SMALL BOWEL TUMORS

Question 1

Overview

Answer 1

Slightly more common in males + average age of presentation in 6th decade

Question 2

Presentation (6)

Answer 2

Abdominal pain, anorexia, anemia, diarrhea, constipation, LGIB

Question 3

Adenocarcinoma- Overview (2)

Answer 3

1- Most common in the duodenum (D2)- 50% of small bowel malignancies
2- Increased incidence in Celiac disease and Crohn’s

Question 4

Adenocarcinoma- Symptoms (4)

Answer 4

• Symptoms are non-specific abdominal pain, weight loss, gastric/intestinal obstruction in the absence of hernia/prior abdominal surgery
• Bleeding and anemia may also be noted but massive bleeding is rare (tumor ulcerates —> melena and hematochezia)
• Lesions in the periampullary region present with painless jaundice and unexplained pancreatitis
• Endoscopic screening of the periampullary region may allow earlier diagnosis in patients with genetic polyposis syndrome and associated known risk

Question 5

Adenocarcinoma- Diagnosis (3)

Answer 5

• Endoscopy and Biopsy
• CT for metastasis

Question 6

Adenocarcinoma- Treatment

Answer 6

Wide resection of the involved bowel with margins to facilitate the removal of associated lymphatic drainage pathways

Question 7

Lymphomas- Overview (3)

Answer 7

• Rare (15%, mainly non-Hodgkin’s)
• Most common location is the ileum (lymphoid tissue in Peyer’s patches)
• Most common in the fifth and sixth decades

Question 8

Lymphomas- Symptoms

Answer 8

• Non-specific symptoms: vague abdominal pain, weight loss, fatigue, malaise
• 25% of patients present as abdominal emergencies e.g. perforation, hemorrhage, obstruction, and intussuspection

Question 9

Lymphomas- Diagnosis (2)

Answer 9

1- Nodularity and thickening of the bowel wall on contrast studies and CT
2- CT scan also shows associated mesenteric adenopathy

Question 10

Treatment

Answer 10

By surgical resection with subsequent chemotherapy and/or radiation