True about small bowel tumour -
• MC malignant neoplasms of the small bowel: Carcinoid tumors >adenocarcinomas >malignant GISTs >lymphomas.
• Adenocarcinomas are more numerous in the proximal small bowel, whereas the other malignant lesions are more common in the distal intestine (ileum).
Clinical Features
• In contrast to benign lesions, malignant neoplasms almost always produce symptoms
• MC symptom: Abdominal pain >weight loss
• Obstruction develops in 15-35% of patients and, in contrast to the intussusception produced by benign lesions, is usually the result of tumor infiltration and adhesions.
• Diarrhea with tenesmus and passage of large amounts of mucus may occur.
• Adenocarcinomas may produce the typical constricting apple-core lesions similar to those observed in the colon.
• Gastrointestinal bleeding is more common with leiomyosarcomas.
• A palpable mass may be felt in 10-20% of patients, and perforations develop in about 10%, usually secondary to lymphomas and sarcomas.
Diagnosis
• Barium meal follow through (BMFT): Accurate diagnosis in 50–70% of patients with malignant neoplasms of the small intestine
• Enteroclysis (small bowel enema): Diagnostic accuracy of about 90%
Treatment
• Wide resection including regional lymph nodes.
• Often, surgical resection for cure is not possible. Therefore, palliative resection should be performed to prevent further complications of bleeding, obstruction, and perforation.
• Adjuvant radiation and chemotherapy have little role in the treatment of patients with adenocarcinomas of the small bowel.
Prognosis
• Only half of the patients operated on for malignant tumors of the small intestine have lesions amenable to curative resection.
• One third have a distant metastasis at the time of initial surgery
• Overall 5-year survival rate after surgical treatment of malignant tumors is only 25%
• Adenocarcinoma has the poorest prognosis, with an overall survival rate of 15-20%.
• Obstruction in CA small bowel develops in 15-35% of patients, due to tumor infiltration and adhesions.
• Obstruction in benign lesions is due to intussusceptions.
Commonly located in duodenum
Lymphoma is common
Adenocarcinoma has good prognosis
Palliative surgeries are done even in presence of metastasis