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home - Small Bowel - Small Bowel Masses - Adenocarcinoma Written by Dr Sebastian Zeki

Adenocarcinoma

Adenocarcinomas — Adenocarcinomas from 25 to 50% of small bowel cancers Diagnosis On angiography, hypervascular with encased vessels can be seen. Highest incidence in duodeneum (65% periampullary), then progres-sively less through small bowelNB Crohns is opposite -70% in ileum Risk factors:HNPCC.Peutz-Jeghers.FAP.Crohn's.Coeliac sprue.Urological ileal conduit.Increased age more than 50. PresentationAbdominal pain occurs in 66%. Obstruction occurs in 40%. Bleeding occurs in 20%. 75% were stage III or IV at presentation. Adenoma to Carcinoma Sequence Invade Locally 5 year survivalStage I has 100% survivalStage II has 52% survivalStage III has 45% survivalStage IV has 0% survival Jejunal/ Ileal5 year prognosisStage 1- 70%Overal l 25% ChemotherapyNo particular protocolOften prescribed colorectal type chemotherapy as adjuvant or neoadjuvant Small Bowel Adenocarcinoma and Adenomas AdenomasVillous adenomas have the largest potential for malignancy- 30% are malignant.Superfically villous adenomas may look normal with malignancy deeper.Small bowel villous adenomas may also have colonic adenomasVillous adenomas can present with bleeding or obstruction of either the small bowel or biliary tract.Tubular adenomas are most common in the duodenum.Tubular adenomas may present with bleeding or obstruction.Brunner's gland adenomas are rare.Brunner’s adenomas are caused by hyperplasia of the exocrine glands within the proximal duodenal mucosa. Duodenal (prognostic factors/ prognosis as per colorectal cancer 35% distant mets 35% mets to LN 70% resectable Treatment options: Endoscopic polypectomy, simple local resection, or submucosal resection if no malignancy found.Whipples if periampullary villous adenoma.Whipple’s operation is indicated if it’s in the1st/2nd part of the duodenum.Segmental resection is indicated if it’s in the 3rd/4th part of the duodenum.Right hemicolectomy is indicated if it’s in the distal Ileum.Wide local excision is indicated if it’s in the jejunum. Written by Dr Sebastian Zeki

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