Small intestinal neoplasms are very rare universally. Since the patient does not present any symptoms, the detection is generally very late. Physicians too do not look out for such tumours because of rarity. Hence, it is a challenge for both the radiologist and the physician, says Dr Nicholas Gourt Soyiannis, professor of radiology & chairman of department of radiology, University of Crete Dean Medical School, University of Crete, Greece.
There is no direct means to view the tumours in the small intestine. Ultrasound is still the best option, but very soon MR is likely to take over. Radiological appearances of neoplasms, shown with enteroclysis and CT correlate almost perfectly with the morphological changes recognized in the gross pathological specimens. This ability to accurately image small intestinal neoplasm, independently of their size, anatomical localization and growing tendency represents a major improvement in their diagnosis and management.
Adenocarcinoma is the most common malignant neoplasm of the small intestine. In most cases, it is always symptomatic with non-specific clinical presentation. The prognosis is always dismal and this is mainly due to late diagnosis. Lymphoma represents 20 per cent of primary small intestinal malignancies. These clinical presentations are variable, depending on whether involvement is primary or secondary, or proceeded by other disorders. Carcinoid tumour is the most common neoplasm found at autopsy or incidentally during laparotomy. Almost 90 per cent of the lesions are located in the distal ileum and they may multiply in approximately one-third of cases. The other common neoplasms are stromal tumours and lipomas.
Prof. Nicholas stressed the need for early detection. And for this the clinician should have a high index of suspicion when confronted with non- specific and/or unexplained intestinal symptoms, such as intermittent pain, episodes of incomplete obstruction, occult bleeding or unexplained anemia. He should work closely with the radiologist and both should be aware of the importance of using sensitive and meticulously performed radiological techniques to examine the small bowel. Only this will result in better management of the patient.