Small intestine tumors

Question 1

Small intestine primary tumors are very ___ consisting __% of all GI tumors.

Answer 1

rare

5

Question 2

The most common small intestine tumors are: (4) ACLS

Answer 2

adenocarcinoma
carcinoid
lymphoma
sarcoma

Question 3

The most common clinical symptom of small intestine tumors is ___

Answer 3

abdominal pain

Question 4

Name 5 risk factors

Answer 4

Crohn's 
FAP
HNPCC
Peutz Jeghers syndrome
Celiac

Question 5

Carcinoid= ___

Answer 5

neuroendocrine tumor (NET)

Question 6

NET originates from ___ cells

Answer 6

Kulchitsky cells

Question 7

NET is most common in:

1. ___ (38%)
2. ___ (29%)
3. ___ (13%)
4. ___ (12%)
5. ___ (5%)

Answer 7

appendix
distal ileum
colon
stomach
rectum

Question 8

NET are ___ mural, developing in the ___ mucosa

Answer 8

intra

sub

Question 9

NET are commonly cause ___ due to ____ fibrosis

Answer 9

SBO

mesenteric

Question 10

The median age for NET is ___, but it can occur at any age.

Answer 10

63

Question 11

NET can be differentiated to __ grades, based on their mitotic rate.

Answer 11

3

Question 12

What is the most important thing to notice when characterizing NET?

Answer 12

well VS poor differentiated

Question 13

In NET, G_ and _ are considered ___ differentiated, while G_ is __ differentiated

Answer 13

1
2
well
3
poorly

Question 14

The most prognostic factor in NET is the tumor’s ___, followed by ___, which reflects the ___

Answer 14

location
size
metastasis

Question 15

Foregut NET tumors can be found in the ___ and ___. Low production of __ and rarely metastasis. Can be cured with full ___

Answer 15

lungs
thymus
serotonin
resection

Question 16

Midgut (small bowel) NET, produce ___ levels of serotonin, and considered vicious tumors with ___ penetration and fast ___.

Answer 16

high
deep
metastasis

Question 17

Hindgut (___) NET, ___ produce serotonin, but can produce other hormones (___)

Answer 17

rectum
rarely
somatostatin

Question 18

___% of NET are ___ and are an accidental finding during surgery

Answer 18

80

asymptomatic

Question 19

NET size and risk for metastasis:
< 1 cm- ___%
1-2 cm- ___%
>2 cm- ___%

Answer 19

2
50
80-90

Question 20

Typically, NET is a submucosal with __ color and regional ___ reaction in the mesentery. It is ___ in its manner.

Answer 20

yellowish
desmoplastic
insidious

Question 21

When finding NET we must perform ___ and rule out other NET or ___

Answer 21

colonoscopy

AC (CRC)

Question 22

Clinical presentation of NET may include: ___ syndrome. Other symptoms: ___ pain, bowel ___ - due to desmoplastic reaction in the mesentery, or ____

Answer 22

carcinoid
abdominal
obstruction
interception

Question 23

Carcinoid syndrome is very rare (__%), and is the result of ___ substances.

Answer 23

10

vasoactive

Question 24

Which MEN is most linked to to NET?

Answer 24

1

Question 25

Describe the clinical symptoms of carcinoid syndrome: - ___ (80%) - ___ (76%) - ___ (71%) - ___ (90%) - ___ (47%)

Answer 25

``` heat waves/flushing diarrhea hepatomegaly PS HTN drop ```

Question 26

Which amino acid is lacking in NET? Why?

Answer 26

tryptophan | hyperproduction of serotonin which is made from it

Question 27

Treating carcinoid syndrome:

Answer 27

IV octreotide, hydrocortisone, IV antihistamine

Question 28

Carcinoid syndrome may present with ___ attacks during flushing

Answer 28

asthma

Question 29

Diagnosing NET is made with combination of:

Answer 29

24 h urine collection for chromogranin A and NT-Pro BNP in the blood

Question 30

Treating NET is made with both ___ and ___ surgery

Answer 30

octreotide | debulking

Question 31

What is the most common small bowel primary tumor (50%)?

Answer 31

adenocarcinoma

Question 32

We usually find adenocarcinoma in the small bowel in the ___ and proximal ___

Answer 32

duodenum | jejunum

Question 33

Treating AC in the small bowel usually involves ___ resection of the primary tumor, and ___ resection. We also include ___ treatment as optional de-staging

Answer 33

wedge mesentery neoadjuvant

Question 34

If the AC is in the duodenum in the 1,3,4 parts- ___

Answer 34

simple segment resection

Question 35

If the AC is in the duodenum in the 2 parts- ___

Answer 35

Whipple surgery

Question 36

What is the most common small bowel cancer in children under the age of 10?

Answer 36

lymphoma

Question 37

_ cell ___ is the most common and most difficult to treat small bowel cancer. It is also more resistant to ___ and tends to ___

Answer 37

T lymphoma chemotherapy relapse

Question 38

Why lymphoma is usually found in the ilium?

Answer 38

It is most concentrated with MALT

Question 39

Risk factors for lymphoma are: (3)

Answer 39

immunosuppression celiac IBD

Question 40

Small bowel lymphoma tumors tend to be >__ cm. 25% of cases result in small bowel ___

Answer 40

5 | perforation

Question 41

Asymptomatic small bowel lymphoma should be treated with ___ and ___ only!

Answer 41

chemo | radiation

Question 42

Symptomatic small bowel lymphoma should be treated with a combination of ___, ___, and ___

Answer 42

chemo radiation surgery

Question 43

GIST tumors originate from the ___ cells and are found mostly in the ___

Answer 43

Cajal | ileum jejunum

Question 44

GIST may lead to: (3)

Answer 44

bleeding obstruction perforation

Question 45

If possible, GIST should be treated with ___, if not than with ___

Answer 45

surgery | Gleevec (Imatinib) = TKI

Question 46

What is the most common small bowel tumor?

Answer 46

metastasis from other organs

Question 47

Name 3 organs which typically metastases to the small bowel:

Answer 47

cervix ovary kidney

Question 48

Name the most common extra abdominal site from which tumor metastasize to the small bowel

Answer 48

skin- melanoma

Question 49

Peutz Jeghers syndrome is ___, characterized by numerus hamartomatous ___ in the small bowel and ____

Answer 49

AD polyps hyperpigmentation

Question 50

Which area tend to be hyperpigmented in Peutz Jeghers syndrome? (4)

Answer 50

face (buccal) feet palms perianal