Small intestine tumors Flashcards
Small intestine primary tumors are very ___ consisting __% of all GI tumors.
rare
5
The most common small intestine tumors are: (4) ACLS
adenocarcinoma
carcinoid
lymphoma
sarcoma
The most common clinical symptom of small intestine tumors is ___
abdominal pain
Name 5 risk factors
Crohn's FAP HNPCC Peutz Jeghers syndrome Celiac
Carcinoid= ___
neuroendocrine tumor (NET)
NET originates from ___ cells
Kulchitsky cells
NET is most common in:
- ___ (38%)
- ___ (29%)
- ___ (13%)
- ___ (12%)
- ___ (5%)
appendix distal ileum colon stomach rectum
NET are ___ mural, developing in the ___ mucosa
intra
sub
NET are commonly cause ___ due to ____ fibrosis
SBO
mesenteric
The median age for NET is ___, but it can occur at any age.
63
NET can be differentiated to __ grades, based on their mitotic rate.
3
What is the most important thing to notice when characterizing NET?
well VS poor differentiated
In NET, G_ and _ are considered ___ differentiated, while G_ is __ differentiated
1 2 well 3 poorly
The most prognostic factor in NET is the tumor’s ___, followed by ___, which reflects the ___
location
size
metastasis
Foregut NET tumors can be found in the ___ and ___. Low production of __ and rarely metastasis. Can be cured with full ___
lungs
thymus
serotonin
resection
Midgut (small bowel) NET, produce ___ levels of serotonin, and considered vicious tumors with ___ penetration and fast ___.
high
deep
metastasis
Hindgut (___) NET, ___ produce serotonin, but can produce other hormones (___)
rectum
rarely
somatostatin
___% of NET are ___ and are an accidental finding during surgery
80
asymptomatic
NET size and risk for metastasis:
< 1 cm- ___%
1-2 cm- ___%
>2 cm- ___%
2
50
80-90
Typically, NET is a submucosal with __ color and regional ___ reaction in the mesentery. It is ___ in its manner.
yellowish
desmoplastic
insidious
When finding NET we must perform ___ and rule out other NET or ___
colonoscopy
AC (CRC)
Clinical presentation of NET may include: ___ syndrome. Other symptoms: ___ pain, bowel ___ - due to desmoplastic reaction in the mesentery, or ____
carcinoid
abdominal
obstruction
interception
Carcinoid syndrome is very rare (__%), and is the result of ___ substances.
10
vasoactive
Which MEN is most linked to to NET?
1
Describe the clinical symptoms of carcinoid syndrome:
- ___ (80%)
- ___ (76%)
- ___ (71%)
- ___ (90%)
- ___ (47%)
heat waves/flushing diarrhea hepatomegaly PS HTN drop
Which amino acid is lacking in NET? Why?
tryptophan
hyperproduction of serotonin which is made from it
Treating carcinoid syndrome:
IV octreotide, hydrocortisone, IV antihistamine
Carcinoid syndrome may present with ___ attacks during flushing
asthma
Diagnosing NET is made with combination of:
24 h urine collection for chromogranin A
and
NT-Pro BNP in the blood
Treating NET is made with both ___ and ___ surgery
octreotide
debulking
What is the most common small bowel primary tumor (50%)?
adenocarcinoma
We usually find adenocarcinoma in the small bowel in the ___ and proximal ___
duodenum
jejunum
Treating AC in the small bowel usually involves ___ resection of the primary tumor, and ___ resection. We also include ___ treatment as optional de-staging
wedge
mesentery
neoadjuvant
If the AC is in the duodenum in the 1,3,4 parts- ___
simple segment resection
If the AC is in the duodenum in the 2 parts- ___
Whipple surgery
What is the most common small bowel cancer in children under the age of 10?
lymphoma
_ cell ___ is the most common and most difficult to treat small bowel cancer. It is also more resistant to ___ and tends to ___
T
lymphoma
chemotherapy
relapse
Why lymphoma is usually found in the ilium?
It is most concentrated with MALT
Risk factors for lymphoma are: (3)
immunosuppression
celiac
IBD
Small bowel lymphoma tumors tend to be >__ cm. 25% of cases result in small bowel ___
5
perforation
Asymptomatic small bowel lymphoma should be treated with ___ and ___ only!
chemo
radiation
Symptomatic small bowel lymphoma should be treated with a combination of ___, ___, and ___
chemo
radiation
surgery
GIST tumors originate from the ___ cells and are found mostly in the ___
Cajal
ileum jejunum
GIST may lead to: (3)
bleeding
obstruction
perforation
If possible, GIST should be treated with ___, if not than with ___
surgery
Gleevec (Imatinib) = TKI
What is the most common small bowel tumor?
metastasis from other organs
Name 3 organs which typically metastases to the small bowel:
cervix
ovary
kidney
Name the most common extra abdominal site from which tumor metastasize to the small bowel
skin- melanoma
Peutz Jeghers syndrome is ___, characterized by numerus hamartomatous ___ in the small bowel and ____
AD
polyps
hyperpigmentation
Which area tend to be hyperpigmented in Peutz Jeghers syndrome? (4)
face (buccal)
feet
palms
perianal
