Small Bowel

Question 1

What is the most common appendiceal tumor?

Answer 1

Carcinoid

Question 2

What percentage of appendiceal tumors is comprised of carcinoid tumors?

Answer 2

2/3

Question 3

What is the surgical treatment for appendiceal carcinoid tumors?

Answer 3

If 2 cm, right hemicolectomy
If in the small intestine, resect tumor with mesenteric lymph nodes
Resect any solitary liver metastasis considered resectable

Question 4

What is the medical treatment for cacinoid tumors?

Answer 4

Serotonin antagonists (e.g. cyproheptadine) or somatostatin analoges (e.g. octreotide) for symptomatic relief.

Question 5

What cardiac condition can carcionoid syndrome lead to?

Answer 5

Tricuspid stenosis.

Question 6

What percentage of primary small bowel maligancies are composed of carcinoid tumors?

Answer 6

40%

Question 7

What are the signs and symptoms of carcinoid tumors?

Answer 7

Often asymptomatic. Most common symptom is abdominal pain. May also cause obstruction, rectal bleeding, pain, and weight loss. Carcinoid syndrome presents in 10% of cases.

Question 8

What is the most common sight for development of carcinoid tumors of the small bowel?

Answer 8

The ileum

Question 9

Define carcinoid tumors.

Answer 9

Malignant tumor of enterochromaffin cell origin. They are part of the APUD (amine precursor uptake and decarboxylation) system.

Question 10

What are the peak ages of presentation with carcinoid tumors?

Answer 10

50-70

Question 11

What are the most common locations of carcinoid neoplasms?

Answer 11

46% in appendix (3% metastasize), 28% in ileum (35% metastasize), and 17% in rectum

Question 12

What percent of carcinoid tumors present as multiple lesions?

Answer 12

30-40%

Question 13

What are the biochemical mediators of carcinoid syndrome?

Answer 13

Serotonin, bradykinin, and tryptophan.

Question 14

What are the characteristics of carcinoid syndrome?

Answer 14

Cutaneous flushing, diarrhea, heart valve lesions (right>left), and bronchoconstriction

Question 15

At what point do carcinoid tumors cause carinoid syndrome?

Answer 15

Typically only after they have metastasized to the liver.

Question 16

How can you diagnose carcinoid tumors?

Answer 16

Most are found incidentally at the time of surgery. In carcinoid syndrome, increased 5-HIAA (hydroxyindolacetic acid) or 5-HTP (hydroxytryptophan) in 24 hour urine samples are diagnostic.

Question 17

What is the significant of increased 24 hour urinary 5-HTP in the workup of carcinoid syndrome?

Answer 17

Indicates bronchial location of the neoplasm.

Question 18

What is the 5 year survival for carcinoid tumors that underwent palliative resection?

Answer 18

25%

Question 19

What is the 5 year survival for carcinoid tumors that underwent curative resection?

Answer 19

75%