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Tumors of Small Intestine - Surgical Lecture
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Prof. Zahid Mahmood
Prof. Zahid Mahmood
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2026-04-07T17:07:37Z
2026-04-07T17:07:37Z
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Tumors of Small IntestineA Comprehensive Surgical LectureProf. Zahid MahmoodDepartment of SurgeryFinal Year MBBS | UHS / CPSP Aligned CurriculumBailey & Love Style · Exam-Oriented · Viva Ready · Case-Based LearningPK
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02Learning Outcomes▶ Define and classify tumors of small intestine▶ Enumerate benign and malignant tumour types▶ Recognise clinical features and investigations▶ Plan management; understand carcinoid synd.Prof. Zahid Mahmood | Small Intestine Tumors | Final Year MBBS | UHS / CPSPPK
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03Definition & Epidemiology▶ Rare tumors: 3–6% of all GI neoplasms▶ Benign more common; malignant = poor prognosis▶ Duodenum most common site for malignancy▶ Presentation late — vague abdominal symptomsProf. Zahid Mahmood | Small Intestine Tumors | Final Year MBBS | UHS / CPSPPK
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04Classification — Benign Tumors▶ Adenoma: tubular/villous; duodenum; premalig.▶ Leiomyoma: smooth muscle; submucosal; bleeding▶ Lipoma: submucosal; intussusception in adults▶ Haemangioma: GI bleed; Peutz-Jeghers (hamartoma)Prof. Zahid Mahmood | Small Intestine Tumors | Final Year MBBS | UHS / CPSPPK
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05Classification — Malignant Tumors▶ Adenocarcinoma: commonest malignant; duodenum▶ Carcinoid (NET): ileum; serotonin-secreting▶ Lymphoma: ileum; MALT; Crohn's association▶ GIST: c-Kit positive; ileum; spindle cellsProf. Zahid Mahmood | Small Intestine Tumors | Final Year MBBS | UHS / CPSPPK
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06Types / Variants — Special Syndromes▶ Peutz-Jeghers: hamartomas + lip pigmentation▶ FAP: duodenal adenomas; periampullary Ca risk▶ Carcinoid syndrome: flushing, diarrhoea, wheeze▶ GIST: imatinib (Gleevec) — targeted therapyProf. Zahid Mahmood | Small Intestine Tumors | Final Year MBBS | UHS / CPSPPK
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07Etiology / Risk Factors▶ Crohn's disease: 6x ↑ risk of small bowel Ca▶ Coeliac disease: T-cell lymphoma (EATL) risk▶ FAP / hereditary polyposis: adenoma → Ca risk▶ Immunosuppression: lymphoma; HIV-related riskProf. Zahid Mahmood | Small Intestine Tumors | Final Year MBBS | UHS / CPSPPK
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08Pathophysiology — How Tumors Present▶ Obstruction: intussusception, luminal narrowing▶ Bleeding: chronic anaemia or acute haemorrhage▶ Perforation: rare; peritonitis; lymphoma-related▶ Malabsorption: lymphoma disrupts lymphaticsProf. Zahid Mahmood | Small Intestine Tumors | Final Year MBBS | UHS / CPSPPK
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09Clinical Features — Signs & Symptoms▶ Vague colicky pain; bloating; weight loss▶ Anaemia (IDA): occult GI bleed — common▶ Palpable mass: large GIST or lymphoma▶ Carcinoid: flushing, diarrhoea, R-heart lesionsProf. Zahid Mahmood | Small Intestine Tumors | Final Year MBBS | UHS / CPSPPK
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10Investigations — Labs & Imaging▶ FBC: anaemia; LFTs; tumour markers (CEA, Ca19-9)▶ Urinary 5-HIAA: carcinoid; serum chromogranin A▶ CT enterography: gold standard for small bowel▶ Capsule endoscopy / DBE: mucosal lesionsProf. Zahid Mahmood | Small Intestine Tumors | Final Year MBBS | UHS / CPSPPK
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11Management — Benign Tumors▶ Adenoma: endoscopic resection if pedunculated▶ Large / sessile: segmental bowel resection▶ Peutz-Jeghers: surveillance; polypectomy▶ Leiomyoma / GIST: surgical resection marginProf. Zahid Mahmood | Small Intestine Tumors | Final Year MBBS | UHS / CPSPPK
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12Management — Adenocarcinoma▶ Duodenal: Whipple's (pancreatoduodenectomy)▶ Jejunal/ileal: wide segmental resection + nodes▶ Chemotherapy: FOLFOX regimen post-resection▶ 5-year survival: 20–40% (stage dependent)Prof. Zahid Mahmood | Small Intestine Tumors | Final Year MBBS | UHS / CPSPPK
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13Management — Carcinoid / GIST / Lymphoma▶ Carcinoid: resect; Octreotide for symptoms▶ Metastatic carcinoid: PRRT; liver resection▶ GIST: resect; imatinib adjuvant (Kit+ tumors)▶ Lymphoma: CHOP chemotherapy; surgery if obstructProf. Zahid Mahmood | Small Intestine Tumors | Final Year MBBS | UHS / CPSPPK
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14Complications — Early & Late▶ Obstruction: most common presentation overall▶ Haemorrhage: acute → transfusion + urgent resect▶ Carcinoid crisis: periop serotonin; fatal▶ Late: recurrence; liver mets; carcinoid heartProf. Zahid Mahmood | Small Intestine Tumors | Final Year MBBS | UHS / CPSPPK
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15Mnemonics & High-Yield Exam Points▶ CARD: Carcinoid, Adenoca., EATL, GIST▶ 5-HIAA ↑ = carcinoid; chromogranin A = NET▶ GIST: c-Kit positive; CD117 stain; imatinib Rx▶ Carcinoid: right heart — tricuspid/pulmonaryProf. Zahid Mahmood | Small Intestine Tumors | Final Year MBBS | UHS / CPSPPK
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Clinical Scenario — Case-Based LearningCASE: 52-yr male; 4-month history of colicky central pain, weight loss 8 kg, and episodic flushing with diarrhoea after meals. Examination: mild RIF tenderness. Investigations: Hb 9.2 g/dL, urinary 5-HIAA elevated 3x normal, CT shows 2 cm ileal mass + liver nodules.Q1: Most likely diagnosis?✔ Ileal carcinoid (NET) with hepatic metastases and carcinoid syndromeQ2: Management plan?✔ Octreotide → resect primary → PRRT / liver resection for metastasesProf. Zahid Mahmood | Small Intestine Tumors | Final Year MBBS | UHS / CPSPPK
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MCQs — SBA Style (CPSP / UHS Pattern)1Q1. Commonest malignant tumor of small intestine?A) Lymphoma B) GIST C) Adenocarcinoma ✔ D) Carcinoid2Q2. Carcinoid syndrome marker in urine?A) CEA B) AFP C) 5-HIAA ✔ D) Ca 19-93Q3. GIST is positive for which immunostain?A) CD20 B) CEA C) c-Kit (CD117) ✔ D) AFP4Q4. Duodenal adenocarcinoma: procedure of choice?A) Wide resection B) Whipple's ✔ C) FOLFOX alone D) BypassProf. Zahid Mahmood | Small Intestine Tumors | Final Year MBBS | UHS / CPSPPK
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High-Yield Summary 1Adenocarcinoma: commonest malignant SI tumor; duodenum 2Carcinoid: ileum; 5-HIAA; right heart disease; octreotide 3GIST: c-Kit +ve; imatinib for unresectable / metastatic 4CT enterography = gold standard; late presentation = poor outcomeProf. Zahid Mahmood | Small Intestine Tumors | End of LecturePK
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