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Tumor Board
Englewood Hospital and Medical Center
Donald Baril
Department of Surgery
Mount Sinai School of Medicine
December 10, 2004
Transmural invasion
Lymphovascular invasion
2.
3.
4.
5.
Clinical presentation
Abdominal pain
Nausea and vomiting
Bleeding/Anemia
Weight loss
Gastric outlet obstruction
Diarrhea
Mean time to diagnosis from the onset of the initial
complaint is 7 months
50% of patients present emergently with
obstruction or bleeding
UGI/SBFT
Mass
Mucosal defect
Intussusception
Enteroclysis
CT
CT enteroclysis
MRI
Ultrasound
Endoscopy/Enteroscopy
Push enteroscopy allows for visualization of 40-60
cm of small bowel beyond the ligament of Treitz
Intraoperative endoscopy
EUS
Capsule endosocopy
Exploratory laparotomy/laparoscopy
Crohns
Celiac disease
IgA deficiency
Alcohol abuse
Neurofibromatosis
Urinary diversion procedures
? Red meat
Stage III tumors with any bowel wall extension and positive
lymph nodes
Cunningham et
al.
Annals of Surgery
1997
Talamonti et
al.
Archives of Surgery
2002
Location
Stage at presentation
Duodenum
and jejunum
Ileum
II
III
IV
79%
21%
6.9%
24%
24%
45%
76%
24%
4.8%
19%
38%
38%
Surgical pearls
Adjuvant therapy
No prospective studies
Survival
Prognosis
Stage I 100%
Stage II 52%
Stage III 45%
Stage IV 0%
Prognosis
Study
Cunningham et
al.
Annals of Surgery
1997
Curative
resection
rate
Overall 5
year
survival
66%
62%
Curative
resection
30%
23
37%
40
Talamonti et al.
Archives of Surgery
2002
Prognosis
Treatment is palliative
Limited resection
Intestinal bypass
Melanoma
Cunningham et
al.
Annals of Surgery
1997
Location
Stage at presentation
Duodenum
and jejunum
Ileum
II
III
IV
75%
25%
25%
12.5%
0%
63.5%
80%
20%
12%
20%
48%
20%
Talamonti et al.
Archives of Surgery
2002
Cunningham et
al.
Annals of Surgery
1997
Curative
resection
rate
Overall 5
year
survival
50%
84%
Curative
resection
25%
66
22%
22
66
Talamonti et al.
Archives of Surgery
2002
STI-571
Cunningham et
al.
Annals of Surgery
1997
Location
Stage at presentation
Duodenum
and jejunum
Ileum
II
III
IV
28%
72%
11%
0%
22%
66%
22%
78%
8%
24%
38%
30%
Talamonti et al.
Archives of Surgery
2002
Cunningham et
al.
Annals of Surgery
1997
Curative
resection
rate
Overall 5
year
survival
67%
65%
Curative
resection
Not
reported
18
81
64%
32
Not
reached
Talamonti et al.
Archives of Surgery
2002
Hepatic metastases
Surgical resection
Hepatic artery embolization
Cryosugery
Radiofrequency ablation
Transplantation
Conclusions