From the Guidelines
The most common presenting symptom of malignant small bowel neoplasms or small bowel cancer is abdominal pain (option B). While small bowel cancers can present with various symptoms, abdominal pain is typically the earliest and most frequent complaint. According to the British Sarcoma Group clinical practice guidelines 1, the most common symptoms of GIST include upper gastrointestinal bleeding and anaemia, whilst larger tumours may present with abdominal pain/discomfort and a palpable mass. Some key points to consider include:
- Abdominal pain is often vague, intermittent, and may worsen after eating as the tumor obstructs or partially obstructs the intestinal lumen.
- Weight loss, GI bleeding, and obstruction are also common presentations but occur less frequently as initial symptoms.
- GI bleeding may manifest as occult blood loss leading to iron deficiency anemia or as melena.
- Complete obstruction typically occurs later in the disease course as the tumor grows.
- Perforation is a rare but serious complication.
- Nausea and vomiting can occur, particularly with more proximal tumors or when obstruction develops.
- The pain associated with small bowel malignancies results from tumor invasion of the intestinal wall, obstruction of the lumen, or involvement of the mesentery and surrounding structures, as noted in the guidelines 1.
From the Research
Presentation of Malignant Small Bowel Neoplasms
The presentation of malignant small bowel neoplasms can vary, but some symptoms are more common than others. According to the studies, the most common presenting signs and symptoms of small bowel tumors are:
- Abdominal pain 2
- Nausea and vomiting 2
- Other symptoms such as gastrointestinal hemorrhage, obstruction, and weight loss may also occur, but are less common as initial presenting symptoms.
Specific Symptoms
Some specific symptoms that may be associated with malignant small bowel neoplasms include:
- Abdominal pain: this is a common symptom, especially in patients with primary malignant tumors 2, 3
- Gastrointestinal hemorrhage: this may occur in patients with benign tumors, but can also be a symptom of malignant tumors 2
- Obstruction: this may occur in patients with metastatic tumors, and can also be a symptom of malignant tumors 2, 3
- Weight loss: this is a non-specific symptom that can occur in patients with malignant small bowel neoplasms, but is not as common as abdominal pain or nausea and vomiting 4, 5
Diagnosis and Treatment
Diagnosis of malignant small bowel neoplasms can be challenging due to the non-specific nature of the symptoms and the difficulty in visualizing the tumors with normal endoscopic techniques. Treatment options vary depending on the type and stage of the tumor, but may include surgical resection, chemotherapy, and radiation therapy 3, 4, 5, 6.