Intestinal

Neoplasm
Prepared by: Lovely Roan R. Riola
 Tumors of the Small Intestine

Epidemiology
Primary neoplasms of the small intestine are very rare,
comprising approximately 4% (range 1.6-6%) of all tumors of
the gastrointestinal tract.  Approximately 60% of these tumors
are malignant. Benign neoplasms of the small intestine
comprise 5% of benign tumors of the intestinal tract. 
The most frequent malignant tumors are:
•adenocarcinoma
•carcinoid tumor
•leiomyosarcoma
•Lymphoma

The most frequent benign tumors are:

•leiomyoma
•adenoma
•lipoma
•hemangioma
 Clinical Manifestations:

The clinical manifestations are non-specific and can include:

•nausea and vomiting
•abdominal pain
•melena
Tumor-related obstructions do not produce symptoms until a late stage,
due to the fluid contents of the small intestine. Imaging at that time,
usually, documents an advanced tumor stage with a correspondingly low
5-year survival rate (<20%).
 Diagnostic Procedures:

1. Gastric and colonic endoscopy, ultrasound and

small bowel barium examinations are the first-line
studies for all non-specific clinical GI symptoms.

2. Enterography (and enteroclysis) with CT and

especially MRI have become important in the
investigation of GI disorders. These techniques are
superior to enteroclysis in the evaluation of
eccentric tumors and secondary lesions (peritoneal
carcinomatosis).
 Diagnostic Procedures:

3. Endoscopic ultrasonography (EUS) is very sensitive

and effective for the workup of neoplasms in the
ampullary region.

4. CT angiography may be useful for demonstrating the

site of bleeding and the responsible lesion.

5. Capsule endoscopy has facilitated early diagnosis of

small bowel tumors
 Benign Tumors:

•small bowel leiomyoma 

• 1-10 cm in size
• mostly located in the jejunum
• typically rounded, well-circumscribed
• frequently ulcerate and cause bleeding
• obstructive in case of intraluminal growth
• irregular lesion margins and enlarged lymph nodes
should raise suspicion of leiomyosarcoma
• angiography: hypervascular lesion
• MRI is better than enteroclysis for showing
extraluminal growth patterns
 Benign Tumors:

•small bowel adenoma 

• 1-3 cm in size
• predominantly in the duodenum, also in the ileum
(ileocecal valve)
• large polyps may cause intussusception
• enteroclysis
 Benign Tumors:

•small bowel lipoma 

• mostly located in the ileum (ileocecal valve)
• MRI

•small bowel hemangioma 

• predominantly in jejunum
• may cause severe GI bleeding
• cavernous types resemble a submucosal polyp
• capillary types are multiple and may appear as small, flat, inconspicuous
filling defects on enteroclysis
• MRI and CT
 Malignant Tumors:

•small bowel carcinoid: 30-45% occurs in the appendix, 25-35% in the small
intestine (90% in distal ileum)
•characterized by increased serotonin production
•typically invasive growth and pronounced perifocal fibrotic reaction (
desmoplastic reaction)
•features: muscularis propria thickening, puckering, wall retraction, serosal
invasion, mesenteric metastases (similar echogenicity to the primary tumor, may
calcify)
•MRI
 Malignant Tumors:

•small bowel adenocarcinoma: most common GIT malignancy 

•mostly located near the papilla in the duodenum, less frequently in
jejunum
•enteroclysis: infiltrative tumor with irregular and segmental luminal
narrowing
•asymmetrical nodular wall thickening
•non-homogeneous moderate contrast enhancement
•streaky infiltration of the mesentery indicates tumor spread
•regional mesenteric lymphadenopathy
•CT: dystrophic calcifications can be seen (better with CT
than MRI)

•Ultrasound: smooth, intraluminal, hypoechoic masses

interrupting the submucosal layer

•MRI
 Malignant Tumors:

•small bowel leiomyosarcoma 

• may occur anywhere in the small bowel, mainly ileum and
jejunum
• large tumors, usually >6 cm, with extraluminal growth
• imaging findings are comparable to leiomyoma (see above),
and the differentiation can be difficult
• frequently ulcerate and cause bleeding
 Malignant Tumors:
•small bowel lymphoma 
• typically shows asymmetrical but
circumferential wall thickening with associated
luminal dilatation (intestinal aneurysm), due to
tumor extension into muscularis propria and
destruction of autonomic nerve plexus
• rarely causes bowel obstruction (tumor does
not elicit desmoplastic response)
• significant enlargement of mesenteric lymph
nodes
• MRI
• ultrasound: wide variety of appearances,
anechoic/hypoechoic, destruction of gut
signature, aneurysmal dilation, wall thickening 
 Malignant Tumors:

•gastrointestinal stromal tumor (GIST) 

• most common mesenchymal tumor
• from interstitial cells of Cajal which regulate gut peristalsis
• most frequently affect the stomach and small bowel
• intraluminal mass or can extend through serosa as an exophytic
mass with a large extraluminal component 
• bowel obstruction is rare even with large tumors 
• tends to displace adjacent structures rather than direct invasion
• 50% have metastases at time of diagnosis (liver, peritoneum)
 Neoplasm of the Large Intestine

Adenomatous Polyps
Asymptomatic
Adenomatous polyps, often known as adenomas, are a type of polyps that
can turn into cancer.
Adenomas may form in the mucous membrane of the lining in the 
large intestine, making them colon polyps. Another type of adenoma is 
gastric polyps, which form in the lining of the stomach.

Adenomas often appear in several growth patterns. The two most common

patterns are tubular and villous.
 Diagnostic Procedure:

•Colonoscopy: This examination involves using a camera tube. A doctor

inserts the tube through the rectum and into the colon to closely inspect
it. They may also remove polyps or carry out a biopsy, which involves
removing a sample of tissue to send to a laboratory for examination.

•Virtual colonoscopy: This is a minimally invasive test during which a

doctor will use a CT scan, X-ray, or MRI scan to examine the colon. If
the doctor discovers any polyps, a regular colonoscopy will be necessary
to remove them.
 Diagnostic Procedure:

•Flexible sigmoidoscopy: This method is similar to a colonoscopy but

uses a smaller lighted tube. The doctor inserts this through the rectum
to examine it along with the last third of the colon. If the doctor finds
polyps, then a regular colonoscopy will be necessary to remove them.

•Stool test: A doctor may check for blood in a person’s stool. During this
exam, they may also test the DNA in the stool. If certain results arise, the
doctor may then carry out a colonoscopy to investigate further.
Treatment:
If a person has colon polyps, a doctor will usually remove them during a 
polypectomy.
Familial adenomatous polyposis
Familial adenomatous polyposis (FAP) is a rare inherited cancer predisposition
syndrome characterized by hundreds to thousands of precancerous colorectal polyps
(adenomatous polyps).

The signs and symptoms of familial adenomatous polyposis (FAP) vary both within
families and between families. Classic FAP is characterized primarily by hundreds to
thousands of noncancerous (benign) polyps (growths) in the colon that begin to appear
at an average age of 16 years. Unless the colon is removed, these polyps will become
malignant (cancerous), leading to early-onset colorectal cancer at an average age of 39
years.
Causes:
Familial adenomatous polyposis is caused by a defect in
the adenomatous polyposis coli (APC) gene. Most people
inherit the genetic abnormality from a parent. But in
about 25 percent of cases, the genetic mutation occurs
spontaneously.

The abnormal gene causes hundreds or even thousands

of polyps to grow in your colon and rectum, usually
starting by your mid-teens.
Diagnostic Test:

Familial adenomatous polyposis (FAP) is diagnosed based on the symptoms, clinical

examination, and may be confirmed by the results of genetic testing. Imaging studies
of the colon by endoscopy such as flexible sigmoidoscopy, colonoscopy, or other
methods may also be helpful.

Treatment:
To prevent cancer, Mayo specialists recommend surgery for familial adenomatous
polyposis, usually by your late teens or early 20s. Surgery may not be required for
attenuated FAP.
Surgery doesn't cure FAP. Polyps can continue to form in the remaining or
reconstructed parts of your colon, stomach and small intestine. But with careful
monitoring, these polyps usually can be found and removed during colonoscopy before
becoming cancerous.
Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC),
is the most common cause of hereditary colorectal (colon) cancer. As a genetic
disorder, Lynch syndrome occurs when a person inherits an altered or mutated gene.

Signs and Symptoms:

•stomach pain
•constipation
•fatigue
•bleeding inside the gut
•unintentional weight loss
•reduced ability to absorb nutrients from foods
•glioblastoma, an aggressive type of brain tumor
Diagnostic Test:

Analyzing their DNA, before offering genetic testing, a doctor will usually review the
individual’s personal and family medical history to determine their likelihood of having
Lynch syndrome.

Treatment:

•Polypectomy: a surgical procedure in which a doctor removes cancerous polyps lining

the colon.
•Colectomy: a surgical procedure that involves removing all or part of the colon as well
as any affected lymph nodes.
•Ablation: a procedure in which a doctor uses radiofrequency waves, including
microwaves, to destroy small tumors.
•Cryosurgery: a procedure that involves a doctor using a thin
metal probe to administer cold gas to the surface of a tumor to kill
the cancer cells.

•Embolization: a technique that requires a doctor to insert a thin

tube into an artery to block the flow of blood to a large tumor.
 Obesity and Overweight
Overweight and obesity are defined as abnormal or
excessive fat accumulation that presents a risk to
health. In adults, a body mass index (BMI) over 25 is
considered overweight, and over 30 is obese. In
children aged between 5–19 years, overweight is
BMI-for-age greater than 1 standard deviation above
the WHO Growth Reference median; and obesity is
greater than 2 standard deviations above the WHO
Growth Reference median. In children under 5 years
of age, overweight is weight-for-height greater than 2
standard deviations above WHO Child Growth
Standards median.
Symptoms:

1. Above average body weight

2. Trouble sleeping
3. Sleep apnea- a condition in which breathing
is irregular and periodically stops during Sleep
4. Varicose veins
5. Skin problems caused by moisture that
accumulates in the folds of your Skin
6. Gallstones
7. Osteoarthritis in Weight-bearing joints,
especially the knees
Common tests & procedures
Body mass index (BMI): Calculated based on
height and weight ratio. Thirty or more defines
obesity

Anthropometric evaluation: Tape measurement

for circumference of waist and hips, calipers for
skin folds.
Procedures:
Gastroplasty: Stomach is stapled to create a small pouch that
allows only limited amounts of food.

Laparoscopic adjustable gastric banding: Placing an adjustable

band around the stomach with minimally invasive surgery.

Sleeve gastrectomy: Removal of approximately 80 percent of

the stomach. The remaining stomach is a tubular pouch that
resembles a banana.

Biliopancreatic diversion with duodenal switch: Removal of a

portion of stomach and bypassing a large portion of the small
intestine
 Self-care
Follow a healthy diet and exercise regularly.

Nutrition
Foods to eat:
•Choose minimally processed, whole foods
•Whole grains (whole wheat, steel cut oats, brown rice, quinoa)
•Vegetables (a colorful variety)
•Whole fruits (not fruit juices)
•Nuts, seeds, beans, and other healthy sources of protein (fish
and poultry)
•Plant oils (olive and other vegetable oils)
Crohn’s Disease
A more extensive distribution of intestinal inflammation has been reported among
African American or Black (AA), Hispanic, and Asian patients with CD than among
White patients. In studies that directly compared disease location among patients from
different racial groups, higher proportions of White patients were found to have
isolated ileal disease compared with AA, Hispanic, or Asian patients with CD.
There are variations among reports of the presence of more complicated disease
phenotypes. Many studies found that AA patients with CD have increased rates of
perianal disease and other complications compared with White patients. However,
other studies found that AA and White patients have similar rates of perianal disease. A
recent systematic review and meta-analysis concluded that AA patients were
significantly more likely to have penetrating disease compared with the 3 other
reported racial or ethnic groups, and more likely to have perianal disease compared
with White patients.
Colitis
In comparisons of disease extent, AA patients were more likely to have proctitis or left-
sided colitis compared with White patients (who were more likely to have extensive
colitis) in multiple studies. However, no racial differences were observed in other
comparisons. A study of Hispanic patients found an increased frequency of extensive
colitis compared with White patients, whereas multiple studies found no significant
difference in disease location. In an evaluation comparing Asian patients and White
patients, Asian patients were less likely to have extensive disease. In summary, a
consistent difference in disease extent between patients of different races or
ethnicities with UC has not been demonstrated.
Reference:

Barnes, E. L., Loftus, E. V., & Kappelman, M. D. (2021). Effects of race

and ethnicity on diagnosis and management of inflammatory bowel
diseases. Gastroenterology, 160(3), 677–689.
https://doi.org/10.1053/j.gastro.2020.08.064
Evidence Based Practice in Acute Gastritis:

Although most cases of acute gastroenteritis require minimal medical

intervention, severe dehydration and hypoglycemia may develop in cases of
prolonged vomiting and diarrhea. The mainstay of treatment for mild-to-
moderately dehydrated patients with acute gastroenteritis should be oral
rehydration solution. Antiemetics allow for improved tolerance of oral
rehydration solution, and, when used appropriately, can decrease the need
for intravenous fluids and hospitalization. This issue reviews the common
etiologies of acute gastroenteritis, discusses more-severe conditions that
should be considered in the differential diagnosis, and provides evidence-
based recommendations for management of acute gastroenteritis in
patients with mild-to-moderate dehydration, severe dehydration, and
hypoglycemia.
Reference:
K;, B. (n.d.). Acute gastroenteritis: Evidence-based
management of pediatric patients. Pediatric emergency
medicine practice. Retrieved November 5, 2021, from
https://pubmed.ncbi.nlm.nih.gov/29369591/.