Tumores de

Intestino Delgado
Dr. Miguel Angel Ros Trejo
FECHA: 08 / Ene / 13

GENERALIDADES
5% tumores GI --- 2% cncer
5 000 casos / ao --- 1 000 muertes
+ 95%
Adenocarcinoma
Linfoma

Carcinoide
Sarcoma

Factores:
Alcalinidad
Rpido trnsito intraluminal
Niveles IgA
Baja cuenta bacteriana
Alto recambio cels epiteliales (minimiza exposicin)

Neugut AI. Cancer Epidemiol Biomarkers Prev 1998;7:243-251

Zinner MJ, Aashley SW. Maingots Abdominal Operations. 11th edition

GENERALIDADES
Correlacin con sitio anatmico
Adeno duodeno
Linfoma / carcinoide yeyuno, ileon

Neugut AI. Cancer Epidemiol Biomarkers Prev 1998;7:243-251

Zinner MJ, Aashley SW. Maingots Abdominal Operations. 11th edition

GENERALIDADES
Geografa
Gnero
Masculino

Edad
Promedio 60a
Linfoma + jven

Neugut AI. Cancer Epidemiol Biomarkers Prev 1998;7:243-251

Zinner MJ, Aashley SW. Maingots Abdominal Operations. 11th edition

GENERALIDADES
Raza

Neugut AI. Cancer Epidemiol Biomarkers Prev 1998;7:243-251

Zinner MJ, Aashley SW. Maingots Abdominal Operations. 11th edition

GENERALIDADES
Benignos
Adenomas

Malignos
Adenocarcinoma
Carcinoide

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

GENERALIDADES
Factores Riesgo

Crohn
HNPCC
Enf celiaca
*Mutacin K-ras, p53, APC

PAF
Peutz-Jeghers
Derivacin biliar

Factores Controversiales
Tabaquismo
Carne roja

Alcohol (+ 80gr / da)

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

DIAGNOSTICO
Alta sospecha
Dx correcto preQx 20 50%
Trnsito intestinal

50 70%

Endoscopia
Duodeno / ileon terminal

Cpsula endoscpica

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

DIAGNOSTICO
TAC c/ enteroclisis

90%

Extraluminal (GIST)
Estadificacin

Enteroscopa de empuje
USG
Angiografa
Hemangioma

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

BENIGNOS
GIST - + sntomas
Oclusin
Sangrado

Adenoma - + comn
Adenoma verdadero
Glndula de Brunner
Duodeno 20%

Adenoma velloso

Yeyuno 30%

Lipoma
+ comn ileon

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

Ileon 50%

BENIGNOS
Sntomas

Mayora ASINTOMTICO
Dispepsia
Anorexia
Dolor clico
Oclusin
Sangrado

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

BENIGNOS
Tratamiento
Reseccin y anastomosis
Enterotoma
Polipectoma
Revisin completa

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

MALIGNOS
Adenocarcinoma (50%)
70 aos
Masculino
Duodeno / yeyuno proximal

GIST (20%)

50 aos
Masculino
Yeyuno / ileon
+ 80% mayor 5 cm

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

MALIGNOS
Linfoma (25%)
Nios tumor intestinal + comn
Ileon
Inmunodeficiencia

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

MALIGNOS
Sntomas

Dolor
Prdida de peso
Oclusin
Diarrea
Sangrado
Tumor palpable
Perforacin (linfoma)

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

MALIGNOS
Tratamiento
Reseccin
Whipple (duodeno)
Radio / Quimio (Linfoma)
Imatinib (GIST)

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

MALIGNOS
Pronstico
50% candidato a reseccin
30% mets a distancia
Sobrevida a 5 aos 25%
AdenoCa 15%
GIST
50%

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

CARCINOIDES
Cels enterocromafines en criptas Lieberkuhn
Tracto GI principal sitio
Apndice (45%)-- Intestino delgado (28%) --- Recto (16%)

Mayora en ltimos 60 cm ileon

Producen

Cromogranina
Serotonina
Neuropeptido
Polipptido pancretico
Sustancia P

100%
88%
67%
40%
35%

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

CARCINOIDES
Potencial maligno
Localizacin
Ileon 35%
Tamao
+ 2cm hasta 90%
Profundidad Invasin

Multicentrico 20%
Coexistencia 2do primario
Adenocarcinoma colon

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

CARCINOIDES
Sntomas
80% asintomtico

Dolor abdominal
Oclusin
Diarrea
Prdida de peso

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

CARCINOIDES
Sndrome Carcinoide

10%
Rubor cutneo
80%
Diarrea (5-HT)
76%
Hepatomegalia
71%
Lesin cardiaca (vlvula derecha)
Estenosis pulmonar 90%

Asma

25%

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

CARCINOIDES
DIAGNSTICO
Serotonina
Cromogranina A
Serotonina
Sustancia P

Hgado
Pulmn

cido5-Hidroxi-indoleactico

Estudios Baritados
Mltiples defectos de llenado

TAC
Metstasis

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

CARCINOIDES
TRATAMIENTO
Tamao
< 1 cm, sin mets linftica
> 1 cm, mltiples o mets linftica

Reseccin segmentaria
Excisin intestinal y
mesentrica amplia

Sitio
Ileon terminal
Duodenal

Hemicolectoma derecha
Excisin local o Pancreatoduodenectoma

Presencia mets
Debulking
Embolizacin art heptica
Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

CARCINOIDES
TRATAMIENTO
Mdico
Paliar sntomas

Diarrea, ruborizacin

Octreotide (anlogo somatostatina)

IFN alfa
Ondansetrn (antagonista serotonina)
QuimioTX
Sintomtico / SIN respuesta a tx

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

CARCINOIDES
PRONSTICO
Mejor pronstico
Sobrevida a 5 aos: 25 65%

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

METASTSICOS
+ COMUNES a primario
De rganos intra-abdominales
Otros:
Melanoma
Mama
Pulmn

Townsend CM. Sabiston Textbook of Surgery 2007. 18th edition

DUDAS,
PREGUNTAS