The structure of the small intestine is divided into three sections:

the duodenum, the shortest, received its name because of its length, equal to the length of 12 fingers in diameter;
the jejunal section in the anatomy of the small intestine is due to its relatively small diameter;
The iliac region is located near the iliac fossa, and therefore is called so to speak because of the area of location.

The small intestine, in which food is exposed to intestinal juice, bile, and pancreatic juice, is located in the middle region of the abdomen, downward from the stomach and transverse colon. In the small intestine, digestion products are also absorbed into the blood and lymphatic vessels. The length of the small intestine ranges from 2.2 to 4.4 m, its thickness is from 4.5 to 6 cm. The small intestine begins from the pylorus of the stomach and flows into the cecum in the region of the right iliac fossa. The structure of the human small intestine is divided into the duodenum, jejunum and ileum.

Small intestine cancer and tumor location

Small intestine cancer accounts for 1-2% of malignant tumors of the digestive tract. According to ICD-10 it has code C17.

Due to the vagueness of the first symptoms, small intestine cancer is diagnosed accidentally, very often during an X-ray examination or organ surgery abdominal cavity during treatment of another disease. In this case, metastasis begins, due to which secondary intestinal cancer develops.

The most common tumors of the small intestine are:

duodenal cancer (about 50% of cases);
jejunal cancer (30%);
ileal cancer (20%).

It is worth noting! Small intestinal cancer primarily affects men over 60 years of age and almost never occurs in people under 50 years of age.

Why are malignant tumors in the small intestine so rare? The contents of the small intestine have a liquid consistency and move very quickly, so they do not irritate the mucous membrane. Carcinogens ingested from food do not have time to cause harm. The small intestine contains very few bacteria but a lot of lymphoid tissue. Alkaline pH and the enzyme benzopyrene hydroxylase are considered protective factors.

Metastases reach regional lymph nodes and other distant parts of the intestine, so the following may develop:

Causes of small intestine cancer

Specific direct causes of small intestinal cancer have not yet been discovered. Attention is always paid to chronic enzymatic or inflammatory bowel disease; cancer symptoms may be hidden behind signs of diseases such as diverticulitis, ulcerative colitis, enteritis, Crohn's disease, duodenal ulcer. Often a tumor develops against the background of adenomatous tumors, which are prone to degeneration into oncogenic ones.

The duodenum is often affected due to the irritating effect of bile. The initial part of the small intestine is due to the juice of the pancreas and active contact with carcinogenic substances from food, fried foods, alcohol and nicotine.

Other reasons for the appearance of a tumor include:

Peutz-Jeghers syndrome;
duodenitis;
celiac disease;
gene pathologies;
benign tumors;
metastasis of the malignant process of other organs.

The first symptoms and signs of small intestine cancer in men and women

If duodenal cancer is suspected, the first symptoms will be similar to gastric and duodenal ulcers and will manifest as aversion to food, dull pain in the epigastric zone radiating to the back. Cancer manifests itself at a late stage duodenum symptoms associated with poor patency of the bile ducts and intestines due to tumor growth. The patient will suffer from endless nausea and vomiting, flatulence and manifestations of jaundice.

The jejunum and ileum are the first to signal cancer local signs and general dyspeptic disorders:

nausea and vomiting;
bloating;
pain in the intestines;
spasms in the navel and/or epigastrium;
frequent loose stools with mucus.

It has been proven that symptoms of small intestinal cancer appear more often in men than in women. Tied up this fact with the lifestyle of men, nutrition and abuse of malicious habits: alcohol, smoking and drugs. In addition, small intestinal cancer develops slightly differently in men due to the different structure of the genitourinary system.

Very often, signs of bowel cancer appear in women. When the tumor metastasizes, symptoms of bowel cancer in men may appear. If the tumor compresses neighboring organs, this leads to the development of pancreatitis, jaundice, ascites, and intestinal ischemia.

The tumor grows, so the symptoms of cancer in the small intestine intensify:

pain during bowel movements;
intestinal patency is impaired;
obvious or hidden intestinal blood loss appears;
perforation of the intestinal wall develops;
the contents enter the peritoneal cavity and peritonitis begins;
intoxication (poisoning) of the body increases due to ulcers and intestinal fistulas;
iron deficiency increases;
the functions of the pancreas and liver are impaired.

Cancer is not gender specific, so the symptoms of bowel cancer in women and men are largely the same:

increasing weakness;
weight loss;
malaise;
anemia, rapid and unexplained fatigue;
neurosis;
anorexia;
difficulty with defecation accompanied by pain;
frequent urge to go to the toilet;
anemia;
pallor skin;
dizziness and migraine;
temperature rise.

It is worth noting! Unlike small intestine cancer, symptoms of colon cancer can be detected in a person regardless of gender and age. The disease is diagnosed even in children, although it is quite rare.

Symptoms and signs of small intestine cancer in women and men

The development of tumors in the early stages in women and men occurs almost equally. The progression of the tumor and its growth into nearby organs makes a distinction in the symptoms. When cancer spreads, it initially affects the vagina of women and the prostate organs of men. Afterwards, the cancer affects the rectum and sphincter canal, causing complaints in both sexes. Pain appears in the area of the anus, lumbar spine, coccygeal region and sacrum. Men experience problems urinating, which indicates damage to the bladder. Body temperature rises significantly, and ureteral infections are likely to develop.

Symptoms at stages 3 and 4

Detection of cancer in the final stages of development significantly complicates the treatment process. The disintegration of the tumor leads to complete intoxication of the body. Patients feel severe pain that radiates to the lumbar region, sacrum, and anus.

At stage 4, symptoms appear such as:

incessant vomiting;
increased gas formation;
development of jaundice;
intestinal ischemia;
pancreatitis.

Compression of neighboring organs by the tumor leads to the formation of fistulas and provokes the appearance of the following symptoms of cancer:

intestinal bleeding;
pain during bowel movements;
disruption of the gastrointestinal tract;
sudden changes in mood and neuroses;
severe fatigue;
peritonitis;
exhaustion;
dry skin;
disorders of the functioning of neighboring organs;
low protein levels in the blood.

Where does small intestinal cancer metastasize?

There are many important organs near the small intestine, and when the cancer spreads, their damage begins.

Also, cancer cells spread through the blood throughout the body to distant lymph nodes; in this case, the following are affected:

lungs;
ovaries and uterus in women;
mammary gland;
prostate;
kidneys and adrenal glands;
bladder;
pancreas;
colon;
liver;
peritoneum.

Classification of small intestine cancer

Depending on their growth characteristics, malignant neoplasms are conventionally divided into the following types:

Exophytic - grows inside the intestinal lumen. Cancer processes provoke stagnation feces in the affected areas of the jejunum, with the development of the disease turning into obstruction. The tumors resemble fungi or polyps with well-defined, structured boundaries, becoming saucer-shaped when ulcerated.
Endophytic, or infiltrative. Neoplasms without clearly defined edges are distributed along the walls of the intestine, gradually growing into a distant organ through the lymphatic system. Tumors can lead to rupture of the intestinal wall and hemorrhage.

According to histological classification, oncological formations of the small intestine are:

- develops from glandular tissue next to the major papilla of the duodenum. The tumor is ulcerated and covered with a fleecy surface.
– develops in any part of the intestine, most often in the appendix. Less often - in the ileum, very rarely - in the rectum. The structure is similar to the epithelial form of cancer.
– a rare tumor formation (18%) and combines lymphosarcoma and ().
– large tumor formation, more than 5 cm in diameter, can be palpated through the peritoneal wall. The tumor creates intestinal obstruction and wall perforation.

Lymphoma of the small intestine can be primary or secondary. If primary lymphoma of the small intestine is confirmed, the symptoms are characterized by the absence of hepatosplenomegaly, enlarged lymph nodes, changes on the sternum x-ray, CT scan, in the blood and bone marrow. If the tumor is large, disturbances in the absorption of food will be observed.

If the retroperitoneal and mesenteric lymph nodes spread tumor cells, then a secondary lymphoma forms in the small intestine. Types of small intestinal cancer include signet ring cell, undifferentiated and unclassified cancer. Growth form – exophytic and endophytic.

Classification of colon cancer according to the TNM system

According to the clinical and anatomical classification according to the international TNM system, the following stages are distinguished in the development of small intestinal cancer:

T - tumor:

Tis - preinvasive cancer;
T1 – tumor invasion of the submucosal layer of the intestine;
T2 – tumor invasion of the muscular layer of the intestine;
T3 is tumor invasion of the subserous layer of the intestine or retroperitoneal space. The tumor is no more than 2 cm;
T4 – tumor invasion of the visceral peritoneum, non-peritoneal areas over an extended period. The tumor is more than 2 cm.

N - damage to lymph nodes:

N0 - no lymph node involvement.
N1 – metastatic lesion of regional lymph nodes.

M – presence of distant metastases:

M0 – absence of isolated metastasis;
M1 - distant metastasis is present.

Stages of small intestine cancer

There are five stages of intestinal adenocarcinoma:

Stage 0 or cancer in situ. A single small tumor that is located on the surface of the mucous membrane and does not grow deeper. There are no metastases.
Stage 1 - the tumor has grown deeply into the intestinal wall, but has not spread to neighboring organs. There are no metastases.
At stage 2 of intestinal cancer, the tumor has grown through the entire thickness of the intestinal wall and has spread to neighboring organs.
At stage 3 of small intestine cancer, cancer cells have spread to regional lymph nodes. There is no growth into other organs or distant metastases.
At stage 4 of small intestine cancer there are distant metastases. Most often they are found in the lungs and liver. bones and other organs.

Diagnosis of small intestine cancer

To recognize bowel cancer at an early stage, it is necessary to carry out a series of diagnostic studies which will determine what treatment will be used, the patient’s condition and the prognosis for survival.

Diagnosis of small intestine cancer depends on the location of the tumor in the intestine itself:

Fibrogastroduodenoscopy and contrast fluoroscopy, using these methods, diagnose the duodenum.
Irrigoscopy and colonoscopy - performed to diagnose the ileum.
To identify stenosis and the presence of obstacles to the movement of barium sulfate suspension, the method of barium passage in the lumen of the tract is used.

During an endoscopy, samples of cancer cells are taken for further laboratory examination to confirm or refute the diagnosis.

Metastasis and spread of a cancerous tumor is detected using:

Ultrasound of the peritoneum;
CT scan of the intestinal tract;
X-ray of organs chest;
bone scintigraphy.

If there is any doubt about the diagnosis, laparoscopy is performed along with surgical intervention.

For malignant tumors, the following laboratory tests are performed:

A blood test reveals a decrease in hemoglobin, increase in ESR, which is typical for any cancer.
Biochemistry – when carcinoembryonic antigen is detected in the plasma, a tumor is diagnosed and its stage of development is established.
A toxic compound occurs in the intestinal tract - the substance indican; it can be detected using a urine test.
Blood for the presence of jejunal cancer is likely to be accompanied by markers,.

Based on stool analysis, the presence of occult blood in the patient’s waste products is revealed.

How to identify intestinal cancer, the symptoms of which do not manifest themselves in anything specific? During this period, it is very important to confirm or refute the suspicion of cancer, because the sooner treatment begins, the easier it is for the patient to endure its stages, the greater the chance of a positive result. When symptoms appear, the oncological process can be considered advanced, and the moment of early treatment will be missed.

Important! TO early symptoms refers to a “young” state that should alert any person - this is a reluctance to work or do household chores due to increased weakness and fatigue. The skin becomes pale and “transparent”. The patient constantly has heaviness in his stomach, he does not feel like eating at all. Following this, dyspeptic disorders appear: nausea, vomiting, pain and heartburn even from water.

Where does the diagnosis of small intestinal cancer begin?

When visiting a doctor, a blood test is immediately prescribed and examined, which is mandatory if bowel cancer is suspected. A general basic blood test can reveal anemia, the patient's condition, and the presence of inflammation.

Then, based on the results of the blood test, a blood test for small intestinal cancer is performed, if necessary. The most informative and common tumor markers are alpha-fetoprotein, total/free PSA, CEA, CA 19-9, and cytokeratin.

For example, with the help of tumor markers CA 19-9 and CEA (carcinoembryonic antigen), screening diagnostics of colon cancer is carried out. If CEA is determined, then you can find out the staging before surgery and monitor the patient diagnosed with colorectal cancer after it. If the disease progresses, then the level of CEA in the serum will increase. Although it may grow not in connection with a tumor, in later stages colorectal cancer can be detected without an increase in CEA in the blood.

Endoscopic diagnosis and open intestinal biopsy are the main methods for confirming small intestinal oncology.

Treatment of small intestine cancer

Treatment of cancer of the small intestine, namely the duodenum, jejunum and ileum, is carried out depending on the type of tumor and stage. The main method is bowel resection and removal of tumor formation.

The extent of surgical intervention depends on the stage of tumor development, its location and the degree of damage to surrounding tissues, organs and systems. Early stage cancers are removed using laparoscopic surgery. Surgery to remove a tumor of the small intestine is performed through several punctures in the anterior abdominal wall. A laparoscope with an LED is inserted through the puncture; a video camera is also inserted into the puncture, transmitting the entire operation process to the computer screen, with its help the surgeon performs surgical manipulations.

If tumors big size, which indicates late stages of cancer development, then in this case extensive operations are used, which include:

resection of the small intestine, in which the affected part of the small intestine is removed along with the lymph nodes and part of the healthy surrounding tissue;
radical surgery in which huge tumors and all tissues affected by metastases are removed;
contactless operation. Carried out by blocking all blood vessels and lymphatic vessels around the tumor. Resection is performed to prevent malignant cells from dispersing throughout the body;
duodenectomy, an operation that is performed for duodenal cancer by resection of the affected area of the small intestine with the subsequent restoration of continuous intestinal patency. The operation is performed independently, as well as in combination with pancreatoduodenectomy, when resection of the pancreas is performed for cancer of the head of the pancreas. Along with surgery on a segment of the small intestine, gastrectomy can be performed. For advanced ileal cancer, a hemicolectomy of the right side of the colon is performed.

With a confirmed diagnosis of small intestinal cancer, surgery reduces symptoms and increases life expectancy. If it is not possible to remove a malignant tumor of the small intestine at a late stage or it is determined that the tumor is sensitive to chemotherapy, drugs that prevent the growth of cancer cells are used.

Chemotherapy for small intestinal cancer

Chemotherapy for small intestine cancer as an independent method of therapy is considered ineffective. It is prescribed as an additional treatment to reduce the risk of developing metastases and as for. Chemotherapy is used before surgery to reduce tumor size and inhibit the development of cancer cells, and after surgery to reduce the risk of tumor recurrence.

After palliative surgery (alleviating the patient's suffering), treatment is carried out with chemotherapy (polychemotherapy), but without radiation.

After the operation, intestinal motility is additionally diagnosed using electrogastroenterography to prevent the development of dangerous complication- intestinal paresis.

To alleviate the patient's condition after surgery and chemotherapy, the following are introduced into complex therapy: alcohol tinctures, infusions and decoctions of medicinal herbs, mushrooms and berries. The corresponding prevents paresis, nausea and vomiting, improves gastrointestinal motility.

Prevention of small intestine (bowel) cancer

It is impossible to reduce the risk of small intestinal cancer, but there are a number of preventive measures that help avoid the formation of tumors in the intestine:

undergo regular preventive examinations;
adhere to principles healthy image life and proper nutrition;
treat diseases in a timely manner gastrointestinal tract;
have an annual stool test for occult blood (the Colon View test, which can detect occult blood in the stool and detect bowel cancer at an early stage);
do not delay and consult a doctor if any alarming symptoms from the digestive system.

What is the prognosis for life with small intestinal cancer?

A favorable outcome of the disease directly depends on the stage at which the diagnosis was made, as well as on the location of the tumor in the intestine.

If the tumor is located regionally and does not have metastases, then after surgery the number of survivors for 5 years is 40 - 50%. Each subsequent stage reduces the percentage of positive outcomes in patients by 15 - 20%.

You can’t take health on credit and you can’t buy it with cash.

Initial signs, symptoms and diagnostic algorithm for small intestinal cancer

Small intestinal cancer is a fairly rare disease that affects three parts of the intestine: the duodenum, jejunum and ileum. In the morbidity structure, tumors of the small intestine occur in 0.5% of cases. Small bowel cancer almost never occurs in people under 50 years of age. After this age, the risk of morbidity increases every year.

The tumor grows from the epithelial tissue of the folds (crypts) of the intestine, the glandular epithelium of the duodenum, and rarely the superficial epithelium can degenerate.

Small intestinal cancer can grow into the lumen of the organ, that is, it will have exophytic growth, and it will grow into the intestinal lining and surrounding tissues – endophytic growth.

Histologically, adenocarcinoma is distinguished in 60% of all cancers and signet ring cell carcinoma in 40%.

Small intestinal cancer can present with a variety of signs and symptoms, depending on the pattern of growth and damage to adjacent organs and structures.

Signs

A malignant neoplasm of this location is characterized by a long asymptomatic course. The first thing patients most often pay attention to is the tarry stool that forms when bleeding from the tumor vessels. When a large vessel is ulcerated, the patient develops melena – loose, foul-smelling black stool. This condition is an alarming sign because it can threaten the patient’s life without specialized help.

Bleeding may be hidden. In this case, the stool will be macroscopically unchanged, but anemia will gradually increase. Chronic blood loss leads to a decrease in the number of red blood cells and hemoglobin. The patient will complain of pallor, dizziness, fatigue, tachycardia.

As with all malignant diseases, asthenic syndrome and causeless weight loss will be observed. The patient complains of decreased physical and mental performance, loss of appetite. An increase in temperature to subfebrile levels is typical.

Symptoms

With an exophytically growing tumor, there is a risk of developing intestinal obstruction. Depending on the degree of obstruction of the intestinal lumen by the formation, the clinical picture of the condition will depend. With increasing mechanical obstruction, the patient will be disturbed by the following complaints:

Abnormal stool. Initially, diarrhea may develop, followed by constipation.
Pain syndrome. Characterized by a gradual increase in pain intensity, up to sharp paroxysmal colic
Nausea, belching with fecal odor
Bloating, distension of the intestines
Profuse vomiting of intestinal contents, followed by slight relief
In advanced cases - dilated intestine visible to the naked eye, paroxysmal strong pain, rumbling

With prolonged vomiting, dehydration occurs and symptoms of intoxication appear. If this condition is not treated, peritonitis may develop - a rupture of the intestinal wall with the release of intestinal contents into the abdominal cavity.

There are some differences in symptoms when the tumor is localized in the duodenum.

If small intestinal cancer forms near the papilla of Vater, the clinical picture will resemble duodenal ulcer. In this case, the patient is bothered by pain in the epigastric region. At the same time, food intake and drug therapy will not bring relief.

If the tumor completely blocks the lumen of the duodenum in the initial part, then the patient complains of distension in the epigastric region, profuse vomiting, after which relief comes. It is noteworthy that bile is not mixed with vomiting, since the total bile duct located below the site of obstruction.

A tumor that develops in the periampullary portion of the duodenum will be characterized by symptoms of compression of the common bile and Wirsung ducts. Bile from the duct will not be able to enter the intestines, while the gallbladder will gradually fill, then the bile will begin to enter the bloodstream through the vessels in the liver. At the same time, the skin acquires yellow, itching may occur. IN biochemical analysis blood there will be an increase in total and direct bilirubin.

Small intestinal cancer localized in the infraampullary part of the duodenum, jejunum and ileum will manifest itself only with the development of mechanical obstruction or with ulceration of the vessel with the development of bleeding.

With endophytically growing malignant neoplasms, the tumor grows through the thickness of the intestinal wall. Further development of the disease can follow several paths:

Perforation of the intestinal wall with the release of contents into the abdominal cavity leads to the development of peritonitis - inflammation of the peritoneum. This is a life-threatening condition. Only emergency laparotomy will save the patient from death.
A tumor that grows into the intestinal wall can form a narrowing of the lumen, which also leads to intestinal obstruction.
Tumor growth into neighboring organs. Most often, the head of the pancreas is involved in the process. Sometimes it is difficult for clinicians to determine which tumor was primary: intestinal or pancreatic. Only by performing an intraoperative biopsy and immunohistochemical study can the answer to this question be known.

Diagnostics

Diagnosing small intestinal cancer is not an easy task, requiring the doctor to have in-depth knowledge of the course of the pathological process. Diagnosis must be preceded by a correct history taking, indications of previous diseases, as well as a description of the onset of the existing disorder.

First you need to evaluate general form the patient, the color of his skin, behavior, gait. If you are careful, even such minor details can point you in the right direction of your search.

Very often, a tumor can creep in or grow into a vessel, which gradually becomes the cause of the development of anemia.

Anemia is a condition caused by a decrease in the concentration of hemoglobin in the blood. Such patients will have pale skin and mucous membranes, they will feel constant weakness and have difficulty tolerating physical exercise. To compensate for the reduced level of partial pressure of oxygen, such patients will need to carry out a large number of respiratory movements, which is expressed in the form of shortness of breath.

If you use physical research methods, then upon palpation you can feel a tumor-like formation on the anterior abdominal wall. It is usually painful and has irregular shape and heterogeneous in its structure. With the help of palpation, one can only indirectly judge the size and consistency of the tumor, so this method is not specific and will only allow one to suspect the presence of an oncological process.

It is difficult to hear something special by auscultation and can only be achieved in the later stages of the disease. When the tumor reaches large sizes and blocks the intestinal lumen - the noise of peristalsis of the digestive tract disappears and the so-called “falling drop” symptom appears. When “tapping”, you can listen to a dullness of percussion noise in the projection above the tumor.

Laboratory research

The diagnostic algorithm for a tumor of the small intestine includes:

Clinical analysis of blood, urine
Feces for occult blood
Blood chemistry
Tumor markers
X-ray of the abdominal organs with contrast enhancement
EFGDS
Colonoscopy and irrigoscopy
Biopsy and histological examination
CT scan
Magnetic resonance imaging

Laboratory research methods include a number of tests that help in diagnosing the disease. It should be said that there are simply no specific tests that speak in favor of the presence or absence of an oncological process. But there are several indicators that allow us to suspect the development of an oncological process.

A general blood test shows us the main indicators, the number of red and white blood cells, as well as their ratio. As mentioned above, anemia often occurs as the tumor grows; in tests, this is manifested by a decrease in hemoglobin concentration, as well as erythrocytopenia. All this speaks in favor of hemorrhagic anemia.

White blood cells can be either increased or decreased, or may even be normal; there is no definite dependence here, since this indicator is not specific to the tumor process.

Changes in the biochemical blood test begin with the development of complications of a tumor of the small intestine. Prolonged vomiting with intestinal obstruction leads to thickening of the blood - the hematocrit increases, changes in ionic ratios occur, and metabolic alkalosis develops in the body - a shift in pH to the alkaline side.

When the tumor obstructs the papilla of the common bile duct, obstructive jaundice develops. In a blood test, this will be manifested by an increase in the concentration of total and bound bilirubin.

When analyzing stool, hidden blood can be detected, which can lead us to the development of an oncological process.

For carcinoma, the detection of tumor markers is most indicative. Tumor markers are special biological compounds that are waste products of a neoplasm or synthesized by healthy tissues of the body as a response to a pathological process.

This indicator allows you to suspect the presence of a tumor and prevent further progression of growth if timely treatment. Tumor markers are a very convenient diagnostic method, especially when you need to examine a large number of people. Small intestinal tumors are characterized by CEA, ACE, CA 19-9, CA 242, CA 72-4, Tu M2-RK.

Instrumental methods

Instrumental methods are the most relevant and indicative today. There are many techniques that make it possible to visualize a tumor, but ultrasound is considered the simplest.

Using ultrasound, you can assess the size of the tumor, its density, shape and location. However, it should be said that no oncologist can make a correct diagnosis based only on these data. Ultrasound is only a screening diagnostic method in this matter, which will provide justification for further research.

Endoscopic imaging techniques play a leading role in detecting tumors in the upper digestive tract.

An endoscope is a special optical device, in the form of a tube, with a built-in camera that transmits an image to a screen. Using an endoscope, you can not only see the tumor, but also collect biological material for further research.

When tumor formation is localized in the upper gastrointestinal tract, esophagogastroduodenoscopy (EFGDS) is most relevant. To perform this procedure, the patient is asked to swallow the endoscope and lie on his side. The surgeon guides the device through the digestive tract, assesses the condition of the walls of the esophagus, their color, shine, shape of the folds and several other indicators; a similar assessment occurs in the stomach.

The duodenum interests us most of all. Using endoscopy, you can detect a tumor, evaluate the direction of its growth (endo- or exophytic), the degree of lumen overlap, and also take a sample for laboratory research. Colonoscopy and irrigoscopy are considered the most useful for examining the terminal ileum.

Another value of endoscopic manipulation is small intestinal biopsy. Biopsy is special technique thanks to which it is possible to carry out intravital sampling of pathological and healthy tissues from the area of interest to us. In diagnosing small intestinal cancer, we may be interested in two types of small intestinal tumor biopsy - endoscopic and intraoperative.

With the endoscopic method, a tumor is visualized using an optical device, then biomaterial is taken, the endoscope is withdrawn, and the tumor cells pass further research in the laboratory. During pathohistological examination, the nature and structure of the biomaterial is assessed and on this basis a decision is made about the malignancy of the formation. In the future, based on this decision, further treatment tactics will be decided.

Intraoperative biopsy is one of the stages surgical intervention. The surgeon gains access to the abdominal cavity, detects a tumor, collects biomaterial, then gives tumor samples to a laboratory assistant, and the histologist, after a rapid biopsy, renders his verdict. If the tumor is malignant, then several scenarios are possible.

For small tumors, the surgeon performs a resection of part of the intestine. The removed tissue is then also examined by a histologist to confirm the diagnosis. If the tumor is large and grows into neighboring organs, then the surgeon leaves the abdominal cavity, sutures the surgical wounds, and in the future such a patient will be treated by radiologists or chemotherapists.

Contrast fluoroscopy is also very useful in instrumental diagnostics. To carry it out, you will need an x-ray and a special contrast solution, usually barium sulfate. Contrast is used to obtain a clearer image, as well as to obtain clear contours of the walls of hollow organs. In the presence of a tumor, a narrowing of the lumen will be observed, looking like an isthmus in a certain area.

Additional instrumental methods such as computed tomography or magnetic resonance imaging are very convenient for searching for metastases. These techniques are very good and allow detailed visualization of the tumor, especially if it has a heterogeneous structure.

Symptoms and diagnosis of small intestinal tumors depend on the location of the cancer. If carcinoma grows in the upper parts of the duodenum, then, as a rule, the disease manifests itself in the early stages. When localized lower in the intestine, it may take a long time for pathognomonic symptoms to appear.

Cancerous tumors can form in virtually any organ and system of the human body. Their proliferation leads to functional disorders and destructive tissue changes, which without proper treatment almost always ends in death. There are a number of dependencies between certain types of disease regarding the likelihood of their development at a given age or condition. Thus, small intestinal cancer is quite rare disease, but this does not reduce its danger.

What is small intestinal cancer

Small intestinal cancer is an oncological disease localized in the digestive tract. In most cases, the tumor begins to grow from epithelial cells, gradually filling the intestinal lumen. This type of cancer occurs infrequently; metastases primarily spread through the lymphatic system, affecting the liver, adrenal glands, kidneys, lungs and bones.

As for the frequency of diagnosis of this type of tumor, it is worth noting that the data differs slightly among different authors. For example, a number of experts claim that such diseases are detected on average in 10% of cases, however, according to summary statistics, small intestinal cancer accounts for approximately 3% of all cases of malignant tumors detected in the digestive system.

Specialist's note: greatest number cases of the disease are observed in Asian countries that are at the stage of development, and the least in developed European countries. Men are more predisposed to developing this type of cancer: compared to women, there are one and a half times more male patients with this diagnosis. Also noted age characteristics– the largest number of cases occurs over the age of 60 years.

Classification

Depending on which intestinal cells were affected, several types of cancer are distinguished.

Table: types of small intestine cancer

	Characteristic
Carcinoma	The carcinoid type of tumor develops most often, and the lesions are multiple. This formation is formed on the layers of squamous epithelium. Like any other type, it can grow unlimitedly, while affecting other organs and systems.
Adenocarcinoma	Unlike the previous type, it is formed from altered cells of the glandular epithelium. A feature of the cells that serve as the basis for the development of neoplasms is their ability to produce mucus. The size and shape of a tumor can be very different.
	Sarcomas are formed from connective tissue. This type of small intestinal cancer differs rapid growth and a tendency to relapse. It has no clear boundaries and smoothly passes into healthy tissues. Often this type of tumor develops together with another malignant formation in the intestine.
	Elements affected lymphatic system located in the small intestine. Easily and quickly spread throughout the body.

Causes

To date, doctors cannot name the exact reasons that would directly influence the formation of a cancerous tumor in the small intestine. In approximately half of the cases, the neoplasm is localized in the area of the duodenum, which is explained by the location of the department - it is the first to come into contact with aggressive substances that enter the body. There are a number of factors that contribute to the emergence and development of this disease:

hereditary predisposition;
pathological changes resulting from poor nutrition;
frequent stress, states of nervous tension;
work that involves contact with toxic chemicals;
long-term development chronic diseases gastrointestinal tract (for example, Crohn's disease, the presence of ulcerative formations, diverticulitis, etc.);
benign tumor;
irritating effects of bile and stomach juice on parts of the small intestine;
sporadic polyposis of the adenomatous type is an increased risk factor;
the person has bad habits (smoking, alcoholism);
contact with radiation;
some genetic diseases;
oncological diseases of other organs digestive system.

Symptoms

Manifestations of the disease develop gradually; at the first stage, the tumor usually does not give any symptoms, which is the main danger - patients often come in at later stages, when the likelihood of recovery is extremely low or completely absent.

The most common symptoms are the following:

the appearance of periodic pain in the intestinal area, they are of the nature of spasms;
nausea and vomiting;
weight loss;
loss of appetite;
Bleeding is often observed in the presence of sarcoma;
the stool becomes unstable;
if the tumor grows strongly, the intestinal lumen may become blocked, causing obstruction to develop;
in the presence of metastases, symptoms associated with disruption of the functioning of other affected organs occur.

Diagnostics

Making a diagnosis requires a thorough examination of the patient's condition. In a circle necessary measures includes:

examination of family medical history;
collection of patient complaints;
medical examination;
blood test to determine the current state of its components;
analysis of stool for the presence of occult blood;
examination of the duodenum using an endoscope;
ultrasonography;
CM (computed tomography), MRI (magnetic resonance imaging);
tissue biopsy of the detected tumor.

Physician's Note: Special Importance for Diagnosis oncological diseases takes blood and urine to identify tumor markers - special protein formations that are released during development in the body malignant tumor.

Stages of the disease and treatment prognosis

The success of treatment for cancer largely depends on the speed of the patient’s response to the identified signs and the condition of the tumor at the time of initiation of treatment.

Table: stages of cancer

	Tumor status
	The tumor is concentrated within the lumen or walls of the small intestine and does not spread beyond the organ.	The first two stages of cancer are considered the most favorable in terms of prognosis for recovery. The tumor in such a situation is localized, which makes it possible to effectively influence it.
	The formation begins to extend beyond the intestinal walls, being at the stage of spread, but not yet metastasizing.
	There are metastases, but they are located in close proximity to the tumor (for example, in several lymph nodes near the intestine).	The prognosis is considered unfavorable, but with active therapy with aggressive techniques there is a chance of recovery.
Fourth	Metastases have spread to distant organs	The process is uncontrollable and irreversible, recovery is impossible. However, at this stage all apply possible methods to improve the patient’s quality of life and maximize its prolongation. The five-year survival rate reaches approximately 5%.

Treatment

Treatment of a cancerous tumor is a complex and multifactorial process, which is quite difficult for the patient to tolerate due to the use of aggressive techniques. However, it is precisely this approach that allows you to fight the disease and achieve positive results.

Surgical

To date, the only treatment method that gives real results is intestinal resection, that is, surgical removal of the affected area. The scope of a particular operation and the techniques used during it are completely determined by the current condition of the patient and the extent of the cancer. In general, two types of intervention can be distinguished:

radical operations (their main goal is to completely remove the source of the problem, namely the affected part of the intestine and nearby tissues damaged by the process);
palliative procedures are necessary to alleviate the patient's condition.

Chemotherapy

If the tumor cannot be removed or the formation is considered sensitive to chemicals, then chemotherapy must be included in the course of treatment. The procedure involves the introduction of powerful toxins into the body, which are designed to have a destructive effect on tumor cells. Unfortunately, such treatment is very difficult, often affects the cells of healthy organs, and has a large list of side effects:

baldness;
damage to mucous membranes;
death of some blood cells (that is, weakening of the immune system);
nausea and vomiting.

It is worth noting that even the presence of pronounced side effects is not a reason to stop therapy with this method.

Radiation therapy is an additional method that is used to enhance the effect of chemotherapy and surgery. The procedure is carried out using special devices with ionizing radiation, the source of which is a radioactive substance.

Diseased cells die due to radiation from a radioactive substance

The action is based on the fact that cancer cells are more susceptible to this type of radiation; under its influence, multiple mutations develop in them, which is why diseased cells die. Healthy cells have greater resistance to such radiation, so they usually cannot be destroyed. In some cases, radiation therapy can minimize the symptomatic manifestations of developing cancer.

Traditional methods

It is worth understanding that cancer is a very serious and dangerous disease, and that is why it requires active traditional treatment. Traditional methods in this case can only play a supporting role, strengthening the body and helping to alleviate symptomatic manifestations.

In various sources you can find the following recipes for patients with small intestinal cancer:

It is recommended to take 100 ml of cabbage juice daily for at least a month.
A decoction of buckthorn (2 parts) and chamomile (1 part). The composition is poured with hot water and boiled over low heat for about 10 minutes.
A decoction of calamus root (30 grams of the main ingredient will require a liter of water), which is drunk warm every morning.
As an immunomodulator, you can use a tincture from the pericarp of a regular walnut. To prepare the composition, the amniotic part of nuts in the amount of 25 pieces is placed in 2 liters sugar syrup and insist for three days. Take the resulting infusion daily, two tablespoons before meals.
Pumpkin juice (you should drink half a glass a day to maintain immunity).

Photo gallery of folk remedies

Calamus roots for decoction Chamomile for decoction Buckthorn bark for decoction

Examples of treatment for small intestine cancer - reviews

There are many cancer patients in all age groups, and all their stories are different - some manage to cope with the disease, while others do not. You can find a huge number of real stories from people who have encountered small intestinal cancer in their lives.

Small intestinal cancer is the second case of cancer in the last 10 years. During the third stage, she underwent 8 courses of chemotherapy, several surgeries and radiation therapy. Today, the consequences of all this horror still remain, but thanks to the desire to live and the support of friends, I coped with the terrible diagnosis.

Svetlana

My father-in-law was 55 years old when he was diagnosed with stage 3 cancer. Despite undergoing chemotherapy, the body could not cope, everything ended after 2 years of struggle.

http://www.woman.ru/health/medley7/thread/4245436

The problem was discovered by chance during an abdominal ultrasound. We were caught at the first stage, so everything was done with one operation and concomitant therapy.

http://forumjizni.ru/showthread.php?t=12361

Possible complications and concomitant diseases

The most dangerous complication of the development of a cancer tumor in the small intestine is its metastasis. When the affected cells move to other organs and systems other than the place of their initial formation, a variety of consequences can be observed: jaundice, significant depletion, and others, depending on the organ affected by metastases. Without proper and active treatment, cancer gradually destroys the body, leading to death.

Prevention

Considering the fact that doctors cannot identify specific causes, all a person can do to prevent the occurrence of small intestine cancer is to minimize the number of negative factors in their life that increase the risk of the disease, namely:

rejection of bad habits;
rational healthy nutrition;
avoiding stress and nervous tension, visiting a specialist if necessary;
periodic passage comprehensive survey body;
timely response to the presence of other diseases and their correct treatment.

If detected early, small intestinal cancer can be successfully treated; in general, it all depends on the condition of the patient’s body. Therapy for such a disease is complex and lengthy, but with the right approach it gives good results and allows you to prolong a person’s life.

The length of the loop-shaped small intestine reaches 4.5 m. It consists of intestines: duodenum, jejunum and ileum. In each of these components, under favorable conditions, small intestinal cancer can degenerate from a normal cell.

Malignant tumor of the small intestine

The absence of obvious specific primary symptoms forces patients to seek help from a doctor in the later stages of the disease. In this case, metastasis begins, due to which secondary intestinal cancer develops.

Metastases reach regional lymph nodes and other distant parts of the intestine, so the following cancers can develop:

Causes of small intestine cancer

Specific direct causes of small intestinal cancer have not yet been discovered. Attention is always paid to chronic enzymatic or inflammatory bowel disease; cancer symptoms can be hidden behind signs of diseases such as diverticulitis, ulcerative colitis, enteritis, Crohn's disease, duodenal ulcer. Often the tumor develops against the background of adenomatous polyps, which are prone to degeneration into oncogenic ones.

The first symptoms and signs of small intestine cancer in men and women

If duodenal cancer is suspected, the first symptoms will be similar to gastric and duodenal ulcers and will manifest as aversion to food, dull pain in the epigastric zone radiating to the back. At a late stage, duodenal cancer exhibits symptoms associated with poor patency of the bile ducts and intestines due to tumor growth. The patient will suffer from endless nausea and vomiting, flatulence and manifestations of jaundice.

The jejunum and ileum signal about oncology with the first local signs and general dyspeptic disorders:

nausea and vomiting;
bloating;
pain in the intestines;
spasms in the navel and/or epigastrium;
frequent loose stools with mucus.

It has been proven that small intestinal cancer symptoms and manifestations occur more often in men than in women. This fact is associated with the lifestyle of men, nutrition and abuse of malicious habits: alcohol, smoking and drugs. In addition, small intestinal cancer develops; signs and symptoms manifest themselves somewhat differently due to the different structure of the genitourinary system.

Very often, with breast, cervical and ovarian cancer, signs of intestinal cancer appear in women. With metastases of a tumor of the prostate gland or testicle, symptoms of intestinal cancer in men may appear. If the tumor compresses neighboring organs, this leads to the development of pancreatitis, jaundice, ascites, and intestinal ischemia.

Small intestine cancer: symptoms and manifestations

The tumor grows, so the symptoms of oncology in the small intestine intensify:

intestinal patency is impaired;
obvious or hidden intestinal blood loss appears;
perforation of the intestinal wall develops;
the contents enter the peritoneal cavity and peritonitis begins;
intoxication (poisoning) of the body increases due to the breakdown of tumor cells, ulcers and intestinal fistulas appear;
iron deficiency increases;
the functions of the pancreas and liver are impaired.

Cancer does not have a gender identity, so the symptoms of bowel cancer in women and men are largely the same: increasing weakness, weight loss, malaise, anemia and rapid and unexplained fatigue, nervousness, anorexia, difficulty defecating, accompanied by pain, itching , frequent urges.

Classification of stages of small intestine cancer. Types and Types of Small Bowel Cancer

According to histological classification, oncological formations of the small intestine are:

adenocarcinoma - develops from glandular tissue next to the major papilla of the duodenum. The tumor is ulcerated and covered with a fleecy surface;
carcinoid - develops in any part of the intestine, most often in the appendix. Less often - in the ileum, very rarely - in the rectum. The structure is similar to the epithelial form of cancer.
lymphoma is a rare tumor (18%) and combines lymphosarcoma and lymphogranulomatosis (Hodgkin's disease);
leiomyosarcoma is a large tumor, more than 5 cm in diameter, that can be palpated through the peritoneal wall. The tumor creates intestinal obstruction and wall perforation.

Stages of small intestine cancer:

Stage 1 cancer of the small intestine – tumor within the walls of the small intestine, no metastases;
Stage 2 of small intestine cancer – the tumor extends beyond the intestinal wall, begins to penetrate other organs, there are no metastases;
Stage 3 of small intestine cancer - metastasis to the nearest lymph nodes, germination to other organs, no distant metastases;
small intestine cancer stage 4 – metastasis in distant organs (liver, lungs, bones, etc.).

Diagnosis of small intestine cancer

How to recognize colon cancer at an early stage? This determines what treatment will be used, the patient’s condition and the prognosis for survival.

Diagnosis of small intestine cancer is carried out using popular methods:

X-ray examination;
fibrogastroscopy;
angiography of the vessels of the peritoneal cavity;
laparoscopy;
colonoscopy;
CT and MRI;
biopsy examination: determine the type of cells and the degree of their malignancy;
electrogastroenterography: detect disturbances in small intestinal motility characteristic of cancer.

How to identify intestinal cancer, the symptoms of which do not manifest themselves in anything specific? During this period, it is very important to confirm or refute the suspicion of cancer, because the sooner treatment begins, the easier it is for the patient to endure its stages, the greater the chance of a positive result. When symptoms appear, the oncological process can be considered advanced, and the moment of early treatment will be missed.

Important! Early symptoms include a “young” state, which should alert any person - this is a reluctance to work or do household chores due to increased weakness and fatigue. The skin becomes pale and “transparent”. The patient constantly has heaviness in his stomach, he does not feel like eating at all. Following this, dyspeptic disorders appear: nausea, vomiting, pain and heartburn even from water.

When visiting a doctor, a blood test for colon cancer is immediately prescribed and examined. A general basic blood test can reveal anemia, the patient's condition, and the presence of inflammation. According to the level of ESR and hemoglobin - problems in the liver, kidneys and blood. The composition of the blood may indicate certain diseases, including cancer.

Tumor markers for small intestinal cancer are detected in the blood. The most informative and common tumor markers are alpha-fetoprotein, total PSA/free PSA, CEA, CA-15.3, CA-125, CA-19.9, CA-72.4, CYFRA-21.1, hCG and cytokeratin .

For example, using the tumor markers CA 19.9 and CEA (carcinoembryonic antigen), screening diagnostics of colon cancer is carried out. If CEA is determined, then you can find out the staging before surgery and monitor the patient diagnosed with colorectal cancer after it. If the disease progresses, then the level of CEA in the serum will increase. Although it may grow not in connection with a tumor, in later stages colorectal cancer can be detected without an increase in CEA in the blood.

Endoscopic diagnosis and open intestinal biopsy are the main methods for confirming small intestinal oncology.

Treatment of small intestine cancer

Treatment of small intestinal cancer: duodenal, jejunal and ileal intestines is carried out depending on the type of tumor and stage. The main method is bowel resection and removal of tumor formation.

With a confirmed diagnosis of small intestinal cancer, surgery reduces symptoms and increases life expectancy. If it is not possible to remove malignant tumors of the small intestine at a late stage or it is determined that the tumor is sensitive to chemotherapy, drugs that prevent the growth of cancer cells are used.

After a palliative operation (alleviating the patient's suffering), treatment is carried out with chemotherapy (polychemotherapy), but without radiation.

After the operation, intestinal motility is additionally diagnosed using electrogastroenterography to prevent the development of a dangerous complication - intestinal paresis.

To alleviate the patient's condition after surgery and chemotherapy, traditional medicine for intestinal cancer is introduced into complex therapy: alcohol tinctures, infusions and decoctions of medicinal herbs, mushrooms and berries. Appropriate nutrition for intestinal cancer prevents paresis, nausea and vomiting, and improves gastrointestinal motility.

Forecast and prevention of small intestine (bowel) cancer

Prevention of small intestinal cancer consists of timely removal of benign tumors and polyps, constant monitoring by specialists of patients with chronic inflammatory processes of the gastrointestinal tract, switching to a healthy diet and lifestyle, and giving up bad habits.

If treatment was given and bowel cancer was removed, how long do people live? If there are no regional or distant metastases, the tumor is removed, survival in the subsequent 5-year period can be 35-40%.

Conclusions! If the tumor is operable, a wide resection of a section of the intestine with lymph nodes and mesentery is performed within the boundaries of healthy tissue. To restore the integrity of the gastrointestinal tract, enteroenteroanastomosis is performed - small intestine into the small intestine or enterocoloanastomosis - small intestine into the large intestine.

For cancer of the duodenum, as part of the small duodenum, duodenectomy and sometimes distal resection of the stomach or pancreas (pancreaticoduodenectomy) are performed. In case of advanced oncology of the small intestine, a bypass anastomosis is performed between loops that remain unaffected. Surgical treatment is supplemented with chemotherapy.

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Initial signs, symptoms and diagnostic algorithm for small intestinal cancer

The tumor grows from the epithelial tissue of the folds (crypts) of the intestine, the glandular epithelium of the duodenum, and rarely the superficial epithelium can degenerate.

Small intestinal cancer can grow into the lumen of the organ, that is, it will have exophytic growth, and it will grow into the intestinal lining and surrounding tissues – endophytic growth.

Histologically, adenocarcinoma is distinguished in 60% of all cancers and signet ring cell carcinoma in 40%.

Small intestinal cancer can present with a variety of signs and symptoms, depending on the pattern of growth and damage to adjacent organs and structures.

Signs

Symptoms

With an exophytically growing tumor, there is a risk of developing intestinal obstruction. Depending on the degree of obstruction of the intestinal lumen by the formation, the clinical picture of the condition will depend. With increasing mechanical obstruction, the patient will be disturbed by the following complaints:

Abnormal stool. Initially, diarrhea may develop, followed by constipation.
Pain syndrome. Characterized by a gradual increase in pain intensity, up to sharp paroxysmal colic
Nausea, belching with fecal odor
Bloating, distension of the intestines
Profuse vomiting of intestinal contents, followed by slight relief
In advanced cases - dilated intestine visible to the naked eye, paroxysmal severe pain, rumbling

There are some differences in symptoms when the tumor is localized in the duodenum.

If small intestinal cancer forms near the papilla of Vater, the clinical picture will resemble duodenal ulcer. In this case, the patient is bothered by pain in the epigastric region. In this case, eating and drug therapy will not bring relief.

If the tumor completely blocks the lumen of the duodenum in the initial part, then the patient complains of distension in the epigastric region, profuse vomiting, after which relief comes. It is noteworthy that bile is not mixed with vomiting, since the common bile duct is located below the site of obstruction.

A tumor that develops in the periampullary portion of the duodenum will be characterized by symptoms of compression of the common bile and Wirsung ducts. Bile from the duct will not be able to enter the intestines, while the gallbladder will gradually fill, then the bile will begin to enter the bloodstream through the vessels in the liver. The skin becomes yellow in color and itching may occur. A biochemical blood test will show an increase in total and direct bilirubin.

With endophytically growing malignant neoplasms, the tumor grows through the thickness of the intestinal wall. Further development of the disease can follow several paths:

Perforation of the intestinal wall with the release of contents into the abdominal cavity leads to the development of peritonitis - inflammation of the peritoneum. This is a life-threatening condition. Only emergency laparotomy will save the patient from death.
A tumor that grows into the intestinal wall can form a narrowing of the lumen, which also leads to intestinal obstruction.
Tumor growth into neighboring organs. Most often, the head of the pancreas is involved in the process. Sometimes it is difficult for clinicians to determine which tumor was primary: intestinal or pancreatic. Only by performing an intraoperative biopsy and immunohistochemical study can the answer to this question be known.

Diagnostics

Initially, it is necessary to assess the general appearance of the patient, the color of his skin, behavior, and gait. If you are careful, even such minor details can point you in the right direction of your search.

Very often, a tumor can creep in or grow into a vessel, which gradually becomes the cause of the development of anemia.

Anemia is a condition caused by a decrease in the concentration of hemoglobin in the blood. Such patients will have pale skin and mucous membranes, they will feel constant weakness and cannot tolerate physical activity well. To compensate for the reduced level of partial pressure of oxygen, such patients will need to carry out a large number of respiratory movements, which is expressed in the form of shortness of breath.

If you use physical research methods, then upon palpation you can feel a tumor-like formation on the anterior abdominal wall. It is usually painful, has an irregular shape and is heterogeneous in its structure. With the help of palpation, one can only indirectly judge the size and consistency of the tumor, so this method is not specific and will only allow one to suspect the presence of an oncological process.

It is difficult to hear something special by auscultation and can only be achieved in the later stages of the disease. When the tumor reaches a large size and blocks the intestinal lumen, the noise of peristalsis of the digestive tract disappears and the so-called “falling drop” symptom appears. When “tapping”, you can listen to a dullness of percussion noise in the projection above the tumor.

Laboratory research

The diagnostic algorithm for a tumor of the small intestine includes:

Clinical analysis of blood, urine
Feces for occult blood
Blood chemistry
Tumor markers
X-ray of the abdominal organs with contrast enhancement
EFGDS
Colonoscopy and irrigoscopy
Biopsy and histological examination
CT scan
Magnetic resonance imaging

White blood cells can be either increased or decreased, or may even be normal; there is no definite dependence here, since this indicator is not specific to the tumor process.

When the tumor obstructs the papilla of the common bile duct, obstructive jaundice develops. In a blood test, this will be manifested by an increase in the concentration of total and bound bilirubin.

When analyzing stool, hidden blood can be detected, which can lead us to the development of an oncological process.

This indicator allows you to suspect the presence of a tumor and prevent further progression of growth with timely treatment. Tumor markers are a very convenient diagnostic method, especially when you need to examine a large number of people. Small intestinal tumors are characterized by CEA, ACE, CA 19-9, CA 242, CA 72-4, Tu M2-RK.

Instrumental methods

Instrumental methods are the most relevant and indicative today. There are many techniques that make it possible to visualize a tumor, but ultrasound is considered the simplest.

Endoscopic imaging techniques play a leading role in detecting tumors in the upper digestive tract.

The duodenum interests us most of all. Using endoscopy, you can detect a tumor, evaluate the direction of its growth (endo- or exophytic), the degree of lumen overlap, and also take a sample for laboratory testing. Colonoscopy and irrigoscopy are considered the most useful for examining the terminal ileum.

Another value of endoscopic manipulation is small intestinal biopsy. A biopsy is a special technique that makes it possible to carry out intravital sampling of pathological and healthy tissues from the area of interest to us. In diagnosing small intestinal cancer, we may be interested in two types of small intestinal tumor biopsy - endoscopic and intraoperative.

With the endoscopic method, a tumor is visualized using an optical device, then biomaterial is taken, the endoscope is withdrawn, and the tumor cells undergo further examination in the laboratory. During pathohistological examination, the nature and structure of the biomaterial is assessed and on this basis a decision is made about the malignancy of the formation. In the future, based on this decision, further treatment tactics will be decided.

Intraoperative biopsy is one of the stages of surgical intervention. The surgeon gains access to the abdominal cavity, detects a tumor, collects biomaterial, then gives tumor samples to a laboratory assistant, and the histologist, after a rapid biopsy, renders his verdict. If the tumor is malignant, then several scenarios are possible.

Small bowel cancer

Small intestine cancer is a malignant tumor lesion of parts of the small intestine: duodenum, jejunum or ileum. Small intestinal cancer manifests itself as dyspeptic disorders (nausea, vomiting, flatulence, cramping abdominal pain), weight loss, bleeding, and intestinal obstruction. Diagnosis of cancer of the small intestine can be carried out using FGDS, radiography, capsule endoscopy, colonoscopy, gastrointestinal scintigraphy, tomography, endoscopic biopsy, laparoscopy. Treatment of small intestinal cancer consists of resection of the affected area of the intestine, excision of regional lymph nodes and mesentery, and the application of enteroenteroanastomosis.

Small bowel cancer

In the structure of malignant tumors of the digestive tract, small intestinal cancer accounts for 1-2%. Among small intestinal neoplasms in gastroenterology, duodenal cancer is more common (about 50% of cases); less often - jejunal cancer (30%) and ileal cancer (20%). Small intestinal cancer is a disease that predominantly affects men over the age of 60.

Causes of small intestine cancer

In most cases, small intestinal cancer develops against the background of chronic enzymatic or inflammatory diseases of the gastrointestinal tract (celiac disease, duodenitis, peptic ulcer, enteritis, Crohn's disease, nonspecific ulcerative colitis, diverticulitis) or epithelial benign tumors intestines. The predominant damage to the duodenum is explained by the irritating effect of bile and pancreatic juice on the initial part of the small intestine, as well as its active contact with carcinogens entering the digestive tract with food.

Cases of sporadic or familial adenomatous polyposis are increased risk factors for developing small intestinal cancer. The likelihood of developing small intestinal cancer is higher in smokers, people exposed to radiation exposure those suffering from alcohol addiction; people whose diet is dominated by animal fats, canned foods, and fried foods.

There is a certain mutual relationship between colon cancer and tumor damage to the small intestine.

Classification of small intestine cancer

Based on the nature of the growth of tumor tissue, exophytic and endophytic cancer of the small intestine are distinguished. Exophytic tumors grow into the intestinal lumen, causing its narrowing and the development of intestinal obstruction; macroscopically may resemble a polyp or cauliflower. Endophytic forms of cancer infiltrate the wall of the small intestine in depth, accompanied by intestinal bleeding, perforation and peritonitis.

According to the histological structure, malignant tumors of the small intestine are often represented by adenocarcinoma; Less common in oncological practice are sarcomas, carcinoids, and intestinal lymphoma.

According to the clinical and anatomical classification according to the international TNM system, the development of small intestine cancer is divided into stages:

Tis - preinvasive cancer
T1 – tumor invasion of the submucosal layer of the intestine
T2 – tumor invasion of the muscular layer of the intestine
T3 – tumor invasion of the subserous layer of the intestine or retroperitoneal space in an area of no more than 2 cm
T4 – tumor invasion of the visceral peritoneum, non-peritoneal areas more than 2 cm in length, structures or organs adjacent to the intestine.
N0 and M0 – absence of regional and isolated metastasis
N1 – metastatic lesion of regional lymph nodes (pancreaticoduodenal, pyloric, hepatic, mesenteric).
Ml – the presence of distant metastases in the peritoneum, liver, omentum, lungs, kidneys, bones, adrenal glands.

Symptoms of small intestine cancer

Manifestations of small intestinal cancer are characterized by polymorphism, which is associated with variability in the location, histology and size of the tumor. IN initial stages I am concerned about periodically recurring spasmodic pain in the abdomen, stool instability (diarrhea and constipation), flatulence, nausea and vomiting. Intoxication and progressive loss of body weight are noted, which is associated both with decreased nutrition and tumor growth.

Destructive processes in small intestinal cancer can lead to the development of intestinal bleeding, perforation of the intestinal wall, entry of contents into the abdominal cavity and peritonitis. Exophytic growth of tumors is often accompanied by obstructive intestinal obstruction with a corresponding clinical picture. When the tumor compresses neighboring organs, pancreatitis, jaundice, ascites, and intestinal ischemia can develop.

Sometimes there is fusion of the tumor with neighboring intestinal loops, the bladder, large intestine, and omentum with the formation of a single, sedentary conglomerate. When ulceration and decay of small intestinal cancer occurs, intestinal fistulas can occur.

Diagnosis of small intestine cancer

The diagnostic algorithm for small intestinal cancer of various locations has its own characteristics. Thus, in the recognition of tumors of the duodenum, fibrogastroduodenoscopy and contrast fluoroscopy play a leading role. Colonoscopy and irrigoscopy can be informative for diagnosing tumors of the terminal ileum.

An important role in the diagnosis of small intestinal cancer is played by barium passage radiography, which makes it possible to identify obstacles to the advancement of the contrast agent, areas of stenosis and suprastenotic dilatation of the intestine. The value of endoscopic studies lies in the possibility of performing a biopsy for subsequent morphological verification of the diagnosis. Selective angiography of the abdominal cavity may be of certain diagnostic interest.

In order to detect metastases and germination of small intestinal cancer into the abdominal organs, ultrasound (liver, pancreas, kidneys, adrenal glands), MSCT of the abdominal cavity, chest radiography, and bone scintigraphy are performed. In unclear cases, diagnostic laparoscopy is advisable.

Small intestinal cancer must be differentiated from intestinal tuberculosis, occlusion of mesenteric vessels, benign tumors of the small intestine, Crohn's disease, renal dystopia, retroperitoneal tumors, and in women - from tumors of the appendages and uterus.

Treatment of small intestine cancer

When small intestinal cancer is operable, it is most effective to perform a wide resection of the affected area of the intestine, lymph nodes and mesentery. The length of the small intestine allows radical removal of the tumor within the boundaries of healthy tissue. The integrity of the gastrointestinal tract is restored by applying enteroenteroanastomosis (small intestine to small intestine) or enterocoloanastomosis (small intestine to large intestine).

For duodenal cancer, duodenectomy is indicated, sometimes with distal gastrectomy or pancreatic resection (pancreaticoduodenectomy). For advanced small intestinal cancer that does not allow radical resection, a bypass anastomosis is performed between unaffected loops of intestine. Surgical stage treatment of small intestinal cancer is complemented by chemotherapy; this same method may be the only way to treat inoperable tumors.

Prognosis and prevention of small intestinal cancer

The long-term prognosis for small intestinal cancer is determined by the stage of the process and the histological structure of the tumor. For localized tumor processes without regional and distant metastases, radical resection allows to achieve 35-40% survival over the subsequent 5-year period.

Prevention of small intestinal cancer requires timely removal of benign intestinal tumors, observation by a gastroenterologist of patients with chronic inflammatory processes of the gastrointestinal tract, smoking cessation, and normalization of nutrition.

Small intestinal cancer is a malignant lesion of the departments in the represented area, which has a tumor origin. In this case, the duodenum, jejunum or ileum may be affected. The symptoms associated with small intestinal cancer fall into the dyspeptic category and may also include nausea, weight loss, and other symptoms.

Briefly about the disease

In the general structure malignant neoplasms, identified in the area of the digestive system, as experts note, cancer of the small intestine makes up no more than one to two percent. Among all neoplasms associated with the small intestine, in the field of gastroenterology, oncology of the duodenum is most often encountered (at least 50% of cases). Cancer associated with the jejunum is formed much less frequently - this is no more than 30% of registered cases according to WHO and oncology of the ileum (no more than 20%).

The symptoms of each of the diseases presented are more than pronounced, but despite this, the condition is very often identified too late. Small intestinal cancer is a pathological condition that affects, in the vast majority of cases, males. Moreover, they are in a specific age category, namely over 60 years old.

Considering the criticality of the presented disease and its more than aggressive symptoms, I would like to draw attention to treatment methods. They consist of removing the affected part of the intestine, resection of regional lymph nodes and mesentery. In addition, specialists apply enteroenteroanastomosis, which makes it possible to relieve symptoms.

Symptoms of small intestine cancer

Signs of cancer associated with the small intestine area are characterized as polymorphic.

This is due to the fact that they can be identified various options the location of the neoplasm, its histology and the more than impressive size that malignant tumors can take on over time.

On initial stage The development of the patient’s pathological condition is alarmed by symptoms such as periodically forming spastic painful sensations in the abdominal area. However, the presented signs are rarely paid due attention, taking them for a general malaise or evidence of age. As noted earlier, small intestinal cancer and its symptoms mainly develop in males over 60 years of age.

Further symptoms may be accompanied by stool instability, namely diarrhea and constipation. They appear regardless of the quality and quantity of food consumed, as well as other characteristics that under normal conditions determine the general condition of the body. Symptoms may include flatulence, nausea and vomiting. In addition to all this, over time, intoxication and a rapidly progressive decrease in body weight begin to be identified. All this is associated with two main factors, namely, aggravated nutrition (due to reluctance to eat food or the inability to properly digest it) and an increase in the size of the tumor, which also provokes certain symptoms.

Destructive algorithms for small intestinal oncology can lead to:

the formation of bleeding in the intestinal area;
perforation of intestinal walls;
penetration of contents into the peritoneal area.

No less often, the consequence of the formation of small intestine cancer is such a dangerous condition as peritonitis. About what exactly they are additional symptoms of the described oncological disease will be discussed further.

Exophytic growth of neoplasms often occurs accompanied by obstructive intestinal obstruction and has corresponding symptoms of the condition.

When a neoplasm presses on neighboring organs, a variety of pathological conditions can form. We are talking about diseases such as pancreatitis, jaundice, ascites and ischemia in the intestinal area.

Significantly less often, but nevertheless, it is possible that signs such as fusion of the neoplasm with neighboring loops in the intestinal area or bladder will form. In addition, the probable process is damage to the intestines and omentum with the further formation of a single conglomerate. The conglomerate is characterized by a minimal degree of mobility. It should also be taken into account that symptoms, especially within the framework of ulceration and decay of small intestinal cancer, may be associated with intestinal fistulas.

Thus, the symptoms of tumor formation in the small intestine are more than eloquent. However, to confirm the condition and select the most effective restorative technique, it is necessary to take care to carry out a correct and complete diagnosis.

Diagnostic measures

Considering that small intestinal cancer can have different localizations, it should be taken into account that the diagnosis will also be variable. For example, in order to identify tumors in the duodenum area, fibrogastroduodenoscopy and contrast-type fluoroscopy are performed. To identify such tumors that are located in the terminal ileum, specialists resort to the introduction of not only colonoscopy, but also irrigoscopy.

The most important role in making a diagnosis in connection with oncology of the small intestine is given to barium passage radiography. The technique is unique because it makes it possible to identify obstacles in the path of movement of the contrast component used. In addition, this is how areas of stenosis and suprastenotic expansion in the intestinal area are identified.

The effectiveness and therefore high value of endoscopic studies justifies the possibility of performing a biopsy to further confirm the diagnosis.

In this case, of course, all symptoms and the strength of their manifestation must be taken into account. Of some interest within the framework of a diagnostic examination may be the implementation of so-called selective angiography, carried out in the presented situation for the abdominal region.

A very important stage of the examination should be considered the identification of metastases, as well as the likelihood of germination of an oncologically dependent tumor of the small intestine into the peritoneal organs. To do this, experts insist on performing an ultrasound (internal organs such as the liver, pancreas, kidneys and adrenal glands are examined). In addition, diagnosis should include MSCT of the abdominal cavity, chest x-ray and bone scintigraphy. As noted earlier, this is what will make it possible to determine the presence or absence of metastases, as well as the degree of their prevalence in the body and associated symptoms.

In unclear diagnostic situations, it makes sense to resort to diagnostic laparoscopy. Oncology of the small intestine must be subjected to differential diagnosis. The point is to differentiate the described pathological condition from diseases such as tuberculosis in the intestinal area, occlusion of mesenteric vessels. In addition, an important part of the examination should be the exclusion or confirmation of benign neoplasms in the small intestine, Crohn's disease, and kidney dystopia.

The likelihood of the presence of retroperitoneal neoplasms should be taken into account, and in females differential diagnosis should be carried out for neoplasms in the area of the appendages and uterus. About the forecast and preventive measures will be discussed further.

Prognosis and prevention

Small intestine cancer and its prognosis are directly dependent on the stage at which the disease was identified.

An equally important characteristic is the histological structure of the tumor.

If localized tumors are present without any metastases (distant or regional), then radical removal makes it possible to achieve 35-40% survival. We are talking about a long-term five-year period in the life of a cancer patient. In the future, it is very important to pay attention to any manifestation, because all this may indicate resumption of tumor growth.

Speaking about the prevention of cancer in the small intestine, it is necessary to pay attention to the timely resection of benign neoplasms in the intestinal area. An equally important step is the observation by a specialist of such patients who are faced with chronic inflammatory algorithms of the gastrointestinal tract. Prevention must necessarily imply refusal nicotine addiction and normalization of the diet, introduction of a special diet, if necessary.

Thus, small intestinal cancer is, of course, an extremely dangerous condition that has specific symptoms and signs. It is their formation that should push a person to conduct diagnostics and implement a special rehabilitation course. In this case, it will be possible to talk about the continuation of human life and maximum preservation of vital functions.

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HOW TO SIGNIFICANTLY REDUCE THE RISK OF CANCER?

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1.Can cancer be prevented?
The occurrence of a disease such as cancer depends on many factors. No person can ensure complete safety for himself. But everyone can significantly reduce the chances of developing a malignant tumor.

2.How does smoking affect the development of cancer?
Absolutely, categorically forbid yourself from smoking. Everyone is already tired of this truth. But quitting smoking reduces the risk of developing all types of cancer. Smoking is associated with 30% of deaths from cancer. In Russia, lung tumors kill more people than tumors of all other organs.
Eliminating tobacco from your life - best prevention. Even if you smoke not a pack a day, but only half a day, the risk of lung cancer is already reduced by 27%, as the American Medical Association found.

3.Does it affect excess weight on the development of cancer?
Look at the scales more often! Overweight will affect not only the waist. The American Institute for Cancer Research has found that obesity promotes the development of tumors of the esophagus, kidneys and gallbladder. The fact is that adipose tissue not only serves to preserve energy reserves, it also has a secretory function: fat produces proteins that affect the development of a chronic inflammatory process in the body. And oncological diseases appear against the background of inflammation. In Russia, WHO associates 26% of all cancer cases with obesity.

4.Do exercise help reduce the risk of cancer?
Spend at least half an hour a week training. Sport is on the same level as proper nutrition when it comes to cancer prevention. In the United States, a third of all deaths are attributed to the fact that patients did not follow any diet or pay attention to physical exercise. The American Cancer Society recommends exercising 150 minutes a week at a moderate pace or half as much but at a vigorous pace. However, a study published in the journal Nutrition and Cancer in 2010 shows that even 30 minutes can reduce the risk of breast cancer (which affects one in eight women worldwide) by 35%.

5.How does alcohol affect cancer cells?
Less alcohol! Alcohol has been blamed for causing tumors of the mouth, larynx, liver, rectum and mammary glands. Ethyl alcohol breaks down in the body to acetaldehyde, which is then converted into acetic acid under the action of enzymes. Acetaldehyde is a strong carcinogen. Alcohol is especially harmful for women, as it stimulates the production of estrogens - hormones that affect the growth of breast tissue. Excess estrogen leads to the formation of breast tumors, which means that every extra sip of alcohol increases the risk of getting sick.

6.Which cabbage helps fight cancer?
Love broccoli. Vegetables not only contribute to a healthy diet, but they also help fight cancer. This is why recommendations for healthy eating contain the rule: half of the daily diet should be vegetables and fruits. Particularly useful are cruciferous vegetables, which contain glucosinolates - substances that, when processed, acquire anti-cancer properties. These vegetables include cabbage: regular cabbage, Brussels sprouts and broccoli.

7. Red meat affects which organ cancer?
The more vegetables you eat, the less red meat you put on your plate. Research has confirmed that people who eat more than 500g of red meat per week have a higher risk of developing colorectal cancer.

8.Which of the proposed remedies protect against skin cancer?
Stock up on sunscreen! Women aged 18–36 are especially susceptible to melanoma, the most dangerous form of skin cancer. In Russia, the incidence of melanoma has increased by 26% in just 10 years, world statistics shows an even greater increase. Both tanning equipment and sun rays are blamed for this. The danger can be minimized with a simple tube of sunscreen. A 2010 study in the Journal of Clinical Oncology confirmed that people who regularly apply a special cream have half the incidence of melanoma than those who neglect such cosmetics.
You need to choose a cream with a protection factor of SPF 15, apply it even in winter and even in cloudy weather (the procedure should turn into the same habit as brushing your teeth), and also not expose it to the sun's rays from 10 a.m. to 4 p.m.

9. Do you think stress affects the development of cancer?
Stress itself does not cause cancer, but it weakens the entire body and creates conditions for the development of this disease. Research has shown that constant worry alters the activity of immune cells responsible for triggering the fight-and-flight mechanism. As a result, a large amount of cortisol, monocytes and neutrophils constantly circulate in the blood, which are responsible for inflammatory processes. And as already mentioned, chronic inflammatory processes can lead to the formation of cancer cells.

THANK YOU FOR YOUR TIME! IF THE INFORMATION WAS NECESSARY, YOU CAN LEAVE A FEEDBACK IN THE COMMENTS AT THE END OF THE ARTICLE! WE WILL BE GRATEFUL TO YOU!

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Can cancer be prevented?
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How does smoking affect the development of cancer?
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Does excess weight affect the development of cancer?
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Does exercise help reduce the risk of cancer?
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How does alcohol affect cancer cells?