Malignant Neoplasms of the Small Intestine Clinical Presentation

Updated: Sep 26, 2019
  • Author: Ponnandai S Somasundar, MD, MPH, FACS; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Presentation

History

Small-bowel cancer is typically asymptomatic in its early stages, but more than 90% of patients eventually develop symptoms as the disease progresses. This unfortunately reflects advanced disease. Because of the nonspecific nature of symptoms, a significant delay between the onset of symptoms and diagnosis often occurs, averaging 6-8 months.

Nausea, vomiting, and intestinal obstruction are common presenting symptoms. Half of these patients undergo emergency surgery for intestinal  obstruction. Abdominal pain and weight loss complicate the clinical presentation; bleeding is less common.

The few published series on small bowel neoplasms that are available cannot be used as generalizations for presentation of the individual histologic subtypes. However, it does appear that adenocarcinomas are more frequently associated with pain and obstruction when compared to sarcomas and carcinoids. Gastrointestinal stromal tumors (GISTs) present more commonly as acute GI bleeding.

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Physical Examination

Patients with small-bowel malignancies may present with fairly unremarkable physical examination findings. A tender and distended abdomen may be found due to obstruction. Peritoneal signs indicate perforation. Jaundice from biliary obstruction or liver metastases may occur rarely.

Guaiac-positive stool or acute GI bleeding suggests intestinal bleeding, although this occurs more frequently in persons with benign small-bowel tumors.

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