Diagnosis and staging of small bowel neoplasms
- James C Cusack, Jr, MD
James C Cusack, Jr, MD
- Associate Professor of Surgery
- Harvard Medical School
- Michael J Overman, MD
Michael J Overman, MD
- Associate Professor
- Department of Gastrointestinal Medical Oncology
- MD Anderson Cancer Center
A variety of tumors, both malignant and benign, may arise within the small intestine. Malignant tumors include adenocarcinomas, neuroendocrine tumors (carcinoids), stromal tumors, and lymphomas. Benign lesions that may arise in the small bowel include adenomas, leiomyomas, fibromas, and lipomas.
The diagnosis and staging of small bowel tumors will be reviewed here. The epidemiology, clinical manifestations, and treatment of the specific types of tumors are discussed separately. (See "Epidemiology, clinical features, and types of small bowel neoplasms" and "Treatment of small bowel neoplasms".)
The clinical features of small bowel neoplasms may include one or more of the following: pain, obstruction, bleeding, anorexia, weight loss, perforation, or in the case of a duodenal primary, jaundice. Malignant tumors are more likely to be symptomatic as compared with benign lesions. (See "Epidemiology, clinical features, and types of small bowel neoplasms", section on 'Clinical presentation'.)
The variable nature of the presenting symptoms, combined with the lack of physical findings, can contribute to a delay in diagnosis in many cases . In one study, failure to obtain a proper diagnostic test or misinterpretation of test results accounted for delays of 8 and 12 months, respectively; by comparison, the estimated diagnostic delay due to the patient's failure to report symptoms was less than two months . As prognosis is closely linked to disease extent for all of the major malignant small bowel tumors, early detection and treatment can contribute to a favorable outcome [2-4]. Because of the vagueness and nonspecificity of the presenting symptoms, a high index of suspicion is essential for early diagnosis and treatment [5,6].
Patients whose symptoms are such that a small bowel tumor is part of the differential diagnosis should undergo a complete history, physical examination, and screening for fecal occult blood. A minimum laboratory work-up should include a complete blood count, measurement of serum electrolytes, and liver function tests.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- CLINICAL FEATURES
- DIAGNOSTIC EVALUATION
- Radiographic imaging
- - UGI/SBFT
- - CT scan
- - Angiography and radionuclide scanning
- - Enteroclysis and enterography
- CT enterography
- MR enterography
- - PET and integrated PET/CT
- Neuroendocrine tumors
- Endoscopic techniques
- - Upper endoscopy
- - Wireless video capsule endoscopy
- - Enteroscopy
- - Other methods
- Tumor markers
- Diagnostic testing for neuroendocrine tumors
- - Urinary excretion of 5-HIAA
- - Other biochemical tests
- - Tumor localization by somatostatin receptor-based imaging techniques
- Surgical exploration
- Sarcoma and neuroendocrine tumors
- HISTOLOGY AND DIFFERENTIAL DIAGNOSIS