Small Intestine: Cancer

Benign Tumors

Adenoma

  • Most Common Benign Tumor of the Small Bowel
  • Most Common Site in the Small Intestine: Duodenum
  • Types:
    • Villous – Highest Risk for Malignancy
    • Tubular
    • Brunner’s Gland – Hyperplasia of Brunner’s Glands of the Duodenum Proximal to the Sphincter of Oddi which Secrete Alkaline Mucous
  • Upper GI Contrast-Swallow XR: “Soap Bubble” or “Paint Brush” Sign
  • Tx: Resection
    • Small (< 4 cm) & No Concern for Malignancy: Endoscopic Resection
    • Large (≥ 4 cm) or Concern for Malignancy: Surgical Resection

Leiomyoma

  • Well-Differentiated Smooth Muscle Tumor that Arises from the Submucosa
  • Description: Small, Firm, Gray-White & Well Circumscribed Masses
  • Tx:
    • ASx: Conservative
    • Sx (Bleeding/Obstruction) or Need to Rule Out Leiomyosarcoma: Resect

Lipoma

  • Second Most Common Benign Tumor of the Small Bowel
  • Arise from Submucosal or Serosal Adipose Tissue
  • Diagnostic Fatty Appearance on CT

Hamartomas

  • Associated with Peutz-Jeghers Syndrome
  • Tx:
    • ASx: Conservative
    • Sx (Bleeding/Obstruction): Resect

Hemangioma

  • Diagnostic Appearance on CT, No Bx Needed
  • Tx:
    • ASx: Conservative
    • Sx (Bleeding/Obstruction): Resect

Adenoma 1

Lipoma 1

Hamartoma 1

Malignant Tumors

Metastases

  • Most Common Small Bowel Tumor
  • Intra-Abdominal Source Most Common
  • Most Common Extra-Abdominal Source: Melanoma

Adenocarcinoma

  • Second Most Common Primary Small Bowel Tumor
  • Most Common Site: Duodenum
  • Present Late
    • One-Third Have Nodal Spread at Diagnosis
    • One-Fourth Have Distant Metastases at Diagnosis
  • TNM

Adenocarcinoma 2

  T N M
1 Lamina Propria or Submucosa 1-2 LN Mets
2 Muscularis Propria ≥ 3 LN
3 Subserosa
4 Serosa or Visceral Peritoneum
    • “Early”: T1, Regardless of N
  • Stage
  T N M
I   T1-2 N0 M0
II A T3 N0 M0
B T4 N0 M0
III A Any T N1 M0
B Any T N2 M0
IV   Any T Any N M1
  • Five-Year Survival:
    • Stage I: 70%
    • Stage II: 55%
    • Stage III: 30%
    • Stage IV: 5-10%
  • Tx: Resection & Lymphadenectomy with Wide Local Excision of Mesentery
    • Periampullary: Pancreaticoduodenectomy
    • Terminal Ileum: Ileocecectomy

Primary GI Lymphoma

Leiomyosarcoma

  • Most Common Site: Jejunum & Ileum
  • Can Be Differentiated from GIST by Lack of CD117 & CD34
  • Tx: En Bloc Resection with Lymph Nodes

Gastrointestinal Stomal Tumor (GIST)

Small Bowel Lymphoma 3

Small Bowel GIST 1

References

  1. Kopáčová M, Rejchrt S, Bureš J, Tachecí I. Small intestinal tumours. Gastroenterol Res Pract. 2013;2013:702536. (License: CC BY-3.0)
  2. Suzuki H, Yamada A, Watabe H, Kobayashi Y, Hirata Y, Yamaji Y, Yoshida H, Koike K. Successful treatment of early-stage jejunum adenocarcinoma by endoscopic mucosal resection using double-balloon endoscopy: a case report. Diagn Ther Endosc. 2012;2012:521960. (License: CC BY-3.0)
  3. Chowdhury M, Endo M, Chiba T, Kudara N, Oana S, Sato K, Akasaka R, Tomita K, Fujiwara S, Mizutani T, Sugai T, Takikawa Y, Suzuki K. Characterization of follicular lymphoma in the small intestine using double-balloon endoscopy. Gastroenterol Res Pract. 2009;2009:835258. (License: CC BY-3.0)