Gastroenterology MCQ Answer 39

Answer: ABD

DISCUSSION: Carcinoid tumors should be treated by resection, regardless of the presence of metastases, because growth of the primary neoplasm is slow and local complications, such as obstruction and intussusception, are frequent. At clinical discovery a large percentage (as many as 70%) of small-intestinal carcinoids are metastatic to lymph nodes and/or liver. All tumors should be managed by wide en bloc resection, regardless of the size of the primary lesion or the presence of distant metastases. Lesions in the distal ileum require ileocolectomy. Appendiceal tumors larger than 1.5 cm. should be treated by ileocolectomy. The incidence of metastases depends on the size and location of the primary tumor. Appendiceal carcinoid tumors smaller than 1.5 cm. are rarely malignant and may be treated safely by routine appendectomy. This is not true of larger tumors. Like carcinoid tumors elsewhere in the gastrointestinal tract, the malignancy potential of rectal carcinoid tumors is directly proportional to their size. Tumors smaller than 1 cm. have little or no malignant potential and may be treated by endoscopic excision. Tumors measuring 1 to 2 cm. should be excised operatively with margins, but when they are larger than 2 cm. rectal carcinoid tumors may require anterior resection. In patients with ileal carcinoid tumors, the evidence of a second tumor has been reported as high as 40%. Thus, the search for synchronous metachronous and metastatic neoplasms should be undertaken.

Category: Gastroenterology MCQs