Date:
Patient:
Reason for Visit:
Initial evaluation for suspected small bowel adenocarcinoma
Follow-up for established small bowel adenocarcinoma
Assessment of treatment response or disease progression
Management plan discussion
History:
Presenting Illness: (For initial evaluation)
Onset and duration of symptoms (abdominal pain, nausea, vomiting, diarrhea, weight loss, occult blood in stool)
Risk factors (e.g., Crohn’s disease, celiac disease, family history of GI cancers)
Previous surgeries or procedures involving the gastrointestinal tract
Past Medical History (PMH):
Comorbid conditions (e.g., diabetes, heart disease)
Previous surgeries or procedures (relevant to GI tract)
Medications (including anticoagulants)
Social History:
Smoking history (risk factor)
Alcohol use
Family history of cancer (especially GI cancers)
Physical Exam:
General: Assess vital signs (temperature, heart rate, blood pressure, weight loss).
Abdominal: Evaluate for abdominal distention, tenderness, masses.
Lymph Nodes: Palpate for enlarged or tender lymph nodes in the abdomen or groin.
Diagnostic Tests (may be ordered depending on clinical suspicion):
Laboratory Tests:
Complete blood count (CBC) – may show anemia
Electrolytes – assess for dehydration
Liver function tests (LFTs) – may be abnormal with advanced disease
Tumor markers (CEA, CA 19-9) – elevated levels may suggest malignancy, but not specific for small bowel adenocarcinoma.
Imaging Studies:
Abdominal X-ray – may show signs of bowel obstruction.
CT scan of the abdomen and pelvis – most common imaging modality for diagnosis and staging.
MRI scan (may be used in some cases)
PET scan (may be used for staging or evaluating for recurrence)
Endoscopy (may be performed):
Upper endoscopy (esophagogastroduodenoscopy, EGD) – to visualize the upper GI tract and potentially obtain tissue samples.
Capsule endoscopy – for visualizing the entire small intestine if other modalities are inconclusive.
Biopsy: Tissue sample obtained during endoscopy, surgery, or percutaneous needle biopsy for definitive diagnosis.
Assessment:
Clinical suspicion of small bowel adenocarcinoma: Based on history, physical exam findings, and initial laboratory tests.
Confirmation of diagnosis: Requires histopathological examination of a biopsy specimen.
Staging (if diagnosis confirmed): Determines the extent of cancer spread (localized, regional, or distant metastasis). Staging is crucial for treatment planning and prognosis.
Differential diagnosis: Consider other causes of small bowel symptoms (e.g., inflammatory bowel disease, celiac disease, peptic ulcer disease).
Plan:
Treatment approach depends on several factors:
Stage of cancer
Patient’s overall health and performance status
Surgical options:
Surgical resection (primary treatment for localized disease) with removal of the affected portion of the small intestine and possibly involved lymph nodes.
Palliative surgery (to relieve symptoms like obstruction) may be considered in advanced stages.
Adjuvant chemotherapy (after surgery for high-risk disease)
Palliative care (to manage symptoms and improve quality of life in advanced stages)
Nutritional support: May be needed before, during, and after treatment to address malnutrition or weight loss.
Follow-up (if diagnosis confirmed):
Regular follow-up appointments to monitor for recurrence and manage any side effects of treatment.
Imaging studies (CT scans) to monitor for disease progression.
Additional treatment decisions based on follow-up findings.
Patient education: Provide information about small bowel adenocarcinoma, its diagnosis, treatment options, and potential side effects.
Discuss the importance of a healthy diet and lifestyle modifications (smoking cessation).
Encourage open communication about any concerns or questions.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of small bowel adenocarcinoma.