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The first 25 slides, exactly as they appear. The full deck has 109 content slides.
General Surgery
Tumors of the Small Intestine
Built from Maingot's Abdominal Operations
What’s inside
14 sections · 109 slides
Overview
- Scope of this topic
- Tumour types arising in the small intestine
Epidemiology
How rare these tumours are, and who gets them
- 75%
- Rarity of small bowel tumours
- Limits of the published evidence
- Age, sex and geographic pattern
Pathogenesis
Why cancer so rarely starts in the small bowel
- Absence of a defined progression sequence
- Protective features of the small bowel lumen
- Luminal protective mechanisms
- Cellular and immune protective mechanisms
- Bile acids and prior cholecystectomy
High-risk conditions
Inherited and inflammatory diseases that raise the risk
- Familial adenomatous polyposis
- Crohn's disease
- Celiac disease
- Peutz-Jeghers syndrome and von Recklinghausen's disease
- Chronic immunosuppression and post-transplant lymphoproliferative disorder
- HIV-associated gastrointestinal lymphoma
- Conditions that raise small bowel tumour risk
Clinical presentation
Vague symptoms and a long delay to diagnosis
- Presenting symptoms
- Causes of diagnostic delay
- Presentation of benign lesions
Diagnosis
Imaging, contrast studies, capsule and endoscopy
- Obstacles to diagnosis
- Initial tests
- Computed tomography findings
- Ileal adenocarcinoma on abdominal CT
- Intussusception as a presenting sign
- Ileocolic intussusception on CT
- Mechanism of tumour-led intussusception
- Management of adult intussusception
- Contrast radiography and enteroclysis
- Enteroscopy techniques
- Video capsule endoscopy
- Small bowel adenocarcinoma seen through the video capsule
- Limitations of video capsule endoscopy
- Nuclear medicine imaging and stage at presentation
Benign tumors
Adenomas, lipomas, hamartomas and hemangiomas
- Frequency and presentation of benign tumors
- Principles of resection for benign lesions
- Brunner gland adenoma
- Adenomas of the small bowel
- Detection of duodenal adenomas
- Duodenal filling defect from a benign adenoma
- Assessment and excision of duodenal adenomas
- Outcome after local excision of ampullary adenomas
- Lipomas
- Hamartomas in Peutz-Jeghers syndrome
- Hemangiomas
Malignant neoplasms
The four common cancers and how they behave as a group
- Range of malignant tumors
- Stage at presentation and second primary tumors
Adenocarcinoma
The commonest primary cancer of the small bowel
- Distribution and risk factors for adenocarcinoma
- Clinical presentation of adenocarcinoma
- Apple-core constricting adenocarcinoma of the proximal jejunum
- Diagnosis of adenocarcinoma
- Surgical management of adenocarcinoma
- Palliative options in advanced adenocarcinoma
- Staging of small bowel adenocarcinoma
- Prognostic factors and adjuvant therapy
Non-Hodgkin's lymphoma
The gut is the commonest site outside lymph nodes
- Distribution of gastrointestinal lymphoma
- Diagnostic criteria for primary gastrointestinal lymphoma
- Cell types and MALT lymphoma
- Presentation and diagnosis of small bowel lymphoma
- Bowel wall thickening of small bowel lymphoma on CT
- Tissue diagnosis and stage at presentation
- Stage groups used for gastrointestinal lymphoma
- Stage I and stage II disease
- Stage III and stage IV disease
- Treatment of gastrointestinal lymphoma
Carcinoid tumors
Hormone-producing tumors, desmoplasia and carcinoid syndrome
- Cell of origin and hormone production
- Anatomical distribution of carcinoid tumors
- Epidemiology of small bowel carcinoid
- Clinical presentation of carcinoid tumors
- Multiple tumors and desmoplastic reaction
- Tumor size and risk of metastatic spread
- Prognosis and extent of resection
- Carcinoid syndrome
- Why carcinoid syndrome requires metastatic disease
- Hepatic clearance and sites that bypass it
- Flushing, diarrhea and precipitating factors
- Carcinoid heart disease
- Surgical management of metastatic carcinoid
- Interventional and medical therapy for carcinoid syndrome
- Chemotherapy and targeted radiotherapy for carcinoid
- Radiolabeled somatostatin analogues
Gastrointestinal stromal tumors
From the pacemaker cell of the gut to targeted therapy
- Frequency and distribution of GIST
- Cell of origin and the kit mutation
- Molecular reclassification of mesenchymal tumors
- Clinical behaviour and growth pattern of GIST
- Computed tomography appearance of GIST
- Large gastric GIST invading the diaphragm and spleen on CT
- Assessment of malignant potential in GIST
- Determinants of GIST risk grade
- Surgical treatment of GIST
- Kit signalling and the action of imatinib
- Molecular basis of targeted therapy in GIST
- Clinical use of imatinib
- Resistance and second-line therapy
- Imatinib before and after surgery
Metastases to the small bowel
More common than primary tumors, and mostly palliative
- Routes of metastatic spread to the small bowel
- Imaging of small bowel metastases
- Palliative management of metastatic disease
- Palliative options by site of obstruction
Summary
What to carry away
- Key points on presentation and diagnosis
- Key points on tumour types
- Key points on treatment
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Maingot's Abdominal Operations, 12th Edition