[Verse 1] Duodenum to the ileum, pathology runs deep Four main neoplasms that surgical trainees need to keep Adenocarcinoma hits the duodenum most of all Periampullary region, that's where most of these will fall Whipple's your procedure when it's proximal to the flex Jejunoileal disease gets segmental — don't be perplexed Lymph nodes en bloc, clear your margins, staging drives the call TNM dictates your plan from the duodenal wall [Chorus] A-N-L-G — four letters, four tumours, remember the spread Adeno, NET, Lymphoma, GIST — and melanoma met Multifocal, mesenteric, Whipple or segmental bed Octreotide before you cut or carcinoid crisis fed A-N-L-G — carve it into your head [Verse 2] NETs — neuroendocrine, and multifocality's the trap One lesion on the scan don't mean there's only one on the map Mesenteric fibrosis pulls the bowel like a fist Desmoplastic reaction — loops of bowel get dismissed Carcinoid syndrome: flushing, wheeze, and diarrhoea cascade Serotonin floods the systemic — hepatic mets have made Pre-op octreotide is mandatory, non-negotiable stance Carcinoid crisis intraoperative — don't give it a chance Mesenteric lymphadenectomy wide — chase every node Hepatic metastases resectable — take the aggressive road [Chorus] A-N-L-G — four letters, four tumours, remember the spread Adeno, NET, Lymphoma, GIST — and melanoma met Multifocal, mesenteric, Whipple or segmental bed Octreotide before you cut or carcinoid crisis fed A-N-L-G — carve it into your head [Verse 3] Lymphoma of the small bowel — B-cell, diffuse large MALT and enteropathy-associated T-cell take charge Perforation risk with treatment so your staging must be tight Chemotherapy predominantly, surgery for complication's bite GIST — KIT and PDGFRA mutations, spindle cells aligned Imatinib for high-risk adjuvant — resistance well-defined No lymphadenectomy needed, pseudocapsule intact Rupture spills malignant cells and that's a lethal act Melanoma mets — the small bowel is their favourite haunt Intussusception, bleeding — occult presentation to confront [Bridge] Peutz-Jeghers — hamartomas, mucocutaneous spots STK11 mutation threading through the genetic plots FAP duodenal polyps — Spigelman tells you where you stand Stage four means prophylactic Whipple may be in the plan Size, number, histology, dysplasia — four variables scored Zero to four — tally up, let Spigelman be your lord [Chorus] A-N-L-G — four letters, four tumours, remember the spread Adeno, NET, Lymphoma, GIST — and melanoma met Multifocal, mesenteric, Whipple or segmental bed Octreotide before you cut or carcinoid crisis fed A-N-L-G — carve it into your head [Outro] Proximal or distal, benign-seeming or malign Polyposis syndromes lurking in the Spigelman line Every tumour type demands a different surgical art Know your four, know your staging — that's where masters start
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