Small Bowel Tumours

Question 1

Are small bowel tumours common?

Answer 1

• no
• account for only 3-5% of all malignancies in the west

Question 2

What age are small bowel tumours most common?

1 - 1st decade
2 - 2nd and 3rd decades
3 - 5th and 6th decade
4 - >7th decade

Answer 2

3 - 5th and 6th decade

Question 3

There are a number of small bowel tumours, but which is most common?

1 - sarcoma (bone origin)
2 - adenocarcinoma
3 - neuroendocrine tumours (NETs)
4 - lymphomas

Answer 3

3 - neuroendocrine tumours (NETs)

• used to be adenocarcinomas

Question 4

Neuroendocrine tumours (NETs) are the most common type of small bowel cancers. Are these more common in men or women?

Answer 4

• women

Question 5

Do patients with small bowel tumours typically present with symptoms?

Answer 5

• no
• generally asymptomatic

Question 6

Patients with small bowel tumours do not typically present with symptoms. However, if they do present, it is typically an emergency presentation. Which of the following is NOT a common symptom?

1 - obstruction
2 - perforation
3 - intussusception
4 - GI bleeding
5 - incompetent ileocaecal valve

Answer 6

5 - incompetent ileocaecal valve

• patients can also present with weight loss

Question 7

If a patient has small bowel tumours pain can present. How does this typically present?

1 - focal epigastric pain
2 - intermittent and colicky
3 - right lumbar colicky
4 - umbilical focal pain

Answer 7

2 - intermittent and colicky

Question 8

In patients with Neuroendocrine tumours (NETs) there can be signs of metastatic disease. This is called carcinoid syndrome. What symptoms does this present with?

1 - increased serotonin levels
2 - facial flushing
3 - diarrhoea
4 - all of the above

Answer 8

4 - all of the above

• neuroendocrine tumours increase serotonin levels
• serotonin vasodilates blood vessel causing skin to appear red

Question 9

What is the primary method for diagnosing and staging small bowel tumours?

1 - ultrasound
2 - CT
3 - MRI
4 - FDG-PET/CT

Answer 9

2 - CT

• MRI good for smaller lesions

Question 10

When trying to identify if as patient has small bowel tumours, when can endoscopy be performed?

1 - when patient is stable
2 - patient must be <65 y/o
3 - when tumours are distal or proximal
4 - imaging quality is low

Answer 10

3 - when tumours are distal or proximal

• camera can not get to the jejunum

Question 11

If we suspect a patient has Neuroendocrine tumours (NETs), we can perform what type of scan?

1 - fluorodeoxyglucose-PET
2 - octreotide scan
3 - CT with contrast
4 - MRI with contrast

Answer 11

2 - octreotide scan

• octreotide is synthetic somatostatin and binds to neuroendocrine tumours

Question 12

If we suspect a patient has Neuroendocrine tumours (NETs), we can measure what in the blood?

1 - 5-Hydroxyindoleacetic acid (5-HIAA)
2 - CRP
3 - carcinoembryonic antigen
4 - chromogranin a

Answer 12

4 - chromogranin a

• secreted by neuroendocrine tumours

Question 13

If we suspect a patient has carcinoid syndrome, what would we measure in the urine?

1 - 5-Hydroxyindoleacetic acid (5-HIAA)
2 - CRP
3 - carcinoembryonic antigen
4 - chromogranin a

Answer 13

1 - 5-Hydroxyindoleacetic acid (5-HIAA)

• main metabolite in serotonin
• excreted via the kidneys

Question 14

If we suspect a patient has small intestinal tumours we can perform surgery which can include resection of the tumours. Is the prognosis good for this?

Answer 14

• yes
• if presentation is an emergency, then resection via emergency surgery may be performed

Question 15

If we suspect a patient has small intestinal tumours, when would we consider performing a whipple?

1 - when no other surgical option
2 - if tumours are in duodenum
3 - if small intestines is not curative
4 - if patient is jaundice

Answer 15

2 - if tumours are in duodenum

Question 16

Is prognosis good if the patient has metastatic disease?

Answer 16

• no
• especially Neuroendocrine tumours (NETs) as they have a long survival