Where else can Adenomas Develop?
Some, not all, people with FAP or attenuated FAP may develop adenomas in the first part of the small intestine, or duodenum.
Duodenal adenomas may appear after the colon is removed and tend to grow much more slowly than colorectal adenomas. Examination is recommended from the age of 25.
The specially designed fibre optic tube is called a side-viewing endoscope which is passed down the mouth and into the stomach and duodenum to carefully inspect the lining of the duodenum and the opening, or ampulla, an area where adenomas may cluster. The forward-viewing endoscope, used in the stomach, is unable to get a clear view of the ampulla which is difficult to see and is often referred to as a blind spot.
In the stomach, two types of polyps may be found in people with FAP or attenuated FAP. The first type is very common and is generally located in the body, or fundus, of the stomach. When biopsied, the result is often a diagnosis of benign fundic gland polyps rather than premalignant polyps. No treatment is necessary and examination is repeated every 5 years. The second type, an adenoma, is uncommon and generally isolated. Treatment depends on the degree of change and size of the adenoma. Examination may be performed every 1 to 2 years.
In the duodenum, most patients will never develop symptoms from adenomas. Depending on the biopsy and appearance of the duodenum, side-viewing endoscopy is repeated at different intervals, ranging from 6 months to 3 years. Treatment may include resection through the endoscope, laser, surgery, or ongoing observation and biopsy.
Since duodenal adenomas are generally slow-growing and may, in fact, be rather small in size and number, an operation is generally not required. New research into medications which can control the growth of duodenal adenomas is underway. As well, genetic information may provide a clue to some families where the risk of developing more extensive duodenal adenomas or duodenal cancer is higher while others have the same low risk as in the general population.
In the jejunum, adenomas are uncommon and difficult to diagnose because this area is hard to see directly. The jejunum may be partially examined by endoscope, or more extensively by x-ray or capsule endoscopy (miniaturized camera in a swallowed pill). Capsule endoscopy provides detailed pictures of the small intestine and passes from the body without harm.