Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

1356 Small Bowel Tumors

SMALL BOWEL TUMORS

ALVARO D. DAVILA, MD

history & physical

Risk Factors

■Small bowel tumors rare; account for 5–10% of GI tumors

■Risk from direct exposure to carcinogens:

➣Diet – high in animal fat, protein, red meat, smoked or cured

foods

■Risk from predisposing conditions:

➣Peutz-Jeghers syndrome (malignant degeneration of hamar-

tomatous polyps)

➣Gardner’s syndrome (duodenal adenomas)

➣Crohn’s disease (adenocarcinoma)

➣Familial adenomatous polyposis (adenoma)

➣Celiac disease (lymphoma, adenocarcinoma)

➣Immunodeficiency states (HIV – Kaposi’s sarcoma, lymphoma)

➣Autoimmune disorders (lymphoma)

Signs and Symptoms

■Often asymptomatic until late in the course

■No group of signs or symptoms specific for benign or malignant

tumors

■Most common presenting symptoms: intermittent obstructive GI

symptoms, intussusception, chronic occult bleeding, weight loss,

and abdominal pain

■Less common manifestations: perforation, acute hemorrhage, jaun-

dice, pancreatitis

■Advanced disease: jaundice, ascites, cachexia, hepatomegaly, carci-

noid syndrome (hepatic metastases)

■Physical exam usually benign; palpable abdominal mass (25%), signs

of obstruction (25%), positive fecal occult blood test

Types of Tumors by Pathology

■Benign neoplasms:

➣Adenomas: tubular, villous, or Brunner’s gland

➣Leiomyomas

➣Lipomas: mostly ileum/duodenum

➣Others: desmoid tumors, fibromas, lymphangiomas, heman-

giomas, neurofibromas