🧬 Chapter 393: Tumors of the Digestive Tract

Nelson Textbook of Pediatrics 22nd Edition — Juvenile polyps (hamartomas, most common, benign) present with painless rectal bleeding. Peutz-Jeghers syndrome (STK11) → mucocutaneous pigmentation, hamartomatous polyps, increased cancer risk. Familial adenomatous polyposis (FAP) (APC gene) → hundreds of adenomas, 100% colon cancer risk without colectomy. Carcinoid tumors (appendix) often incidental. GIST (KIT/PDGFRA mutations) rare in children.

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📋 30 Clinical Scenarios — Digestive Tract Tumors

📇 High‑Yield Review Cards (Digestive Tract Tumors)

🩺 Clinical Presentations: Digestive Tract Tumors

Select a presentation for diagnostic clues and management.

📋 Stepwise Evaluation & Management of GI Tumors

🔑 Key Principles — Tumors of the Digestive Tract (Nelson Ch.393)
• Juvenile polyp: Most common (2-5 years). Painless rectal bleeding. Colonoscopic polypectomy. Benign, no malignant potential.
• Peutz-Jeghers syndrome (PJS): STK11 mutation. Mucocutaneous pigmentation (lips, oral mucosa), hamartomatous polyps. Increased risk of GI and extra-GI cancers (breast, pancreas, ovary). Surveillance: endoscopy at 8 years.
• Familial adenomatous polyposis (FAP): APC gene. Hundreds of colorectal adenomas by teens. 100% cancer risk without colectomy. Prophylactic colectomy. Extra-colonic manifestations: desmoid tumors, CHRPE, osteomas.
• Carcinoid tumor: Most common at appendix (incidental appendectomy). <1.5 cm → appendectomy sufficient. >2 cm → right hemicolectomy. Carcinoid syndrome with liver mets.
• GIST: Rare in children, often KIT/PDGFRA wild-type. Complete resection.

    ⚡ Reflex Prompts — GI Tumor Decisions

    📖 Digestive Tract Tumors — Core Summary