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Oncology treatment

Small bowel cancer

Despite the significant extent of the small intestine itself, its tumors account for only 5% of malignant lesions of the gastrointestinal tract. This fact is explained by the fact that food moves through it liquid, and therefore quickly, without having time to cause severe irritation of the walls. Also in the walls of the small intestine there are a large number of protective immune cells - lymphocytes, which not only protect the body from infection from the intestinal lumen, but are also capable of identifying and destroying its own mutated cells.

Why does small intestinal cancer occur?

After all, for the development of a tumor, one altered cell is enough, which, due to DNA damage, will begin to multiply uncontrollably. Most often, tumors of the small intestine occur in the duodenum (duodenum). Compared to other sections (jejunum and ileum), food from the stomach enters the duodenum and, most importantly, active pancreatic enzymes and bile are released here. These enzymes are designed to break down nutrients into the simplest molecules, and therefore, under some circumstances, can cause chronic irritation of the injured mucous membrane (inner membrane).

It is believed that contributing factors for онкологии The small intestine can be damaged by bad habits (smoking, alcohol), chronic diseases (ulcers, polyps), carcinogens in food (nitrates, preservatives, dyes, trans fats). There is also a hereditary predisposition; hereditary syndromes are known that are accompanied by an increased incidence of intestinal tumors (Peutz-Jeghers syndrome, Lynch syndrome, familial polyposis).

How does small intestine cancer manifest?

Tumors can develop from a variety of cells of the small intestine, therefore several types are distinguished: neuroendocrine, lymphoid, sarcomas, adenocarcinomas, stromal, etc. Regardless of the type, tumor growth can be into the lumen (exophytic) or into the intestinal wall (endophytic). Exophytic growth into the intestinal lumen will quickly begin to interfere with the passage of food masses, accompanied by symptoms of intestinal obstruction.
In general, small intestinal cancer does not have specific symptoms unique to it. Common manifestations include pain and indigestion (bloating, irregular bowel movements, diarrhea). Pain occurs due to the fact that the tumor grows into the wall, disrupting normal peristalsis and patency. If the tumor blocks the bile duct and pancreatic duct, enzymes will stop flowing into the duodenum and food will no longer be digested normally, irritating the intestines and causing frequent loose stools.

For small intestinal cancer, the symptoms and manifestations in the initial stages are similar to those of other gastrointestinal disorders, so the disease is rarely detected in time. A person continues to treat false “enteritis” and “dysbacteriosis”, and tumors are discovered at stages when they are already beginning to grow into neighboring organs. In the abdominal cavity, small intestinal cancer can grow into the bladder, omentum, pancreas, and neighboring intestinal loops. Such complications are accompanied by new manifestations, so advanced small intestinal cancer may have specific symptoms in women if the tumor grows, for example, into the uterus.

There are cases when a small intestinal tumor is discovered by chance, during a regular medical examination or examination for another reason.

Why is small intestine cancer dangerous?

If the tumor narrows the intestinal lumen, the movement of food masses becomes very difficult or stops altogether. Above the tumor, the intestines are stretched and swollen, the patient suffers from nausea and vomiting. Below the tumor, food does not arrive. This dangerous condition is called intestinal obstruction and is an indication for surgical treatment.
Even if intestinal patency is at least partially preserved, the overall nutrition of the body suffers and the absorption of nutrients is impaired. In the later stages of the disease, the patient suffers from protein deficiency, vitamin deficiency and general exhaustion with anemia.

Small intestinal tumors that grow into the intestinal wall (endophytic growth) may have other symptoms. Destruction of the intestinal wall leads to either internal bleeding or perforation. Both of these complications are life-threatening and are indications for emergency surgery. Often, a cancerous tumor is discovered during such emergency operations, when the patient is in serious condition, and proper preparation for complete removal of the tumor is impossible.

What is the diagnosis for small intestinal cancer?

If the patient sought medical help before complications, there is a whole arsenal of tools and methods for diagnosing small intestinal cancer. Endoscopic methods are excellent for studying the condition of the mucous membrane from the intestinal lumen, depending on the location of the tumor. For lesions of the duodenum, fibrogastroduodenoscopy (FGDS) and contrast radiography are the standard. For tumors of the lowest section, the ileum, colonoscopy and irrigography are applicable.

You can trace the entire “path” through the intestines using capsule endoscopy (a small swallowed capsule will photograph the intestines from the inside) and x-ray with barium passage (swallowed barium sulfate does not transmit x-rays and its passage through the intestines is clearly visible on x-rays). Other methods are used to search for possible metastases in other organs (lung x-ray, bone scintigraphy, ultrasound, multispiral computed tomography, etc.).

How is small intestinal cancer treated?

The higher the stage of the disease, the more difficult it is to achieve recovery. At the early stages, when the malignant process has not yet spread beyond the tumor of the small intestine, it is possible to completely remove the cancer along with a fragment of the intestine (resection). If tumor foci appear in the surrounding lymph nodes, on the peritoneum and neighboring organs, chemotherapy and radiation therapy are added to the surgical method.

Chemotherapy may be given before surgery to shrink the tumor, or after surgery to destroy any remaining cancer cells. In addition to chemotherapy, there are new classes of anticancer drugs with proven effectiveness. But the main method of treatment remains surgical. Non-surgical treatment is prescribed if the patient refuses surgery or the tumor cannot be removed (resectable cancer). In this case, alternative methods can reduce the size of the tumor and remove it later.

What is the likelihood of relapse?

The risk of relapse increases depending on the extent of the malignant process. The higher the stage, the greater the likelihood of the tumor returning. It is believed that intestinal tumors, compared to other types of cancer, are less likely to metastasize to distant organs. But small intestinal cancer can spread in the abdominal cavity to neighboring organs and the peritoneum.

Therefore, even after the operation, the patient is under medical supervision for several years by an oncologist and regularly undergoes the necessary examinations. The purpose of the examination is to promptly identify possible tumor foci both in the resection area and in the main organs of metastasis (prostate, liver, lungs, bones).

How is a relapse treated?

In case of recurrence of a malignant tumor of the small intestine, a decision is usually made to repeat resection. Even in the presence of multiple metastases in distant organs, surgery can be performed to reduce the tumor burden and to eliminate possible tumor intestinal obstruction. Such palliative treatment improves the patient’s quality of life and prolongs life.

Author of the article:

Aleksanyan Aleksan Zavenovich

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