Tumours of the Small Bowel

Question 1

Primary tumours of the SI are rare. True or False?

Answer 1

True

-Mets from ovaries, colon and stomach are common

Question 2

Where do secondary SI tumours usually come from?

Answer 2

Ovaries
Colon
Stomach

Question 3

3 Types of primary tumour in SI?

Answer 3

Lymphomas
Carcinoid tumours
Adenocarcinoma

Question 4

Lymphoma class?

Answer 4

In the SI= NON-HODGKINS

Question 5

Types of Lymphoma?

Answer 5

B cell:
-Maltomas: distal and terminal ileum
T cell:
-Enteropathy associated T cell lymphomas
-Ulcerated plaques found in the proximal ileum primarily

Question 6

What are T cell lymphomas associated with?

Answer 6

Coeliac disease

Question 7

Who gets T cell type lyphomas?

Answer 7

Coeliac disease

Question 8

Who gets B cell type lymphoma?

Answer 8

Immunoproliferative small intestinal disease

Question 9

How does lymphoma present?

Answer 9

Abdo pain 
Diarrhoea 
Anorexia 
Wt loss 
Anaemia symptoms

Question 10

How is lymphoma diagnosed?

Answer 10

-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)

Question 11

How is lymphoma treated?

Answer 11

Surgery and radiotherapy

Chemotherapy (more extensive)

Question 12

Which type of lymphoma has a better prognosis?

Answer 12

B cell lymphoma

Question 13

How common is a carcinoid tumour?

Answer 13

RARE

Question 14

Most common site for carcinoid tumour?

Answer 14

Appendix

2= terminal ileum

Question 15

Describe carcinoid tumour?

Answer 15

Small
Slow growing
Yellow tumours

Question 16

Where do carcinoid tumours originate?

Answer 16

Enterochromaffin cells of intestine

Question 17

How does carcinoid tumour present?

Answer 17

Acute appendicitis
Abdo pain
Recurrent watery diarrhoea
Cardiac abnormalities (PS or tricuspid incompetance)

Question 18

How is carcinoid tumour diagnosed?

Answer 18

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

Question 19

How are carcinoid tumours treated?

Answer 19

If in appendix surgical resection performed
Octreotide/lanreotide: somatostatin analogues which inhibit gut hormone release, alleviate flushing/diarrhoea
Interferon/chemo: reduce tumour growth

Question 20

What can carcinoid tumour cause?

Answer 20

Intussusception & obstruction 
If liver mets occur = liver enlargement 
Carcinoid syndrome (5% of patients)

Question 21

Prognosis of carcinoid tumour?

Answer 21

Most live 5-10 years after diagnosis

Question 22

How does carcinoid spread?

Answer 22

Locally invasive

Question 23

Carcinoid syndrome?

Answer 23

When there are liver mets it causes flushing and diarrhoea

Question 24

Adenocarcinoma of SI is rare. True or False?

Answer 24

True

Rare carcinoma

Question 25

Where is adenocarcinoma of SI mainly found?

Answer 25

Duodenum

Question 26

Who gets adenocarcinoma of SI?

Answer 26

Associated with Crohn’s and coeliac

Question 27

How does adenocarcinoma SI present?

Answer 27

Late: identical to colorectal carcinoma in appearance
Abdo pain 
Diarrhoea 
Anorexia/ wt loss 
Anaemia

Question 28

How is adenocarcinoma SI diagnosed?

Answer 28

• US & MRI if palpable mass
• Endoscopic biopsy- histology- best if lesion within reach
• Wireless capsule endoscopy used where obstruction by capsule isn’t likely

Question 29

How is adenocarcinoma SI treated?

Answer 29

Surgery– segmental resection with radio/chemotherapy

Question 30

Where do adenocarcinoma SI mets go to?

Answer 30

Liver

Lymph nodes

Question 31

5 Year survival rate of SI adenocarcinoma?

Answer 31

20-35%