Small intestine cancer: symptoms, diagnosis, treatment

What is small intestinal cancer

A malignant tumor of the small intestine is considered one of the most dangerous types of cancer due to its extremely poor prognosis for recovery and even five-year survival. It is distinguished from others by the location of the tumor - it is located in one of three sections of the small intestine:

in the ileum;
in the duodenum;
in the jejunum.

The largest proportion of tumors in this part of the intestine is due to duodenal cancer (about more than half of all cases). Jejunal cancer is diagnosed slightly less frequently (about a third of all cases). The rarest type of small intestinal cancer is ileal cancer.

In the total number of oncological diseases of the digestive tract, cancer of the small intestine, the symptoms of which will be discussed further, accounts for no more than 4% of cases.

Why does small intestine cancer occur?

The exact causes of oncological formations in the small intestine have not yet been clarified. However, reliable data have confirmed that this disease in most patients develops against the background of chronic pathologies of the gastrointestinal tract, as well as during inflammatory processes occurring in various parts of the intestine. Experts suggest that small intestine cancer can occur due to the following ailments:

duodenitis;
colitis;
enteritis;
peptic ulcer;
Crohn's disease;
celiac disease;
Peutz-Jeghers syndrome;
benign formations in the intestines;
genetic pathologies;
malignant neoplasms of other internal organs.

The risk of getting a diagnosis increases if you have bad habits, poor diet (eating red meat, spicy, fatty and smoked foods and not having enough vegetables and fruits on the menu - sources of dietary fiber). Radioactive radiation can also provoke the transformation of cells into cancerous ones.

Small bowel tumors

Although the length of the small intestine is 80%, and the area of the mucous membrane is 90% of the corresponding indicators of the gastrointestinal tract, its benign tumors occur with a frequency of only 3-6%, and malignant ones - 1% of all neoplasms of the digestive system.

Tumors of the small intestine are more often observed in men, whose average age is 62 years for benign neoplasms and 58 years for malignant ones. Adenocarcinoma is usually diagnosed in the 7th decade of life, carcinoid and leiomyosarcoma - in the 6th. The most common malignant tumor of the small intestine in children is lymphoma. The detection of small bowel cancer has been increasing in recent decades, paralleling the increase in colon cancer.

The relative rarity of small intestinal tumors can be explained by the high rate of gastrocecal transit compared to the rate of fecal flow, the relatively low concentration of potential carcinogens in the small intestinal chyme, and the high content of immunoglobulins A in the wall and lumen of the small intestine.

Risk factors for the development of tumors of the small intestine are considered to be immunodeficiency conditions (Crohn's disease, chronic HIV infection), autoimmune diseases (rheumatoid arthritis, Wegener's granulomatosis, systemic lupus erythematosus), celiac disease (celiac enteropathy), viral infection (cytomegalovirus, Einstein virus). Barr), leading to a decrease in the secretion of immunoglobulin A.

About 75% of all tumors of the small intestine are benign neoplasms, among which leiomyoma (30-35%), adenoma (20-22%), lipoma (14-16%), hemangioma (12%), fibroma (6%) are most often detected. ). Of the malignant tumors, adenocarcinoma (40-50%), carcinoid (30%), lymphoma (14%) and sarcoma (11%) are most often found. Tumors can be located in any part of the small intestine, but they are found mainly in the initial part of the jejunum and in the terminal part of the ileum.

Clinical picture and diagnosis. Benign tumors are asymptomatic in 80% of patients, and nonspecific and variable signs are observed in 20% of patients. Most often these are signs of complications: anemia as a reflection of occult bleeding (10-12%) or chronic (less often acute) intestinal obstruction.

Malignant tumors are asymptomatic in 10-12% of patients. In most cases, patients report anorexia, weight loss, and abdominal pain. The severity and nature of pain depend on the size of the tumor, its location, stage of the process, complications (obstruction, perforation). Dull pressing pain occurs when massive tumors (lymphoma, sarcoma) put pressure on surrounding organs. Cramping pain appears with partial intestinal obstruction (circular adenocarcinoma). Complete obstruction is most often caused by adenocarcinoma and carcinoid. Symptoms of an acute abdomen occur when the tumor perforates (typical of lymphoma).

The most common complication of malignant tumors of the small intestine is bleeding. At the same time, tumors of the small intestine account for only 0.2% of patients with profuse bleeding from the upper digestive tract. Malignant tumors cause both occult and profuse bleeding.

It is most often possible to palpate a tumor in the abdomen with lymphomas and lsyomyosarcoma, which reach large sizes. Lymphomas are characterized by signs of malabsorption and steatorrhea.

A carcinoid tumor manifests itself with a characteristic symptom complex (diarrhea, flushing, right ventricular failure, bronchospasm) in the presence of liver metastases.

Due to the absence of specific symptoms, most patients have a long period from the onset of clinical manifestations to diagnosis: in one third of patients - up to 6 months, in the second - from 6 to 12 months, in another 30% - from 1 to 5 years. With a carcinoid tumor, this period is sometimes extended to 9 years.

An important role in the diagnosis of tumors of the small intestine belongs to X-ray examination (probe enterography, examination of the passage of a contrast agent, irrigography for reflux of contrast into the small intestine), which makes it possible to make a diagnosis before surgery in 50% of patients.

It is also advisable to use other methods of radiation diagnostics: ultrasound, computed tomography, selective angiography. Enteroscopy allows you to examine the initial part of the jejunum, and colonoscopy allows you to examine the terminal part of the ileum. To diagnose a carcinoid tumor, a blood test (to measure serotonin content) and urine (to measure the daily output of 5-hydroxyindoleacetic acid) is used. Due to the fact that 90% of neuroendocrine tumors of the digestive organs and their metastases have somatostatin receptors, octreotide (synthetic somatostatin), labeled In

Treatment . When determining treatment tactics, the stage of development of the malignant tumor is important.

Stages of adenocarcinoma of the small intestine:

A - the tumor is limited to the submucosal layer, there are no metastases to regional lymph nodes;
B1 - grows to the muscle layer, there are no metastases to the lymph nodes;
B2 - grows to the serous layer, there are no metastases to the lymph nodes;
C1 - B1 with metastases to the lymph nodes;
C2 - B2 with metastases to the lymph nodes;
D - distant metastases.

Stages of small intestinal lymphoma:

I - tumor in the wall of the small intestine;
II - regional lymph nodes are involved;
III - distant lymph nodes that cannot be removed during surgery are involved;
IV - spreads to other organs.

Due to the fact that the nature of the tumor (benign or malignant) based on examination of the patient, as a rule, cannot be determined, and the manifestations of the disease (most often complications) in most patients threaten their lives (“malignant” course, regardless of the structure of the tumor), already the very fact of detecting a tumor of the small intestine is an indication for surgical treatment.

The operation consists of resection of the affected area of the intestine (for malignant tumors with wedge-shaped resection of the mesentery and removal of regional lymph nodes). If it is impossible or impractical (due to locoregional or distant metastasis) to remove a malignant tumor, a palliative operation is performed - bypass enteroenteroanastomosis to eliminate or prevent intestinal obstruction. For MALToma (lymphoma) of the small intestine, chemotherapy and radiation therapy are used.

Treatment results: the 5-year survival rate of patients with adenocarcinoma averages 25-35%, carcinoid - 60%, lymphoma - 40-50%, sarcoma - 25-30%.

Types of small intestinal cancer

To classify small intestinal oncology, several characteristics inherent to tumors are used:

The growth pattern of cancer cells.
Cellular structure of a cancer tumor.

Based on the nature of their growth, malignant tumors are divided into exophytic and endophytic. Both types of oncology have a number of features:

Upon closer inspection, exophytic small intestinal cancer, which has signs and symptoms that differ in diagnosis and treatment from endophytic cancer, is a tumor that grows toward the inside of the intestine. Externally, they resemble mushrooms (with or without a stalk), plaques or polyps, and have clearly defined boundaries and a bumpy surface. This form most often causes intestinal obstruction.
Endophytic cancer of the small intestine is a tumor without a clearly defined border and looks like a diffuse formation. A tumor of this type penetrates all layers of the intestine through the lymphatic network, and more often than others causes intestinal perforation and heavy bleeding.

Based on cell structure, small intestinal cancer is divided into the following types:

adenocarcinoma - formations localized on glandular tissues in the area of the duodenal papilla of the duodenum (in other parts of the small intestine this type of tumor is very rare);
carcinoid - tumors formed from epithelial tissues, and, in addition to the ileum, can occur in other parts of the small and large intestines;
lymphoma is the rarest type of tumor of the small intestine, which is represented by lymphogranulomatosis and pathology known as Hodgkin's disease;
leiomysarcoma - tumors that grow to large sizes, which are easily palpated through the abdominal wall and often lead to intestinal perforation.

Risk factors

Cases of sporadic or familial adenomatous polyposis are increased risk factors for developing small intestinal cancer. The risk of developing small intestinal cancer is higher in:

Smokers;
Persons exposed to radiation;
Suffering from alcohol addiction;
People whose diet is dominated by animal fats, canned foods, and fried foods.

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 more often represented by adenocarcinoma; sarcomas, carcinoids, and intestinal lymphoma are less common in oncological practice.

The Yusupov Hospital successfully treats patients diagnosed with small intestinal cancer. Here you will be consulted by highly qualified doctors and will conduct diagnostics using modern equipment. Timely visit to the hospital and detection of small intestine cancer at an early stage guarantees the maximum effect of treatment.

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Stages of small bowel cancer

Cancer of the small intestine, as well as its other parts, goes through 4 stages in its development:

The first stage is when the tumor diameter is less than 20 mm. There are no or very mild symptoms. The tumor body is localized on the wall of the small intestine; there is no metastasis.
The second stage – the tumor increases in size slightly. Symptoms are more pronounced due to the fact that the neoplasm grows into adjacent tissues and/or protrudes into the intestinal lumen. there are no metastases.
The third stage - the formation greatly increases in size and begins to metastasize to the lymph nodes located in close proximity to the tumor. The symptoms are severe.
The fourth stage - the tumor actively grows into neighboring organs, and also gives numerous metastases in the liver, pancreas, genitourinary system, and lungs. Symptoms become extremely severe.

Stages of the disease

There are five main stages of small intestinal cancer.

Stage 0. Characterized by a single small tumor that “stands still” and does not spread to neighboring organs and tissues.
Stage I: Small intestinal cancer begins to grow into the walls. Spread to neighboring organs is not observed.
Stage II. The tumor has already grown into the walls. It begins to spread to neighboring organs.
Stage III. The tumor metastasized to neighboring organs, and in particular regional lymph nodes.
Stage IV. Distant metastases are noticeable. The tumor is actively developing. Symptoms of small intestine cancer make themselves felt.

Symptoms of small intestine cancer

Recognizing small intestinal cancer, the symptoms of which vary depending on the stage of the disease, is very difficult at first, because this type of disease is characterized by a complete absence of symptoms in the initial stages of development of the pathological process. Noticeable signs appear only when the tumor leads to the appearance of ulcers or narrows the intestinal lumen.

Symptoms of early stage cancer:

nausea and belching;
diarrhea or constipation;
heaviness in the stomach;
bloating;
spasmodic abdominal pain.

As the tumor grows, the clinical picture expands, and difficulties with bowel movements due to false urges to defecate and/or partial or complete intestinal obstruction, intestinal bleeding and severe abdominal pain are added to the reported symptoms.

Along with this, patients experience a number of common symptoms:

increasing weakness;
fatigue and general ailments;
loss of appetite or aversion to food;
sudden weight loss;
anemia and resulting pallor of the skin and mucous membranes;
dizziness;
persistent increase in body temperature to subfebrile levels.

Diagnosis of small intestine cancer

The most informative methods by which small intestinal cancer can be detected are signs and symptoms, diagnosis using modern technologies. The first allows one to suspect oncology and guess the location of the tumor. Diagnostics using special equipment helps to reliably establish the location of a malignant formation, determine its type and structure, degree of development, and much more.

The most informative methods are:

a screening test for intestinal cancer (stool for occult blood - Colon View immunochemical test) helps to detect oncology at an early stage, since with small intestinal cancer, obvious blood in the stool appears only with heavy bleeding, but most often the bleeding occurs in small quantities, invisible the eye, so an analysis for occult blood in the stool allows one to suspect the disease;
fibrogastroduodenoscopy;
contrast fluoroscopy;
irrigoscopy;
colonoscopy;
histological examination of tumor samples;
Ultrasound of the abdominal cavity;
MCT of the abdominal cavity and others (it is better to write simply CT of the abdominal cavity)

A number of additional laboratory tests of blood and urine are also carried out to determine specific antigens, indican and tumor markers in the body.

Symptoms and signs of small intestine cancer

The surprising thing is that with small intestine cancer there are practically no symptoms. Practice shows that this disease in a given location is diagnosed by chance. Some experts identify certain manifestations and symptoms of small intestinal cancer, but they are mild. You should consult a doctor if:

there is blood in the stool for a long time;
the stool has become dark or black like tar;
stomach pain for a long time;
there are frequent and prolonged diarrhea;
severe nausea and vomiting have been observed for a long time;
noticeable unexplained weight loss (especially sudden).

In the early stages, symptoms of small intestine cancer include:

constant heartburn;
frequent belching;
lack of appetite or decreased appetite;
painful sensations in the upper abdomen.

All this is a manifestation and symptoms of small intestine cancer. But the diagnosis is not always confirmed, since all these signs can be signals of the presence of another illness. To accurately determine small intestinal cancer, it is necessary to undergo a thorough examination in a specialized clinic.

Treatment of small intestine cancer

The most effective treatment for small intestinal cancer is surgical excision of the tumor. During the procedure, the affected parts of the intestine and other organs (in whole or in part) - the gallbladder, pancreas, part of the stomach - can be removed.

Additionally, chemotherapy may be used. In some cases, this method plays a leading role (when the tumor is inoperable). In addition, treatment of small intestinal cancer can be carried out using radiation therapy.

In the postoperative period, the patient is prescribed a combination of medications and chemotherapy to completely eliminate cancer cells. In most cases, several such courses are required for recovery or stable remission.

Prevention of small intestinal cancer

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

Regularly undergo preventive examinations in a specialized clinic.
Adhere to the principles of a healthy lifestyle and nutrition.
Treat diseases of the gastrointestinal tract promptly and completely.
An annual stool test for occult blood (Colon View test, which can reliably detect occult blood in the stool and detect bowel cancer at an early stage).
Consult a doctor if any alarming symptoms from the digestive system appear.

You can complete the last point now. At the bottom of the article there is a form for contacting our specialists - gastroenterologists and proctologists. They are ready to answer questions you ask them about the symptoms and presentation of small intestinal cancer. To do this, just fill out the appropriate form and indicate your email address.