Clinical Manifestation of Small Bowel Neuroendocrine Tumors

ūüĎČMost small bowel carcinoid tumors are asymptomatic and are discovered incidentally.

  • When present, symptoms are often vague and chronic, including:
    • Abdominal pain
    • Obstructive symptoms
    • Weight loss
    • Fatigue
    • Bleeding / anemia
  • Patients with small bowel carcinoids can also present with regional or distant metastases without an obvious primary tumor:
    • Most commonly manifested as a:
      • Mesenteric mass or liver metastases without an obvious small bowel tumor
  • Most small bowel carcinoid tumors:
    • Secrete biologically active amines:
      • But functional hormone syndromes:
        • As seen in pancreatic neuroendocrine tumors:
          • Are rare in small bowel carcinoid tumors
    • However:
      • Patients with metastatic disease:
        • Can present with carcinoid syndrome:
          • Secretory diarrhea (80%)
          • Cutaneous flushing (60% to 85%)
          • Right heart disease (20%)
          • Wheezing and dyspnea (10% to 20%)
        • Classically, patients with carcinoid syndrome:
          • Have hepatic metastases:
            • Which bypass hepatic clearance:
              • Of serotonin
  • Small bowel carcinoids:
    • Most frequently arise in the terminal ileum:
      • Often within 60 cm of the ileocecal valve

#Arrangoiz #SurgicalOncologist #CancerSurgeon #Teacher #Surgeon #SmallBowelCancer

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