GI - Small Bowel Neoplasms And Carcinoid Tumours Flashcards

1
Q

SB neoplasms: benign tumours

  • proportion?
  • Name them
A
  • 35% of small bowel neoplasms are benign
  • Can affect any element of the small bowel
  • Lipoma, leiomyoma, neurofibromas, haemangioma, andenomatous polyps (FAP, Petunia-Jeghers)
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2
Q

SB neoplasms: malignant

-name them

A
  • 65% of SB neoplasms are malignant but only form 2% of GI malignancies (ie SB neoplasms are very rare)
  • Adenocarcinoma (40% of malignant tumours)
  • Carcinoid (40%)
  • Lymphoma (especially associated with coeliac disease)
  • GIST
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3
Q

SB neoplasms: presentation

A
  • often non-specific symptoms so present late
  • Nausea and vomiting/obstruction
  • Wt loss (unintentional) and abdo pain
  • anaemia
  • jaundice (from biliary obstruction or liver mets)
  • change in bowel habits
  • bloating
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4
Q

SB neoplasms: imaging and other Ix

A
  • AXR: SBO
  • Ba follow through
  • CT
  • Endoscopy
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5
Q

Carcinoid tumours: pathology- embryonic origins

A
  • Diverse group of neuro-endocrine tumours of enterochromaffin cell origin caparable of producing 5HT
  • May be derived from: (a) foregut (resp tract), (b) midgut (duodenum, ileum and appendix, (c) hindgut (colorectum)
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6
Q

Carcinoid tumours: pathology - what can they secrete?

A
  • 5HT, VIP, gastric, glucagon, insulin, ACTH

* hindgut tumours rarely secrete 5HT

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7
Q

What is carcinoid syndrome associated with?

A
  • Carcinoid syndrome suggests bypass of first-pass metabolism and is strongly associated with metastatic disease
  • Sites: appendix (45%), ileum (30%), colorectum (20%), stomach (10%)
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8
Q

Carcinoid tumours: presentation - local

A
  • Appendicitis
  • intussusception or obstruction
  • abdominal pain
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9
Q

Carcinoid tumours: presentation - carcinoid syndrome (5HT)

A
  • Need mets for this to happen
  • Flushing: paroxysmal,, upper body +- wheals
  • intestinal: diarrhoea
  • valve fibrosis: tricuspid regurgitate and pulmonary stenosis
  • hepatic involvement: bypassed 1st pass metabolism

-Wheeze: bronchoconstriction

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10
Q

Carcinoid tumours: Ix

A
  • Increased 5-HIAA in urine
  • Increased plasma chromogranin A
  • CT/MRI: find primary
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11
Q

Carcinoid tumours: treatment/Rx

A
  • Symptom relief: loperamide

- Curative: resection, give octreotide to avoid carcinoid crisis

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12
Q

Carcinoid tumours: Rx for carcinoid crisis

A
  • tumour outgrows blood supply or is handled too much —> leads to massive mediator release
  • vasodilation, hypotension, bronchoconstriction, hyperglycaemia
  • Rx: high-dose octreotide
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13
Q

Carcinoid tumours: prognosis

A

-median survival is 5-8 years (3 years if mets present)

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