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