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العنوان
Management of Malignant Neoplasms of the Small Intestine /
المؤلف
Abdul-Maksoud, Ibrahim Magid .
هيئة الاعداد
باحث / Ibrahim Magid Abdul-Maksoud
مشرف / Hasan Sayed Tantawy
مشرف / Mohamed FayekMahfouz
مشرف / Ahmad Samy Mohamed
تاريخ النشر
2015.
عدد الصفحات
139P. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
جراحة
تاريخ الإجازة
1/1/2015
مكان الإجازة
جامعة عين شمس - كلية الطب - General Surgery
الفهرس
Only 14 pages are availabe for public view

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from 32

Abstract

SUMMARY AND CONCLUSION:
The incidence of small-bowel tumors has increased, with the highest rate of increase in men. Adenocarcinomas are the most common small intestinal cancers identified histologically, followed by carcinoid tumors. The former seems to be more frequently seen in the duodenum, the latter in the ileum. Surgery is the treatment of choice for the cure or palliation of small-bowel cancers.
Despite having the greatest epithelial surface area in the gastrointestinal tract, the small bowel rarely develops neoplasms. In fact, small-bowel tumors account for 2% of all gastrointestinal neoplasms (only 0.3% of all neoplasms) and are usually misdiagnosed on first presentation or diagnosed late. The rare incidence of small-bowel tumors may contribute to the relatively low index of clinical suspicion for their presence. The majority of these tumors are clinically silent for long periods of time or manifest with nonspecific symptoms, such as dull, crampy abdominal pain, abdominal distention, fecal occult blood, nausea, and/or vomiting. Obstruction is also a common presentation; indeed, small-bowel tumors are the third most common cause of small-bowel obstruction. Obstruction may be the direct result of the narrowing of the bowel lumen by the tumor or the indirect effect of the tumor functioning as a lead point for intussusception. The larger the tumor, the more likely the patient will have symptoms. Nonetheless, clinical presentation alone rarely permits the distinction between benign and malignant lesions.
Diagnostic modalities used for assessing the existence of small-bowel tumors include endoscopy (for lesions of the duodenum and proximal jejunum) and radiographic imaging (computer tomography and small-bowel series, or enteroclysis). Lesions located distal to the Treitz ligament pose a unique diagnostic challenge for the endoscopist because of the length of the small bowel. Capsule endoscopy is a recently available clinical technology that has been shown to be safe and effective in the diagnosis of small-bowel abnormalities, including neoplasms. Urinary excretion of 5-hydroxyindoleacetic acid and radionuclide localization scans can be useful for the diagnosis of carcinoid tumors. Elevated carcinogen embryonic antigen may indicate an adenocarcinoma but usually in the presence of liver metastases. Often none of the mentioned diagnostic tools are fruitful, and because of progressive symptoms, diagnostic laparoscopy or exploratory laparotomy may be indicated for definitive diagnosis and treatment.
Several environmental as well as genetic syndromes that predispose individuals to developing a malignancy in the small intestine have been described. First, patients with familial adenomatous polyposis have multiple adenomas in the colon and, if untreated, have a 100% risk of developing colon cancer. Moreover, periampullary adenocarcinoma is the leading cause of death in patients with familial adenomatous polyposis who have had a total colectomy. Second, other primary malignancies, such as melanoma and cancers of the colon, rectum, prostate, lung, and breast, may metastasize to the small bowel. Third, patients with Crohn disease have been documented to be at higher risk for developing adenocarcinoma of the small bowel, particularly in the ileum.
The difficulty in establishing early definitive diagnosis and treatment of small-bowel cancers is a challenge that must be met if improved results are to be obtained. Knowledge of the epidemiology of the disease and an increased clinical suspicion can be useful in earlier