Small bowel cancer signs. Small bowel cancer: symptoms and manifestations in women and men in the early stages

Date: 19.10.2019

With cancer small intestine symptoms and manifestations often do not occur on initial stages, due to which the disease can be diagnosed at the wrong time, which becomes the main reason poor prognosis of cancerous tumors small intestine... The presence of a cancerous neoplasm in gastroenterology is more often diagnosed in men after the age of sixty, but sometimes the pathology occurs at the age of forty and earlier.

With this oncology, one of the sections of the small intestine is affected:

Duodenal;
Skinny;
Ileum.

In most of all cases oncological diseases intestinal pathology occurs in the duodenum, in thirty patients out of a hundred affected by the tumor, the jejunum is affected, the remaining twenty percent fall on the ileum. Among all malignant diseases of the large and small intestines, formations in the former are formed in only four percent of cases and more often in Central Asian countries, which may be associated with the consumption of a large amount of spices and marinades.

The reasons for the development of the disease

Most often, malignant pathology develops against the background of inflammation or gastrointestinal diseases associated with enzymes. Such diseases include:

celiac disease;
duodenitis;
ulcerative lesion;
enteritis;
Crohn's disease;
ulcerative colitis;
diverticulitis.

Also, neoplasms in the intestine that are benign and have epithelial structure... Cases of sporadic polyposis are one of the main factors provoking pathology. The fact that oncology most often occurs in the duodenum is associated with an aggressive effect on the intestinal tissue of bile and gastric juice produced by the pancreas. In addition, this department is constantly in contact with carcinogenic substances present in junk food. Other factors in oncology may include:

Smoking;
Alcoholism;
Radiation exposure;
Eating large amounts of animal fats, preservatives and fried foods.

Pancreatic cancer, rectal cancer, and tumors in other organs can lead to the occurrence of metastatic neoplasms in the small intestine.

Classification

The primary classification of ileal cancer involves two types of tumor formations:

Exophytic - the neoplasm grows inside the intestine, which becomes the cause of its narrowing and provocateur intestinal obstruction, microscopically, it can visually resemble a polyp like a raspberry or a mushroom. The boundaries of education are clearly structured. If the tumor ulcerates, it takes the shape of a saucer.
Endophytic - grows into the peritoneal cavity, causing complications such as bleeding inside the intestine, development of its tissues and inflammation of the peritoneum, is a more malignant neoplasm. The tumor does not have clear outlines; it affects the layers of the mucous membrane of the organ, spreading along its walls.

By histological structure neoplasm is:

Adenocarcinoma - is formed from glandular cells and is more often localized in the area of the large duodenal papilla in the duodenum;
Carcinoid - formed from epithelial cells and can occur in any section, but more often affects the ileum;
Lymphoma - is a rare species that manifests itself in lymphogranulomatosis and Hodgkin's disease;
Leiomyosarcoma is the largest type of neoplasm that can even be detected by palpation abdominal wall.

The type and structure of the tumor depends on how the therapy will be carried out, and what will be its outcome.

Degrees

There are four stages of small bowel cancer:

At the first stage, the neoplasm does not go beyond the walls of the small intestine, and there are no metastases, the size of the tumor does not exceed two centimeters;
The second stage is characterized by the growth of the tumor through the intestinal walls, the neoplasm invades the neighboring structures, but does not yet start metastases;
At the third stage, regional metastases are affected. The lymph nodes, the tumor grows into the nearest organs;
Stage four cancer spreads to the liver, lungs, bone tissue, the patient's condition deteriorates sharply.

Treatment and prognosis directly depends on the stage at which the cancer was diagnosed. The sooner the pathology is detected, the more chances for a complete recovery are. But in order to notice deviations in time, it is necessary to understand the causes and symptoms of cancer.

Symptoms

The initial symptoms of cancer of the small intestine include dyspeptic disorders, which are expressed:

Constant nausea;
Vomiting;
Bloating;
Painful syndrome in the navel area.

Also, the first symptoms on early stages may be as follows:

the occurrence of frequent loose stools with big amount mucus;
false painful urges to defecate;
alternating constipation and diarrhea;
development of intestinal obstruction of varying degrees;
when defecating, the patient feels pain.

Common symptoms and signs of small bowel cancer include:

severe and increasing weakness;
decreased performance;
aversion to food;
a sharp decrease in weight;
the development of anemia;
a decrease in the level of protein in the blood;
pallor of the skin and mucous membranes of the mouth and nose;
frequent migraines;
dizziness;
persistent hyperthermia.

Malignant lesions of the intestine in women and in men at the initial stage of development manifest themselves in the same way, but when the tumor begins to progress and spread to other organs, some differences arise. In patients, lesions appear depending on which organ has undergone metastasis.

In men, the lesion occurs on the prostate, and in women on the vaginal tissues, causing the corresponding clinical picture. With metastasis into the rectum, patients of both sexes develop severe pain in the anus, sacrum and lumbar spine. If abdominal pain, stool instability, diarrhea, and other signs of cancer develop, an organ examination should be performed as soon as possible. gastrointestinal tract.

Diagnostics

During the diagnosis of a tumor, it is necessary to take into account its localization in the small intestine, for different departments they are used different methods diagnostics:

The duodenum is examined using X-ray with contrast agent and fibrogastroduodenoscopy;
The ileum is examined by irrigoscopy and colonoscopy;
The jejunum is examined with barium sulfate fluoroscopy.

In endoscopic diagnostics of small intestine cancer, a targeted biopsy is performed to collect a particle of the tumor. The histological examination gives the doctor the opportunity to verify the diagnosis after the examination. The analysis of urine and blood (general and biochemical), as well as a study for tumor markers are mandatory. Feces are also examined for hidden blood... To identify metastases, ultrasound procedure organs abdominal cavity and radiography chest... Bone scintigraphy, multislice computed tomography, and magnetic resonance imaging can also be done.

Treatment

Therapy for cancer of the small intestine involves surgical intervention, in addition, chemical, radiation and drug therapy.

If the duodenal mucosa is affected, the doctor may perform a duodectomy (complete removal). In addition, the gall bladder, the lower part of the stomach, the right half of the colon, pancreas, pancreatoduodenal resection of the affected area is performed. After this, it is necessary to impose an enteroanastoma or connect the remaining ends of the small and large intestine to restore the removed affected part.
When there are contraindications for surgery, for example, when serious illnesses intestines, doctors treat with chemicals that kill cancer cells. Also, chemotherapy can be performed before or after surgery.
Radiation therapy alone has little effect, therefore it is more often used to shrink the tumor before surgery or to remove its remnants after surgery. However, with contraindications to surgery, radiation can be used in conjunction with chemotherapy.
Drug therapy is used to recover from surgery and other treatments. The patient is prescribed immunomodulators, vitamins and other necessary medications.

Traditional methods for the treatment of cancer of the small intestine are not used because they are not effective.

Forecast and prevention

In small bowel cancer, the prognosis depends on the timely onset treatment measures, patient's age, histological type of tumor, its size and degree of development oncological process... If a tumor is identified in time and removed, then a five-year survival rate is observed in forty percent of cases. Prevention of small bowel cancer consists of:

proper nutrition;
giving up bad habits;
timely removal of benign neoplasms and treatment of other diseases of the gastrointestinal tract.

It is important to undergo periodic examination by a gastroenterologist, especially if you are in a high-risk group.

Small intestine cancer - very dangerous disease, from which older (over sixty years old) men most often suffer. According to medical statistics, more cases are registered in the countries of the Central Asian region.

Concept

Small intestine cancer is an ailment in which malignant neoplasms affect the tissues of one of its three departments: the ileum, duodenum, or jejunum.

Most often (in almost half of cases), the tumor is localized in the tissues duodenum, in the second (30%) place in terms of the frequency of lesions is the jejunum, and only a fifth of patients suffer from ileal oncology.

In the general structure of oncological diseases, this disease accounts for no more than 4% of cases.

Types of neoplasms

The nature of the growth of cancerous tumors of the small intestine allows them to be divided into two types:

Exophytic, growing inside the intestinal lumen. At the initial stage of the pathological process, the tumor causes stagnation of the physiological contents of the affected parts of the small intestine (stasis), which eventually turns into intestinal obstruction. Exophytic tumors that look like plaques, polyps, or fungi are characterized by well-defined structured boundaries. With ulceration of exophytic tumors, they acquire a saucer shape.
Endophytic (infiltrative), considered more malignant and dangerous. Tumors of this type have no clear boundaries. Spreading along the walls of the affected intestine, they infect its membranes in layers and penetrate into neighboring and distant organs through the network lymphatic vessels... This type of tumor can lead to perforation of the intestinal wall and bleeding.

The histological structure of cancerous tumors of the small intestine is the basis for dividing them into:

: tumors arising from glandular tissues. The most common localization of these rather rare neoplasms is the area of the large duodenal papilla of the duodenum.
: this type of malignant neoplasm formed from epithelial cells, can be localized in any part of the small intestine. It is most commonly found in the appendix, ileum, and rectum.
: a rather rare type of cancer of the small intestine, represented by lymphogranulomatosis and Hodgkin's disease.
Leiomyosarcomas: Tumors of this type are so large that they can be easily palpated through the abdominal wall. The large size of the tumor provokes intestinal obstruction, ending in and.

Causes

Since the majority of patients with small bowel cancer developed against the background chronic diseases organs of the digestive tract and inflammatory processes occurring in different parts of the small intestine, it can be assumed that the presence of:

Peitz-Jeghers syndrome;
genetic abnormalities;
benign neoplasms in the intestine;
actively metastatic malignant tumors other organs.

Predisposing factors also include:

addiction to smoking and drinking;
eating smoked, fatty, fried foods and the abuse of red meat;
exposure to radioactive radiation.

The probable reason that a cancerous tumor most often affects the tissues of the duodenum is that, being the initial part of the small intestine, it first comes into contact with carcinogens contained in food, in bile and pancreatic juice secreted by the pancreas.

Clinical manifestations of the disease

Cancer tumor the small intestine does not manifest itself at first. The first symptomatology appears only after the pathological process leads to ulceration of the tumor or to narrowing of the lumen of the affected intestine.

Early symptoms

The first symptoms of cancer of the small intestine are characterized by a whole range of dyspeptic disorders:

constant;
vomiting;
bloating;
spastic pain in the epigastric region or in the navel.

In addition, in the initial stages of the disease, patients have:

the presence of frequent loose stools with tenesmus (false painful urge to defecate) and abundant discharge mucus, as well as a constant alternation of constipation and diarrhea;
varying degrees of violation of intestinal permeability;
painful sensations at the time of bowel movement.

Common Symptoms

General symptoms are characterized by:

the appearance of increasing weakness;
constant malaise;
severe fatigue;
loss of appetite;
a sharp decrease in body weight;
a decrease in the amount of protein in the blood plasma;
the development of anemia;
poverty of the skin and mucous membranes lining the oral and nasal cavity;
frequent headaches and dizziness;
persistent increase in body temperature (up to subfebrile values).

Signs of small bowel cancer in women and men

In the initial stages, small intestine cancer in men and women develops in almost the same way. Some difference in symptomatology appears at the time of the progression of the tumor process and its spread to neighboring organs.

When a tumor grows into the tissue of neighboring organs in women, the vaginal tissue is primarily affected, in men, the prostate suffers. When the pathological process invades the rectum and anal canal, patients of both sexes experience severe pain, spreading to the region of the anus, coccyx, sacrum and lower back.

At the same time, men have difficulties associated with the process of urination. This means that a malignant neoplasm of the intestine, having reached Bladder, begins to sprout into its tissue.

This process is accompanied by a significant increase in temperature and the development of infection. urethra(ascending type).

Degrees

Metastasis

Colon cancer most often metastasizes to:

peritoneum;
ovaries;
abdominal organs;
pancreas;
adrenal glands;
bladder;
organs of the small pelvis;
located in the retroperitoneal space.

How to examine?

The choice for detecting cancerous tumors of the small intestine depends on the localization of the pathological process.

Examination of the duodenum is best done with and.
Diagnosing the condition of the ileum will give top scores when using irrigoscopy and colonoscopy.
With the help of contrast radiography (by the method of barium passage) in the lumen of the examined intestine, the presence of obstacles and areas of stenosis that impede the advancement of a suspension of barium sulfate are revealed.

During each endoscopic examination, samples of tumor tissue are taken for subsequent laboratory examination to confirm the diagnosis.

The following procedures help to identify the presence of metastases and confirm the fact of the germination of a malignant formation:

internal organs abdominal cavity;
multislice computed tomography;
bone tissue;
chest x-ray;
laparoscopy ( this procedure, equated to surgical intervention, is prescribed if there is some doubt about the correctness of the diagnosis).

Laboratory methods are assigned an auxiliary value. For cancer of the small intestine, perform:

General blood analysis. Detection of low hemoglobin and increased ESR characteristic for any oncological pathology.
... The detection of a carcinoembryonic antigen in it not only confirms the presence of a cancerous tumor, but also makes it possible to establish its stage.
Analysis of urine for the content of indican (a substance formed in the liver during the neutralization of indole - a toxic compound that occurs in the intestine as a result of decay of proteins).
... In cancer of the small intestine, markers CA 242, CEA, CA 19-9 can be detected.

Modern therapy

The most effective is surgery.

In case of cancer of the duodenum, its complete removal (duodenectomy) can be performed, as well as ectomy of the gallbladder, pancreas, and distal ectomy of the stomach. In advanced cases of cancer of the iliac gland, ectomy of the entire right half of the large intestine is sometimes required.

To restore the removed area, either an enteroanastomosis is applied, articulating the intestinal loops surgically, or enterocoloanastomosis, consisting in the connection of the loops of the small and large intestines. If it is not possible to perform an extensive resection, the surgeon implants a bypass anastomosis using a healthy section of the intestine.

is of secondary importance, although in some cases (if the tumor is inoperable) it is the only method palliative care designed to alleviate the suffering of the patient.
is just as ineffective, therefore it is used either to improve the results of the operation performed during postoperative period, or as a palliative method. There is evidence that with the help of radiation therapy, doctors were able to slightly extend the life of their patients.
Postoperative treatment for small bowel cancer consists of a combined effect drugs(and oxaliplatin) and radiation therapy to the patient. To be sure to remove cancer cells from it, several courses of chemotherapy are given.

Prevention

The best prevention of small bowel cancer is to follow these simple guidelines:

The lifestyle at any age should be active.
The content of coarse vegetable fibers in food should exceed the content of animal fats.
Passage of preventive medical examinations should be regular.
Patients at risk should be registered with an oncologist.
All chronic diseases of the gastrointestinal tract should be treated in a timely manner.
If alarming symptoms appear, you should immediately consult a doctor.

Forecast

Survival in small bowel cancer is determined by many factors: the patient's age, histological type, size and stage of the malignant neoplasm, and the timeliness of the operation.

With timely radical resection of the tumor (which did not give metastases to regional lymph nodes and distant organs), the five-year survival rate of patients is at least 40%.

Carefully! Video about surgery to remove a tumor of the small intestine (click to open)

Cancer tumors can form in virtually any organ and system of the human body. Their growth leads to functional disorders and destructive changes tissues that, without proper treatment, in fact always ends in death. There are a number of dependencies between certain types of the disease regarding the likelihood of their development at a particular age or condition. Thus, cancer of the small intestine is a rather rare disease, but this does not diminish its danger.

What is Small Bowel Cancer

Small bowel cancer is an oncological disease localized in the digestive tract. In most cases, the tumor begins to grow from the epithelial cells, gradually filling the intestinal lumen. This type of cancer is rarely expressed, metastases mainly 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 differ slightly from different authors. For example, a number of experts claim that such diseases are found on average in 10% of cases, however, according to summary statistics, small intestine cancer accounts for approximately 3% of all cases of detection of malignant tumors in the digestive system.

Specialist's note: the largest number cases of the disease are observed in Asian countries that are at the stage of development, and the least in developed European states... Men are more prone to developing this type of cancer: compared with women, male patients with this diagnosis are one and a half times more. Also marked and age features- 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 cancer of the small intestine

	Characteristic
Carcinoma	The carcinoid type of tumor develops most often, and the lesions are multiple in nature. Such a formation is formed on the layers of squamous epithelium. Like any other type, it can grow indefinitely, affecting other organs and systems.
Adenocarcinoma	Unlike the previous type, it is formed from altered cells of the glandular epithelium. A feature of 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 form from connective tissue. This type of cancer of the small intestine differs rapid growth and a tendency to relapse. It has no clear boundaries, smoothly passes into healthy tissues. Often this type of tumor develops along with another malignant growth in the intestine.
	Elements are affected lymphatic system located in the area of the small intestine. Easily and quickly spread throughout the body.

Causes of occurrence

To date, doctors cannot name exact reasons, which would directly affect the formation of a cancerous tumor in the small intestine. In about 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. A number of factors can be distinguished that contribute to the appearance and development of this disease:

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

Symptoms

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

The most common symptoms are:

the appearance of periodic pain in the intestinal area, they are in the nature of spasms;
nausea and vomiting;
weight loss;
loss of appetite;
bleeding is often observed in the presence of sarcoma;
the chair becomes unstable;
if the tumor grows strongly, then the intestinal lumen may be blocked, due to which obstruction develops;
in the presence of metastases, there are symptoms associated with disruption of the work of other affected organs.

Diagnostics

Making a diagnosis requires careful examination of the patient's condition. The range of necessary activities includes:

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

Doctor's note: of particular importance in the diagnosis of oncological diseases is the collection of blood and urine for the detection of tumor markers - special protein formations that are released during the development of a malignant tumor in the body.

Disease stages and treatment prognosis

The success of treatment for oncological disease largely depends on the patient's response rate to the identified signs and conditions of the neoplasm during the initiation of treatment.

Table: stages of cancer

	Tumor condition
	The tumor is concentrated within the lumen or walls of the small intestine, does not spread outside the organ.	The first two stages cancer are considered the most favorable in terms of the prognosis for recovery. The tumor in such a situation is localized, which makes it possible to effectively act on it.
	The formation begins to extend beyond the intestinal wall, being at the stage of spreading, but still without metastases.
	There are metastases, but they are located in the immediate vicinity of the tumor (for example, in several lymph nodes near the intestine).	The prognosis is considered unfavorable, but with active therapy with aggressive methods, there is a chance of recovery.
Fourth	Metastases have spread to distant organs	The process is uncontrolled and irreversible, recovery is impossible. However, at this stage, all possible methods to improve the patient's quality of life and maximize its extension. Five-year survival rate reaches about 5%.

Treatment

Cancer treatment is a complex and multifactorial process that is rather difficult for the patient to tolerate due to the use of aggressive techniques. However, it is 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 bowel resection, that is, the surgical removal of the affected area. The scope of a particular operation and the techniques used in its course are completely determined by the current state of the patient and the degree of cancer prevalence. 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 recognized as sensitive to chemical drugs, 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 destructively affect tumor cells. Unfortunately, this treatment is very difficult, often affects cells healthy organs, and has a large list side effects:

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

It should be noted that even the presence of pronounced side effects is not a reason for stopping therapy with this method.

Radiation therapy is additional method, which is used to enhance the effect of chemotherapy and surgery. The procedure is performed 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, due to which diseased cells die. Healthy cells have greater resistance to such radiation, so they usually do not lend themselves to destruction. In some cases, radiation therapy can minimize the symptomatic manifestations of developing cancer.

Traditional methods

It should be understood 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 an auxiliary role, strengthening the body and helping to alleviate symptomatic manifestations.

In different sources, you can find the following recipes for patients with small intestine cancer:

Cabbage juice is recommended to be taken in 100 ml daily for at least a month.
Buckthorn broth (2 parts) and pharmacy chamomile(1 part). The composition is poured hot water and simmer for about 10 minutes.
A decoction of calamus root (30 grams of the main ingredient will need a liter of water), which is drunk warm every morning.
As an immunomodulator, you can use a tincture from the pericarp of the usual walnut... To prepare the composition, the amniotic part of the nuts in the amount of 25 pieces is placed in 2 liters of sugar syrup and insisted for three days. Take the resulting infusion daily, two tablespoons before meals.
Pumpkin juice (you need to 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 small bowel cancer treatment - reviews

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

Small bowel cancer is the second case of oncology in the last 10 years. At the third stage, she underwent 8 courses of chemotherapy, several operations 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 third-degree cancer. Despite undergoing chemotherapy, the body could not cope, it was all over after 2 years of struggle.

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

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

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

Possible complications and comorbidities

The most dangerous complication the development of a cancerous tumor in the small intestine is its metastasis. When the affected cells move to other organs and systems, different from the place of their initial formation, a variety of consequences can be observed: jaundice, significantly depletion, and others, depending on the organ affected by metastases. In the absence of a correct and active treatment cancer gradually destroys the body, leading to death.

Prevention

Given the fact that doctors cannot identify specific reasons, all that a person can do to prevent the occurrence of small intestinal cancer is to minimize the number of negative factors that increase the risk of the onset of the disease, namely:

rejection of bad habits;
rational proper nutrition;
avoidance of stress and nervous tension, if necessary, visit a specialist;
periodic passage comprehensive survey organism;
timely response to the presence of other diseases and their correct treatment.

With timely detection, cancer of the small intestine can be successfully cured, in general, it all depends on the state of the patient's body. Therapy for such a disease is complex and lengthy, but with a competent approach, it gives good results and allows you to extend a person's life.

You can't take health on credit, and you can't buy it for cash

Initial signs, Symptoms and Diagnostic Algorithm of Small Bowel Cancer

Small bowel cancer is a relatively rare disease that affects three parts of the intestine: the duodenum, the jejunum, and the ileum. In the structure of morbidity, a tumor of the small intestine occurs in 0.5% of cases. Small bowel cancer almost never occurs in people under the age of 50. After given 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, the superficial epithelium can rarely degenerate.

Cancer of the small intestine can grow into the lumen of the organ, that is, it will have exophytic growth, and the intestinal lining and surrounding tissues grow - endophytic growth.

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

Small intestine cancer can manifest itself in various signs and symptoms, depending on the form of growth and damage to adjacent organs and structures.

Signs

Malignant neoplasm of this localization is characterized by a long asymptomatic course. The first thing that patients most often pay attention to is tarry stools that form when bleeding from the tumor vessels. With ulceration large vessel the patient develops melena, a thin, foul-smelling black stool. This condition is an alarming sign, because it can threaten the patient's life without specialized help.

Bleeding may be latent. In this case, the chair will not be macroscopically changed, but anemia gradually builds up. 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 everyone malignant diseases asthenic syndrome and unreasonable weight loss will be observed. The patient complains of a decrease in physical and mental performance, a deterioration in appetite. Typically, the temperature rises to subfebrile numbers.

Symptoms

With an exophytic growing tumor, there is a risk of developing intestinal obstruction. Depending on the degree of obstruction of the intestinal lumen with education, the clinic of the condition will depend. With increasing mechanical obstruction, the patient will be disturbed by the following complaints:

Stool disorder. Diarrhea may develop at first, followed by constipation
Pain syndrome. Characterized by a gradual increase in the intensity of pain, up to sharp paroxysmal colic
Nausea, belching with fecal odor
Bloating, distention of the intestines
Profuse vomiting of intestinal contents, followed by slight relief
In advanced cases - enlarged intestine visible to the naked eye, paroxysmal severe pain, rumbling

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

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

If cancer of the small intestine forms near the papilla of Vater, then the clinic will resemble peptic ulcer duodenum. In this case, the patient is worried about 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 general bile duct located below the obturation site.

A tumor that develops in the periampullary section 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 bile will begin to enter the bloodstream through the vessels in the liver. At the same time, the skin acquires yellow, itching may appear. V biochemical analysis blood will increase total and direct bilirubin.

Cancer of the small intestine, localized in the infra-ampullar part of the duodenum, jejunum and ileum, will manifest itself only with the development of mechanical obstruction or ulceration of the vessel with the development of bleeding.

With endophytic 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 an emergency laparotomy will save the patient from death.
A tumor invading the intestinal wall can form a narrowing of the lumen, which also leads to intestinal obstruction.
Germination of a tumor to 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: intestine or pancreas. Only with intraoperative biopsy and immunohistochemical studies can you find out the answer to this question.

Diagnostics

Diagnosing cancer of the small intestine is a difficult task that requires a doctor to have a deep knowledge of the course of the pathological process. The diagnosis should be preceded by the correct collection of anamnesis, indications of previous diseases, as well as a description of the onset of the existing disorder.

Initially, it is necessary to assess the general appearance of the patient, his color skin, behavior, gait. If you are careful, even such insignificant details can push you into the right track search.

Very often, a tumor can undercut 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 color skin and mucous membranes, they will feel constant weakness and poorly tolerate physical exercise... To compensate for the reduced level of partial pressure of oxygen, such patients will need to exercise big number respiratory movements, which is expressed in the form of shortness of breath.

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

It is difficult to listen to something special by auscultation and is obtained only in the later stages of the disease. When the tumor reaches a large size and blocks the intestinal lumen, the noise of the peristalsis of the digestive tract disappears and the so-called symptom of a "falling drop" appears. When "tapping", you can listen to the dullness of percussion noise in the projection over 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
Contrast-enhanced abdominal x-ray
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 a disease. It should be said that any specific analyzes that speak in favor of the presence and absence of an oncological process is simply not there. But there are several indicators that allow us to suspect the development of the oncological process.

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

White blood cells can be either increased or decreased, or it can even be normal, there is no definite dependence, because this indicator not specific for 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 rises, changes in ionic ratios occur, metabolic alkalosis develops in the body - a shift in pH to the alkaline side.

When a 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 feces, occult blood can be detected, which can push us to the development of the oncological process.

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

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

Instrumental methods

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

With the help of ultrasound, it is possible to assess the size of the tumor, its density, shape and localization. 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 issue, which will provide a rationale for further research.

In the detection of a tumor in upper divisions endoscopic imaging techniques play a leading role in the 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. With the help of an endoscope, you can not only see the tumor, but also take biological material for further research.

With the localization of cancer in the upper parts of the gastrointestinal tract, the most relevant is esophagogastroduodenoscopy (EFGDS). For this procedure, the patient is asked to swallow the endoscope and lie on its side. The surgeon guides the device along the digestive tract, evaluates the condition of the walls of the esophagus, their color, shine, the shape of the folds and a few more indicators, a similar assessment takes place in the stomach.

The duodenum interests us the most. With the help of endoscopy, it is possible to detect a tumor, assess the direction of its growth (endo- or exophytic), the degree of lumen overlap, and also take a sample for laboratory research. For the study of the terminal ileum, colonoscopy and irrigoscopy are considered the most useful.

Another value of endoscopic manipulations is a biopsy of the small intestine. Biopsy is a special technique due to which it is possible to carry out an intravital collection of pathological and healthy tissues from the area of interest to us. In the diagnosis of cancer of the small intestine, we may be interested in two types of biopsy of a tumor of the small intestine - endoscopic and intraoperative.

With the endoscopic method - using optical instrument the tumor is visualized, then the biomaterial is taken, the endoscope is removed, and the tumor cells pass further exploration in the laboratory. During the pathological 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, on the basis of this decree, further treatment tactics will be decided.

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

With a small size of oncology, the surgeon resects part of the intestine. Then the removed tissue is also examined by a histologist to confirm the diagnosis. If the tumor has big sizes 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 already radiologists or chemotherapists.

Contrast fluoroscopy is also very useful in instrumental diagnostics. To carry it out, you will need a radiograph and a special contrast solution, usually barium sulfate. Contrast is applied to obtain a sharper image and also to obtain a clear outline of the walls of the hollow organs. In the presence of a tumor, there will be a narrowing of the lumen, which looks like an isthmus in a certain area.

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

The symptomatology and diagnosis of a tumor of the small intestine depends on the location of the cancer. If the carcinoma grows in the upper parts of the duodenum, then, as a rule, the disease manifests itself in the early stages. When localized down the intestines, it may take a long time for pathognomonic symptoms to appear.

is a malignant tumor that develops from the tissues of the small intestine and can spread to neighboring organs and throughout the body.

Malignant tumors of the small intestine - rare disease, which account for approximately 1% of all malignant tumors of the gastrointestinal tract.

Unfortunately, the diagnosis is made at a later stage, when surgery is almost impossible. The reason for the late diagnosis is the difficulty of instrumental examination of the small intestine, as well as the absence of specific symptoms, which leads to a late visit of the patient to the doctor.

The small intestine occupies most of the abdominal cavity and is located there in the form of loops. Its length reaches 4.5 m. The small intestine is divided into the duodenum, the jejunum and the ileum. Cancer can develop in any part of the small intestine. Most often, cancer affects the duodenum.

The causes of neoplasms of the small intestine

The causes of small bowel cancer have not been conclusively established. In most cases, the tumor develops against the background of chronic enzymatic or inflammatory diseases gastrointestinal tartus (celiac disease, duodenitis, duodenal ulcer, enteritis, Crohn's disease, ulcerative colitis, diverticulitis) or epithelial benign tumors intestines such as adenomatous polyps.

More frequent defeat 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 digestive tract with food.

Other causes can be smoking, alcohol abuse, fried foods, and cancers of other organs that metastasize into the tissue of the small intestine.

Types of small bowel cancer

Adenocarcinoma.
Mucous adenocarcinoma.
Cricoid cell carcinoma.
Undifferentiated and unclassified cancer.

Cancer growth form can be exophytic and endophytic.

Stages of Small Bowel Cancer

Stage 1. The cancerous tumor does not go beyond the walls of the small intestine, does not penetrate into other organs and does not have metastases.

Stage 2. A cancerous tumor extends beyond the walls of the small intestine and begins to grow into neighboring organs, but does not yet have metastases.

Stage 3. The cancer has metastasized to several lymph nodes near the small intestine, but has not yet metastasized to distant organs.

Stage 4. A cancerous tumor of the small intestine metastases to distant organs (liver, lungs, bones, etc.).

Small intestine cancer symptoms

Initially, small bowel cancer does not manifest itself. The first signs appear with the development of a more pronounced narrowing of the intestine or ulceration of the tumor.

The clinic of duodenal cancer resembles gastric ulcer and duodenal ulcer, but aversion to food is characteristic. Most often, a symptom of cancer in this section is a dull pain in the epigastric region. Irradiation of back pain is characteristic. Late symptoms (jaundice, nausea and vomiting) are associated with an increase in obstruction of the biliary tract and closure of the intestinal lumen with a tumor.

Clinical picture cancer of the jejunum and ileum consists of local symptoms and general disorders. The most frequent initial symptoms are dyspeptic disorders - nausea, vomiting, bloating, spastic pain in the intestines, navel or in the epigastrium. In the future, there is a decrease in body weight, which can be associated with both reduced nutrition and rapid tumor growth. Frequent loose stools with a lot of mucus and cramping are also early symptoms.

Intestinal obstruction is a complex of symptoms characteristic of varying degrees of intestinal obstruction, observed in most patients with tumors of the small intestine.

Small bowel cancer is often accompanied by overt or latent blood loss.

Symptoms of general disorders include increasing weakness, weight loss, malaise, weakness, fatigue, and anemia.

A complication of cancer of the small intestine is metastases in the retroperitoneal lymph nodes, distant metastases are observed in the liver, ovaries.

Small bowel cancer diagnostics

The following methods are most often used to diagnose cancer of the small intestine:

Angiography of the vessels of the abdominal cavity.
Laparoscopy.
CT scan.
Magnetic resonance imaging.
Biopsy to determine the type of cells and their degree of malignancy.
Electrogastroenterography- allows you to identify violations of the motility of the small intestine, which often occur with malignant neoplasms in this part of the intestine.

Small bowel cancer treatment

Treatment for small bowel cancer depends on the stage of the disease and the type of tumor. In most cases, they resort to surgical removal of an oncological neoplasm, which often leads to a decrease in symptoms and contributes to an increase in life expectancy.

In some cases, the operation is palliative, that is, it is carried out only with the aim of alleviating the suffering of the patient.

If surgery is impossible or if there is a tumor that is sensitive to chemotherapeutic agents, therapy is used with drugs that suppress the growth and prevent the development of tumor cells.

In the postoperative period, it is important not to miss a dangerous complication - intestinal paresis. To do this, it is necessary to diagnose intestinal motility using electrogastroenterography .

Doctors classify malignant neoplasms of the small intestine under C17 v International classification diseases ICD-10.

Professional Articles on Small Bowel Cancer:

Firsova L.D., Masharova A.A., Bordin D.S., Yanova O.B. Diseases of the stomach and duodenum // - M: Planida. - 2011 .-- 52 p.