging modalities such as CT, MRI, and somatostatin receptor-based PET-CT scans, the diagnosis of small intestinal NETs remains challenging due to nonspecific symptoms, frequently leading to delayed recognition until advanced disease stages. Surgical resection with comprehensive lymphadenectomy remains the cornerstone of curative management for localized disease, offering improved survival outcomes when R0 resection is achieved. Nevertheless, recurrence rates remain high, underscoring the critical importance of postoperative surveillance. This review provides a comprehensive synthesis of recent literature regarding the epidemiology, clinical manifestations, diagnostic methods— including imaging and immunohistochemical markers—and therapeutic approaches, particularly emphasizing surgical management strategies. A clinical case example is integrated into the review to illustrate the real-world complexity and challenges in the diagnosis, treatment, and follow-up of patients with small intestinal NETs.
