Small intestine cancer: causes, symptoms, diagnosis, treatment and prognosis. Signs of the formation of cancer in the small intestine Oncology of the terminal ileum

The ileum (ileum) is a part of the digestive system, which is located between the jejunum and the caecum.

The ileum continues the jejunum and does not have a clearly defined border with it, but differs in thicker walls and a larger diameter.

The length of the organ is 1.5-2.6 meters, the inner diameter is about 2.5 cm.

The ileum is separated from the caecum by the ileocecal valve, which acts as a shutter and passes the food bolus from the ileum to the caecum in one direction. It protects the small intestine from bacteria from the large intestine. Malfunctions of the ileocecal valve lead to backflow of contents with colonic bacteria.

The area in front of the ileocecal valve is called the terminal section. It absorbs fatty acids. The ileum loops are located in the right iliac fossa. A small part is located in the pelvic cavity. The organ is covered by the peritoneum, fixed to the posterior abdominal wall with the help of a fold (mesentery).

The mucous membrane of the walls of the ileum is covered with villi with a cylindrical epithelium. In the center of the villus there is a lymphatic sinus. Through it, the products of the breakdown of fats enter the bloodstream. Monosaccharides enter the capillaries.

The muscular membrane consists of two fibrous layers, between which is a tissue with blood vessels and muscle plexuses.

Due to contractions of the muscular membrane, mixing and pushing of the chyme (slurry) occurs.

The secretory organ secretes about 2.4 liters of intestinal juice per day, which includes substances involved in the breakdown of food (enterokinase, lipase, peptidase, alkaline phosphatase, disaccharidase). Absorption The end products of digestion (monosaccharides, amino acids, lipids) are transported through the microvilli into the blood. In addition, vitamin B12 is absorbed. Motor Mixing and movement of food gruel occurs due to the contraction of muscle fibers.
Violation of any of the functions leads to illness.

General symptoms

Whatever the causes of diseases, they all have the same symptoms:

• increased gas formation;
• stool disorder;
• pain sensations;
• loss of appetite;
• vomit.

The pain is localized in various parts of the abdominal cavity: under the pit of the stomach, in the navel area, in the right side of the abdomen. It is pulling, aching, bursting. Usually, pain is reduced after the discharge of gas and defecation.

The degree of development of the pathological process affects the symptoms of the disease. With exacerbations, intense pain, weakness occur, an admixture of blood appears in the stool.

With ileum lesions, the process of splitting and absorption of vitamins, amino acids, and minerals is disrupted. The patient may develop anemia, xerosis (dryness) of the skin and eyes.

Common diseases

Lymphofollicular hyperplasia

Ileum contains immunoglobulins. They protect the body from viruses and toxins. The mucous membrane provides local immune protection.

As a result of an incorrect reaction of the lymphoid tissue to carcinogens, cell proliferation occurs.

The disease is signaled by: pain, diarrhea, impurities of mucus and blood in the feces, a decrease in the body's resistance,.

Lymphofollicular hyperplasia affects the terminal ileum.
In most cases, excess cell growths disappear without treatment.

But with significant seals, prerequisites for the development of intestinal obstruction appear.
It is better to pay attention to body signals and undergo an X-ray or endoscopic examination. Multiple seals, smooth round nodules, small ulcers indicate the presence of lymphoid hyperplasia.

Inflammation (ileitis, a form of Crohn's disease)

The disease affects the terminal department. Sometimes inflammation passes to the blind, lean, duodenal ulcer with the formation of several foci.

Please note that in the chronic form of ileitis, there are colic in the abdomen, bloating, diarrhea with impurities of blood and pus. Very often the temperature rises and there is weight loss, fatigue.

The acute form of the disease is characterized by nausea, vomiting, diarrhea,.

Diagnosis is hampered by extraintestinal symptoms:

• eczema.
• skin rashes.
• inflammation of the oral mucosa.
• polyarthralgia (pain in many joints).

The chronic form of Crohn's disease can be confused with ulcerative colitis, amoebic dysentery.
In the acute form of the disease, symptoms such as in acute appendicitis are observed.
Diagnostic accuracy is achieved through the use of capsule endoscopy or colonoscopy. In studies, cicatricial changes in the mucous membrane, narrowing of the terminal intestine, edema of the mesenteric lymph nodes, epithelial granulomas, erosions and ulcers alternate with normal areas.

The later stage of Crohn's disease is characterized by intestinal obstruction, the formation of fistulas between the ileum and adjacent organs, and the development of peritonitis.
With a long course, a sharp cicatricial deformation of the wall occurs.

Due to a decrease in the ability to digest food, protein metabolism is disturbed, which leads to amyloid degeneration. As a result, the activity of the glandular apparatus of the small intestine decreases.
If you have been diagnosed with Crohn's disease, then follow all the doctor's instructions. The disease is serious and in some cases incurable, but medical and biological therapy helps to maintain remission and prevent aggravation of the disease.

Malignant neoplasms

A malignant tumor often affects the terminal ileum.
It develops from tissues and can subsequently spread throughout the body. Of all cases of oncology of the small intestine, ileum cancer accounts for about 20%. Many experts believe that this is due to the location of the organ. Carcinogenic substances first enter the initial sections of the small intestine. Smoked and fatty foods are considered a provoking factor. Contribute to the development of the disease adenomatous polyps, ulcers, Crohn's disease, tumors of other organs metastasizing in the tissue of the ileum, exposure to radiation. The immediate relatives of the patient are at high risk.

The chance of ileal cancer increases in men and the elderly.
Clinical manifestations of the disease develop slowly and almost imperceptibly. Therefore, patients seek help at a later date.

Metastases spread through the lymphogenous route to the retroperitoneal lymph nodes, peritoneum, liver, lungs, bones, kidneys, and genitals.

Decaying and ulcerated malignant neoplasms can lead to the formation of fistulas with nearby organs.

With ileum cancer, the same symptoms are observed as with malignant neoplasms in other parts of the small intestine: bloating, nausea, vomiting, heaviness in the iliac region, colic. Later, weight loss occurs. The growth of cancer cells in the lumen of the ileum leads to obstruction.

With sarcoma, intestinal bleeding may occur.

According to the type of growth, tumors are divided into:

Exophytic Grow into the intestinal lumen. They have well-defined borders. Endophytic Grow along the intestine, Infiltrate the entire wall of the tube. Deepen into neighboring organs.

According to the histological type of intestinal tumors are divided:

X-ray helps to find narrowings in the passage of the intestine. Colonoscopy allows you to take tissue and determine the morphological composition of the tumor and the degree of malignancy of the formation.
To diagnose metastasis, ultrasound of neighboring organs is performed.

With the radical removal of the cancerous area together with the lymph nodes at an early stage of the disease, the likelihood of a cure increases. The ileum is poorly supplied with blood, so metastases spread slowly.

Be attentive to your health and in case of systematic violations in the work of the gastrointestinal tract, contact a specialist, and also regularly undergo preventive examinations.

primary ulcer

This is a chronic inflammation of the mucous membrane with numerous defects on its wall.

The disease is rare and affects mainly men. The stronger sex accounts for 80% of diseases.
Usually round or oval ulceration affects the terminal section.

A factor for the development of the disease can be mechanical trauma to the mucous membrane, vascular disorders, increased production of hydrochloric acid, taking drugs containing calcium salts.

The primary ulcer is characterized by pain, which is aggravated by the intake of spicy food. In some cases, there is pain in the right iliac fossa 2-3 hours after eating.

During an exacerbation, bloody-purulent discharge appears in the stool.

If the disease is not recognized in time, internal bleeding, perforation may occur.
Possible complications - stenosis (narrowing) of the intestine, the occurrence of cancer.

In most cases, a stable remission can be achieved. If a tumor is suspected, the affected area is removed surgically.

Atresia

This is a congenital disease characterized by obstruction of the last section of the ileum. Occurs due to intrauterine peritonitis, squeezing of the food tube, penetration of toxins and pathogens through the placenta, insufficient blood flow to the intestines of the fetus. In rare cases, the defect is hereditary.

Symptoms of the disease:

• no meconium;
• Vomiting (occurs from the first day of life. The vomit contains bile, and after a while feces appear in them);
• Bloating
• child's anxiety
• refusal to feed;
• insufficient stool.

The child's condition is rapidly deteriorating, dehydration occurs. Death can result from intestinal perforation and peritonitis.

If atresia is suspected, the patient should be urgently examined. X-ray examination of the lower intestine allows to exclude or confirm the defect.

The child is shown resection of the site of atresia of the ileum, followed by the imposition of the anastomosis. Early correction gives good results - survival in 90-100% of cases.
With prematurity of the fetus, low weight, concomitant anomalies, the survival rate is about 50%.

Resection (clipping)

The operation consists in removing the pathological segment of the intestinal tube. It is performed through an open incision or by laparoscopy.

Resection of the ileum is indicated for:

• strangulated hernias;
• tumors;
• circulatory disorders in the vessels of the mesentery;
• atresia;
• perforations;
• wall necrosis;
• intestinal obstruction;
• bleeding;
• Crohn's disease;
• strangulation of the intestinal tube.

During the operation, the integrity of the ileum is restored by connecting (anastomosis) the tissues of the hollow organs.

Removal of less than 40% of the intestinal tube is well tolerated by patients. Resection of large areas leads to a lack of enzymes and a violation of the digestion and absorption of fat-soluble vitamins. May cause diarrhea and B12 deficiency anemia (pernicious anemia). Nutrients are lost during frequent stools. Diet and special preparations help cover the lack of vitamins and minerals. Over time, the body adapts and includes its own compensation. The rhythm of renewal of the intestinal epithelium accelerates, the diameter of the intestinal tube and the height of the villi increase.

Despite complications and the possibility of recurrence, the quality of life of patients improves significantly.

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Small intestine cancer is a malignant neoplasm that has specific symptoms and manifestations. This lesion affects the duodenum and ileum. Usually the violation is accompanied by dyspeptic disorders. The patient often experiences rapid weight loss. Symptoms and manifestations of small intestine cancer are individual and directly depend on the degree of neglect of the pathology. The first possible signs of deviation are strictly forbidden to be ignored. It is important that the sick person undergoes a comprehensive medical examination and confirms or refutes the presence of the disease.

In this article you will learn:

Disease-causing factors

Bowel cancer has an etiology that has not been fully established. The true reasons for the deviation are not clear. Doctors only highlight a number of possible factors provoking deviation. In most cases, the disease is formed against the background of existing pathologies of the gastrointestinal tract.

Pathology is also formed under the influence of the current inflammatory process. The main provoking factors for bowel cancer are described in the table.

The treatment of the disease is almost not connected with the root causes of the formation of cancer. All that needs to be done is to eliminate the provoking factor. Therapy is selected based on the stage and form of the current deviation.

People who have a hereditary predisposition to develop small intestine cancer should regularly undergo a comprehensive examination. This will allow timely detection of a malignant disease.

Stages and forms

To classify a malignant lesion, pay attention to the following signs:

• the nature of the formation of cancer cells;
• cellular structure of a malignant neoplasm.

Forms of cancer can be different

According to the type of growth of a malignant formation, exophytic and endophytic cancer are distinguished. The first of these tumors grows into the inner part. According to external data, such a neoplasm resembles a mushroom. Plaques and polyps have limited borders. Their surface is bumpy. Pathology is usually accompanied by prolonged constipation.

Endophytic cancer is characterized by intestinal damage that does not have clear boundaries. In appearance, it resembles a blurring neoplasm. All layers of the intestine are affected.

Pathology is also distinguished by the cellular structure. Doctors distinguish the following types of cancer:

• adenocarcinoma;
• carcinoid;
• lymphoma;
• leiomyosarcoma.

Cancer proceeds in 4 stages. At the first stage, the size of the neoplasm in the intestine does not exceed 2 cm in diameter. As a rule, there are no symptoms at this time. Metastases do not spread.

Cancer differs in types and stages

The 2nd stage of the cancerous process in the intestine is characterized by a slight increase in the tumor. The first symptoms appear. The formation grows into adjacent tissues. Metastases do not spread.

The 3rd stage is characterized by the rapid growth of a malignant neoplasm in the intestine. Metastases spread to the lymph nodes. The symptoms of cancer are pronounced.

It is characterized by active germination of the tumor in neighboring tissues and organs. The patient's condition is getting worse. The prognosis is the least favorable. The patient, as a rule, is waiting for a fatal outcome.

Main symptoms

In the first stage of cancer, there are usually no symptoms. The patient is unaware of the course of the pathological process. The disease is detected during a medical examination regarding other problems.

One of the symptoms to look out for is nausea and vomiting.

The main symptoms include nausea and gag reflex. In addition, the patient complains of periodic spasmodic sensations in the abdomen and heaviness. These are the first signs of cancer to appear.

The clinical picture of cancer with localization in the small intestine is very similar to many signs of gastrointestinal diseases. Only a doctor can establish an accurate diagnosis with the help of complex diagnostics.

Associated symptoms

Usually the clinical picture in men and women is the same. However, sometimes patients with cancer are accompanied by:

• failure of the menstrual cycle;
• blanching of the skin;
• discomfort when urinating.

Women may experience menstrual irregularities

Women in the advanced stages of cancer located in the intestines have through defects through which fecal masses and mucous secretions penetrate. Later they exit through the vagina.

Symptoms associated with cancer include:

• intestinal obstruction;
• admixture of blood in fecal masses;
• the formation of ulcers and fistulas;
• dysfunction of some internal organs;
• pain during bowel movements;
• rapid loss of body weight;
• signs of intoxication of the body;
• skin rashes.

The patient complains about the feeling of an unfinished defecation process.

From this video you will learn about the features of the diagnosis and treatment of small intestine cancer:

Symptoms of metastasis

Bowel cancer can metastasize to the liver, lungs, peritoneum, and adrenal glands. In this case, the patient is faced with additional symptoms:

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

• the denudal part, the shortest, got its name because of its length, equal to the length of 12 fingers in diameter;
• the lean 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 bears the name, so to speak, because of the location area.

The small intestine, in which food is exposed to the action of intestinal juice, bile, 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, flows into the caecum in the region of the right iliac fossa. In the structure of the human small intestine, the duodenum, jejunum and ileum are distinguished.

Small intestine cancer and tumor localization

Small intestine cancer in the structure of malignant tumors of the digestive tract is 1-2%. According to ICD-10, it has the code C17.

Due to the blurring of the first symptoms, small intestine cancer is diagnosed by chance, very often during an X-ray examination or abdominal surgery during treatment for another disease. At the same time, metastasis begins, due to which secondary intestinal cancer develops.

The most common neoplasms of the small intestine are:

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

It is worth noting! Small bowel cancer mostly affects men over the age of 60 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 it does not irritate the mucous membrane. Carcinogens ingested with food do not have time to harm. There are very few bacteria in the small intestine, but a lot of lymphoid tissue. Alkaline pH and the enzyme benzpyrene hydroxylase are considered as protective factors.

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

Causes of small intestine cancer

No specific direct cause of oncology of the small intestine has yet been found. Attention is always drawn to chronic enzymatic or inflammatory bowel disease, cancer symptoms can hide behind signs of diseases such as diverticulitis, ulcerative colitis, enteritis, Crohn's disease, duodenal ulcer. Often, the tumor develops against the background of adenomatous, prone to degeneration into oncogenic.

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

Also, the causes of the appearance of a tumor include:

• Peutz-Jeghers syndrome;
• duodenitis;
• celiac disease;
• genetic pathologies;
• benign tumors;
• metastasis of the malignant process to 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 ulcer and duodenal ulcer and will manifest as an aversion to food, dull pain in the epigastric zone with irradiation to the back. At a late stage, duodenal cancer exhibits symptoms associated with poor patency of the biliary tract and intestines due to tumor growth. The patient will suffer from endless nausea and vomiting, flatulence and manifestations of jaundice.

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

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

It has been proven that the symptoms of small intestine cancer are more common in men than in women. This fact is associated with the way of life of men, nutrition and abuse of malicious habits: alcohol, smoking and drugs. In addition, small intestine cancer develops in men somewhat differently due to the different structure of the genitourinary system.

Very often with, there are signs of bowel cancer in women. With tumor metastases, symptoms of bowel cancer in men may appear. If the tumor compresses neighboring organs, then this leads to the development of pancreatitis, jaundice, ascites, intestinal ischemia.

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

• pain during bowel movements;
• intestinal patency is disturbed;
• there is an obvious or hidden intestinal blood loss;
• 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;
• impaired function of the pancreas and liver.

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

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

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

Symptoms and signs of small intestine cancer in women and men

The development of the tumor in the early stages in women and men is almost the same. The progression of the tumor and its growth on nearby organs makes a distinction in the symptoms. As the cancer spreads, it primarily affects the vagina in women and the prostate in men. After cancer affects the rectum and sphincter canal, causing complaints in both sexes. There are pains in the region of the anus, lumbar spine, coccygeal region and sacrum. Men experience problems with urination, which indicates damage to the bladder. The body temperature rises significantly, the development of ureteral infections is likely.

Symptoms in stages 3 and 4

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

At stage 4, symptoms such as:

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

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

• intestinal bleeding;
• pain during bowel movements;
• violations of the digestive tract;
• a sharp change in mood and neurosis;
• severe fatigue;
• peritonitis;
• exhaustion;
• dry skin;
• dysfunction of neighboring organs;
• low levels of protein in the blood.

Where does small intestine cancer metastasize?

Near the small intestine there are many important organs and when the oncotumor 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;
• milk glands;
• prostate;
• kidneys and adrenal glands;
• bladder;
• pancreas;
• colon;
• liver;
• peritoneum.

Classification of small intestine cancer

Depending on the characteristics of growth, malignant neoplasms are conditionally divided into the following types:

1. Exophytic - grow inside the intestinal lumen. Cancer processes provoke stagnation of feces in the affected areas of the jejunum, with the development of the disease turning into obstruction. Tumors look like fungi or polyps with well-defined structured borders, becoming saucer-shaped when ulcerated.
2. Endophytic, or infiltrative. Neoplasms without clearly marked 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 the histological classification, oncological formations of the small intestine are:

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

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 chest x-ray, CT, in the blood and bone marrow. If the tumor is large, there will be disturbances in the absorption of food.

If the retroperitoneal and mesenteric lymph nodes spread tumor cells, then a secondary lymphoma is formed in the small intestine. Small bowel cancers include ring cell, undifferentiated, and unclassified cancers. The growth form is exophytic and endophytic.

Classification of cancer of the horse intestine 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 intestine cancer:

• T - tumor:

1. Tis - preinvasive cancer;
2. T1 - tumor invasion of the submucosal layer of the intestine;
3. T2 - tumor invasion of the muscular layer of the intestine;
4. TK - tumor invasion of the subserous layer of the intestine or retroperitoneal space. The tumor is not more than 2 cm;
5. T4 - germination of the tumor of the visceral peritoneum, non-peritoneal areas with a length. Tumor more than 2 cm.

• N - damage to the lymph nodes:

1. N0 - no lymph nodes affected.
2. N1 - metastatic lesion of regional lymph nodes.

• M - the presence of distant metastases:

1. M0 - no separated metastasis;
2. M1 - Distant metastasis is present.

Stages of small intestine cancer

There are five stages of intestinal adenocarcinoma:

1. Stage 0 or cancer in situ. A solitary small tumor that is located on the surface of the mucous membrane and does not grow deeper. Metastases are absent.
2. Stage 1 - the tumor has grown deep into the intestinal wall, but has not spread to neighboring organs. Metastases are absent.
3. In stage 2 bowel cancer, the tumor has grown through the entire thickness of the intestinal wall and spread to neighboring organs.
4. in stage 3 small bowel cancer, cancer cells have spread to regional lymph nodes. Germination in other organs and distant metastases are absent.
5. In stage 4 small bowel cancer, there are distant metastases. Most often they are found in the lungs, liver. bones and other organs.

Diagnosis of small bowel cancer

To recognize bowel cancer at an early stage, it is necessary to conduct a series of diagnostic studies that 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:

1. Fibrogastroduodenoscopy and contrast fluoroscopy, with the help of these methods, the diagnosis of the duodenum is carried out.
2. Irrigoscopy and colonoscopy - performed to diagnose the ileum.
3. To detect stenosis and the presence of barriers to the movement of barium sulfate suspension, the method of barium passage in the lumen of the tract is used.

During endoscopy, samples of cancer cells are taken for further laboratory study and confirmation or refutation of the diagnosis.

Metastasis and spread of a cancerous tumor is detected using:

• Ultrasound of the peritoneum;
• CT scan of the intestinal tract;
• chest x-ray;
• bone scintigraphy.

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

For malignant tumors, the following laboratory tests are performed:

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

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

How to identify bowel 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 transfer its stages, the greater the chance of a positive result. When the symptoms appear, the oncoprocess can be considered neglected, and the moment of early treatment will be missed.

Important! Early symptoms include a “malicious” condition that should alert any person - this is an unwillingness to work or do household chores due to increased weakness and fatigue. The skin becomes pale and "transparent". The patient constantly has heaviness in the stomach, he does not want to eat at all. Following this, dyspeptic disorders appear: nausea, vomiting, pain and heartburn, even from water.

What is the diagnosis of small intestine cancer?

When contacting a doctor, a blood test is immediately prescribed and examined, which is necessarily carried out if bowel cancer is suspected. According to the general basic blood test, anemia, the patient's condition, and the presence of inflammation can be detected.

Then, based on the results of the blood test, if necessary, a blood test for small intestine cancer is performed. The most informative and common oncomarkers 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 (cancer-embryonic antigen), screening diagnostics of colon cancer is carried out. If CEA is determined, then you can find out the staging before the operation and monitor the patient with a diagnosis of colorectal cancer after it. As the disease progresses, the serum CEA level will rise. Although it may grow and not in connection with the tumor, and in the later stages, colorectal cancer can be detected without an increase in CEA in the blood.

Endoscopic diagnosis, open biopsy of the intestine are the main methods for confirming oncology of the small intestine.

Small bowel cancer treatment

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 oncology.

The volume of surgical intervention depends on the stage of tumor development, its localization and the degree of damage to surrounding tissues, organs and systems. Cancerous tumors at the initial stage are removed using laparoscopic surgery. The operation 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 the tumors are large, which indicates the late stages of cancer development, then in this case, extensive operations are used, which include:

• resection of the small intestine, in which the affected section of the small intestine is removed along with the lymph nodes and part of the healthy surrounding tissues;
• a radical operation in which tumors of a huge size and all tissues affected by metastases are subject to removal;
• contactless operation. Carried out by overlapping all blood and lymphatic vessels around the tumor. Resection is performed to prevent the dispersion of malignant cells 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 pancreatic resection is performed for cancer of the pancreatic head. Along with surgery on a segment of the small intestine, gastrectomy can be performed. In advanced ileal cancer, a hemicolectomy is performed on the right side of the large intestine.

With a confirmed diagnosis of small intestine 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 found that the tumor is sensitive to chemotherapy, drugs that prevent the growth of cancer cells are used.

Chemotherapy for small intestine cancer

Chemotherapy for cancer of the small intestine, 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 with. Chemotherapy is used before surgery to reduce the size of the tumor and inhibit the development of cancer cells, after surgery to reduce the risk of tumor recurrence.

After a palliative operation (which alleviates the suffering of the patient), chemotherapy (polychemotherapy) is carried out, but without radiation.

After the operation, an additional diagnosis of intestinal motility is carried out using the method of electrogastroenterography, so that a dangerous complication does not develop - intestinal paresis.

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

Prevention of cancer of the small intestine (colon)

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

• regularly undergo preventive examinations;
• adhere to the principles of a healthy lifestyle and proper nutrition;
• timely treat diseases of the gastrointestinal tract;
• annually take a fecal occult blood test (Colon View test, with which you can determine the occult blood in the feces and detect bowel cancer at an early stage);
• do not delay and consult a doctor if any alarming symptoms appear on the part of the digestive system.

What is the life expectancy for small intestine cancer?

The 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 the operation the number of survivors for 5 years is 40-50%. Each subsequent stage reduces the percentage of positive outcomes in patients by 15 - 20%.

ILEAL TUMORS COMPLICATED WITH ACUTE

SMALL INTESTINAL OBSTRUCTION

Ibekenov O.T

The article presents literature data, as well as the results of clinical observation and successful surgical treatment of a tumor of the small intestine complicated by acute intestinal obstruction.

Keywords: intestinal tumor, leiomyosarcoma, peritonitis.

According to different authors, the incidence of tumors of the small intestine does not exceed 0.5 - 3.5% among all tumors of the gastrointestinal tract. Of all tumors of the small intestine, which are accompanied by various clinical symptoms and were detected during surgery, 75% are malignant. The low incidence of malignant tumors of the small intestine is associated with intense peristalsis, due to which there are no conditions in the small intestine for stagnation of the contents and decomposition in it. Malignant tumors of the small intestine are mainly localized in the initial sections of the jejunum and in the terminal sections of the ileum.

Symptoms of the disease occur when complications appear - intestinal obstruction (as a result of invagination or obstruction of the intestinal lumen), bleeding due to the collapse of the tumor or ulceration of the mucous membrane above it. The absence of symptoms characteristic of tumors of the small intestine makes it almost impossible to diagnose them on the basis of clinical manifestations. Complications of tumors of the small intestine - the development of acute intestinal obstruction, bleeding.

We present a clinical observation of a patient with a tumor of the small intestine complicated by acute intestinal obstruction.

Patient N., born in 1966, was admitted to the Department of Surgery of the City Emergency Hospital on June 13, 2011 with a referral emergency diagnosis of "acute pancreatitis". At the time of receipt of complaints of cramping abdominal pain, vomiting, bloating. From the anamnesis: the onset of the disease is associated with the intake of fatty foods. He denies past illnesses, there was no operation. Objectively: the abdomen is moderately swollen, soft, moderately painful in the umbilical region. Pathological formations are not palpable. There are no symptoms of peritoneal irritation. In the general blood test: leukocytosis 12.8 x 10 9 /l. Biochemical parameters and urinalysis were within normal limits. Plain radiography of the abdominal cavity shows single levels of fluid and Kloiber cups. After conservative therapy, his condition improved, the pain in the abdomen subsided, there was stool, gases passed. The patient was assigned an X-ray contrast study of the gastrointestinal tract with a suspension of barium sulfate. After 6 hours, a barium x-ray in the small intestine shows fluid levels in the small intestine. After 10 hours, the patient's condition worsened, there was vomiting with an admixture of barium suspension, the picture of acute intestinal obstruction remains on the radiograph of the abdominal cavity. After 12 hours the patient was taken for surgery.

06/14/2011 operation - Laparotomy. Resection of the small intestine with end-to-end anastomosis. Sanitation, drainage of the abdominal cavity.

In the abdominal cavity, a serous-hemorrhagic effusion of about 100 ml. At a distance of about 250 cm from the ligament of Treitz on the small intestine, a tumor-like formation 10x9 cm in size, dark purple-blue in color, large-tuberous, densely elastic in consistency, emanating from the mesentery of the intestine, on a stalk, compresses the intestinal wall, creating an obstructive small intestinal obstruction, was found. Above this area, the intestines are swollen up to 4 cm, below - collapsed. The operating situation was regarded as a tumor of the small intestine. Produced resection of the small intestine with the formation of a retreat of 20 cm proximally and distally of the formation itself. An end-to-end anastomosis was performed with two-row nylon sutures. Further revision revealed no other pathology. Lymph nodes of the mesentery of the small intestine without changes. Sanitation of the abdominal cavity with a solution of chlorhexidine, the small pelvis is drained by a tube. The laparotomic wound was sutured in layers. Histopathological diagnosis: Leiomyosarcoma of the small intestine with foci of necrosis and purulent fusion.

The course of the postoperative period is smooth. The patient underwent antibacterial, detoxification therapy, anticoagulants, drugs that stimulate bowel function, analgesics. The chair was on the 4th day after the operation. Healing by first intention. The patient was discharged on the 7th day after the operation under the supervision of an oncologist.

Final diagnosis: Leiomyosarcoma of the small intestine (T4N0Mx), complicated by obstructive small bowel obstruction. Diffuse serous-hemorrhagic peritonitis.

The patient was examined after 10 months, no pathology was detected, he works as a driver by profession.

Literature:

1. McNally P.R. Secrets of gastroenterology. M.: BINOM, 2005.

2. O. A. Anurova, P. V. Snigur, N. A. Filippova, and V. Yu. Morphological characteristics of stromal tumors of the gastrointestinal tract. - Arch. Pat., 2006; 1:68:10-13.

3. Hamilton S.R., Altonen L.A. WHO Classification of Tumors of the Digestive System. Lyon 2002; 314.

4. Licht J., Weissmann L., Antman K. Gastrointestinal sarcomas. Surg Oncol 1988; 15:181-188.

ІSHEK OUTIMSІZDIGIMEN ASKYNGAN MYKYN ІSHEKTIҢ ІSIGІ

Ibekenov O.T

Tuyin: Makalada, sirek kezdesetin pathology - ash іshek katerlі іsіgіne baylanysty аdebiettegі mаlіmetter zhane osy auruga baylanysty zhasalғan sattі operation nәtizhesі kөrsetіlgen.

Tuyindi sozder: ishek іsіgі, leiomyosarcoma, peritonitis.

Summary: The paper presents literature data and results of clinical observation and successful surgical treatment of tumor of the small intestine, complicated by the acute intestinal obstruction.

Malignant neoplastic lesions of the small intestine: duodenum, jejunum or ileum. Cancer of the small intestine manifests itself as dyspeptic disorders (nausea, vomiting, flatulence, spastic abdominal pain), weight loss, bleeding, 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 cancer of the small intestine consists in resection of the affected area of ​​the intestine, excision of regional lymph nodes and mesentery, and the imposition of enteroenteroanastomosis.

General information

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

Causes of small intestine cancer

In most cases, small intestine cancer develops against the background of chronic enzymatic or inflammatory diseases of the gastrointestinal tract (celiac disease, duodenitis, peptic ulcer, enteritis, Crohn's disease, ulcerative colitis, diverticulitis) or epithelial benign intestinal tumors. The predominant lesion of the duodenum is due to the irritating effect of bile and pancreatic juice on the initial section 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 risk factors for developing small bowel cancer. The likelihood of developing cancer of the small intestine is higher in smokers, persons exposed to radiation exposure, suffering from alcohol dependence; people whose diet is dominated by animal fats, canned foods, fried foods.

There is a certain mutual relationship between colon cancer and tumor lesions of the small intestine.

Classification of small intestine cancer

According to the nature of tumor tissue growth, 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; less common in oncological practice are sarcomas, carcinoid, intestinal lymphoma.

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

• Tis - preinvasive cancer
• T1 - tumor invasion of the submucosal layer of the intestine
• T2 - tumor invasion of the muscular layer of the intestine
• TK - tumor invasion of the subserous layer of the intestine or retroperitoneal space in an area of ​​\u200b\u200bno more than 2 cm
• T4 - germination of the tumor of the visceral peritoneum, non-peritoneal areas with a length of more than 2 cm, structures or organs adjacent to the intestine.
• N0 and M0 - absence of regional and separated metastasis
• N1 - metastatic lesion of regional lymph nodes (pancreatoduodenal, pyloric, hepatic, mesenteric).
• Ml - the presence of distant metastases in the peritoneum, liver, omentum, lungs, kidneys, bones, adrenal glands.

Symptoms of small intestine cancer

The manifestations of small intestine cancer are characterized by polymorphism, which is associated with the variability of localization, histology, and tumor size. In the initial stages, periodically recurring spastic pains in the abdomen, instability of the stool (diarrhea and constipation), flatulence, nausea and vomiting are disturbing. There is intoxication, a progressive decrease in body weight, which is associated with both reduced nutrition and tumor growth.

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

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

Diagnosis of cancer of the small intestine

The diagnostic algorithm for small intestine cancer of various localization has its own characteristics. So, in the recognition of tumors of the duodenum, the leading role is played by fibrogastroduodenoscopy and contrast fluoroscopy. For the diagnosis of tumors of the terminal ileum, colonoscopy and barium enema can be informative.

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

In order to detect metastases and germination of small intestine cancer in the abdominal organs, ultrasound is performed (of the liver, pancreas, kidneys, adrenal glands), MSCT of the abdominal cavity, chest x-ray, bone scintigraphy. In unclear cases, diagnostic laparoscopy is advisable.

Cancer of the small intestine must be differentiated from tuberculosis of the intestine,

In duodenal cancer, duodenectomy is indicated, sometimes with distal resection of the stomach or resection of the pancreas (pancreatoduodenal resection). With advanced cancer of the small intestine, which does not allow radical resection, a bypass anastomosis is performed between the unaffected bowel loops. The surgical stage of treatment for small intestine cancer is complemented by chemotherapy; the same method may be the only way to treat inoperable tumors.

Prognosis and prevention of small intestine cancer

The long-term prognosis for cancer of the small intestine is determined by the staging of the process and the histological structure of the neoplasm. With localized tumor processes without regional and distant metastases, radical resection allows achieving a 35-40% survival rate over the next 5-year period.

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