Tumours of the Small Bowel Flashcards
Primary tumours of the SI are rare. True or False?
True
-Mets from ovaries, colon and stomach are common
Where do secondary SI tumours usually come from?
Ovaries
Colon
Stomach
3 Types of primary tumour in SI?
Lymphomas
Carcinoid tumours
Adenocarcinoma
Lymphoma class?
In the SI= NON-HODGKINS
Types of Lymphoma?
B cell:
-Maltomas: distal and terminal ileum
T cell:
-Enteropathy associated T cell lymphomas
-Ulcerated plaques found in the proximal ileum primarily
What are T cell lymphomas associated with?
Coeliac disease
Who gets T cell type lyphomas?
Coeliac disease
Who gets B cell type lymphoma?
Immunoproliferative small intestinal disease
How does lymphoma present?
Abdo pain Diarrhoea Anorexia Wt loss Anaemia symptoms
How is lymphoma diagnosed?
-US and MRI if there is a palpable mass
-Endoscopic biopsy- histology (best if lesion within reach)
-US/CT: show wall thickening & lymph node involvement
Wireless capsule endoscopy (when obstruction by capsule is unlikely)
How is lymphoma treated?
Surgery and radiotherapy
Chemotherapy (more extensive)
Which type of lymphoma has a better prognosis?
B cell lymphoma
How common is a carcinoid tumour?
RARE
Most common site for carcinoid tumour?
Appendix
2= terminal ileum
Describe carcinoid tumour?
Small
Slow growing
Yellow tumours
Where do carcinoid tumours originate?
Enterochromaffin cells of intestine
How does carcinoid tumour present?
Acute appendicitis
Abdo pain
Recurrent watery diarrhoea
Cardiac abnormalities (PS or tricuspid incompetance)
How is carcinoid tumour diagnosed?
US- confirms presence of liver mets
Urine: conc of 5-Hydroxyindoleacetic qcid (5-HIAA), major metabolite of 5HT
Serum Chromogranin A: raised in nearly all hindgut tumours and 80-90% of symptomatic foregut/midgut tumours
How are carcinoid tumours treated?
If in appendix surgical resection performed
Octreotide/lanreotide: somatostatin analogues which inhibit gut hormone release, alleviate flushing/diarrhoea
Interferon/chemo: reduce tumour growth
What can carcinoid tumour cause?
Intussusception & obstruction If liver mets occur = liver enlargement Carcinoid syndrome (5% of patients)
Prognosis of carcinoid tumour?
Most live 5-10 years after diagnosis
How does carcinoid spread?
Locally invasive
Carcinoid syndrome?
When there are liver mets it causes flushing and diarrhoea
Adenocarcinoma of SI is rare. True or False?
True
Rare carcinoma
Where is adenocarcinoma of SI mainly found?
Duodenum
Who gets adenocarcinoma of SI?
Associated with Crohn’s and coeliac
How does adenocarcinoma SI present?
Late: identical to colorectal carcinoma in appearance Abdo pain Diarrhoea Anorexia/ wt loss Anaemia
How is adenocarcinoma SI diagnosed?
- US & MRI if palpable mass
- Endoscopic biopsy- histology- best if lesion within reach
- Wireless capsule endoscopy used where obstruction by capsule isn’t likely
How is adenocarcinoma SI treated?
Surgery– segmental resection with radio/chemotherapy
Where do adenocarcinoma SI mets go to?
Liver
Lymph nodes
5 Year survival rate of SI adenocarcinoma?
20-35%
