Tumors of the small intestine, such as small intestine cancer, are among the more rare pathological changes in the intestinal tract and are characterized by a stage-wise course of the disease.
What is Small Intestine Cancer?
According to photionary, small bowel cancer or small bowel tumor can be defined as a lump that manifests itself in a specific area of the intestine, i.e. the digestive tract. Small bowel cancer can be recognized as both benign and malignant tumors, depending on its typical nature and the types of cells it contains.
A benign tumor in the small intestine is known as a polyp of the small intestine, and a malignant tumor is known as a cancer of the small intestine. Since the small intestine consists of different zones, the small intestinal tumor does not have to be limited to a specific area and can occur locally in the entire small intestine.
For this reason, small bowel tumors were classified depending on their location. In addition to the small intestine tumor in the duodenum, cancer of the small intestine can also develop in the jejunum or ileum. The malignant form in small bowel tumors is typical of the duodenum.
As part of the targeted search for the cause, it has not yet been possible to unambiguously clarify which triggers for the development of small bowel cancer are in question. At present, various concomitant or previous illnesses such as Crohn’s disease, the so-called polyposis syndromes and Peutz-Jeghers syndrome are shortlisted as hereditary causes as well as a reduced resistance of the immune system for the expression of small intestinal tumors.
In addition to the internal factors that trigger the growth of small intestinal tumors, external influences such as cancer-causing substances from food such as preservatives and dyes as well as various chemical substances may also be considered as causal reasons. Small intestinal tumors can develop, especially in people who are HIV-infected and have survived an organ transplant.
Symptoms, ailments & signs
Initially, there are no symptoms in small bowel cancer. After a while, unspecific symptoms are observed that can also occur with other diseases. The patient often suffers from abdominal pain, nausea, vomiting, constipation and diarrhea. As the disease progresses, bleeding and colic-like pain occur.
In extreme cases, the growth of the tumor can also lead to a life-threatening intestinal obstruction. This is also announced by colic-like pain in the area of the navel and vomiting. Often there is also an increased accumulation of gas in the intestine, severe flatulence and constipation.
However, the latter symptoms only occur in deeper small bowel cancer. If the tumor is higher up in the small intestine, these symptoms are often absent. Without treatment, more and more intestinal sections are affected. First, the cancer spreads in the neighboring loops of the intestine and leads to adhesions. In addition to an intestinal obstruction, intestinal perforations and bleeding can also occur in later phases of the disease.
These are life-threatening complications that can lead to death even before metastases have developed. After metastasis via the lymph nodes, daughter tumors can grow in the lungs, bones and other organs. Eventually, the cancer can spread within the peritoneum and cause significant water retention in the abdomen.
Diagnosis & course
The cancer of the small intestine only becomes noticeable from a certain size. Depending on a certain growth stage, the small intestine tumor causes typical symptoms such as constipation, nausea and vomiting as well as pain in the lower abdomen. Digestive activity can also be impaired, depending on the type of small bowel tumor.
In the advanced stages of small bowel tumors, many people complain of bloody stool and bloody secretions from the intestines. As the tumor continues to grow, a malignant small bowel tumor can lead to the formation of metastases through the spread of cells that attach to other organs and trigger cancerous growth there.
The diagnosis of small intestinal tumors is quite diverse and is carried out using technical procedures such as an X-ray-based examination, mirroring of the intestine, diagnostics with ultrasound and an operative opening of the abdominal cavity. This is also known as an exploratory laparotomy.
In people who are light in body, a large tumor in the small intestine can be felt by hand. Laboratory tests of stool also indicate that a tumor is present in the intestine. The final clarification as to whether it is small bowel cancer is only made through further measures.
The bowel obstruction caused by the tumor is characteristic of small bowel cancer. The subsequent breakthrough through the intestinal wall causes peritonitis. Typical side effects are abdominal pain, constipation, blood in the urine, diarrhea, nausea and vomiting. These health disorders are life threatening and require immediate treatment and intensive medical attention.
Usually these complications are indicative of advanced colon cancer. The type and extent of the health disorders determine the course of the disease and thus the chances of recovery. In the case of benign small intestinal tumors in the form of intestinal polyps, small tumors without involvement of the lymph nodes and neighboring organs with metastases, the prognosis is favorable.
Typical serious disorders are the spread of tumors and metastases to neighboring organs such as the liver, kidneys and bladder. This course of the disease can lead to depressed vital blood vessels as well as infarction and death of the intestine and other affected organs. The liver is most commonly affected by the spread of tumors and metastases.
There are coagulation disorders, liver failure, impaired consciousness and edema. Persistent coughing with blood is an indication that the cancer has already spread to the lungs. The survival rate five years after the onset of the disease is 95 to 5 percent, depending on the complications and the stage of the disease.
If the patient is already in the end stage of the disease, the prognosis is always negative, since death occurs within a few weeks or months even with appropriate therapies and treatments. Without treatment, small bowel cancer is always fatal.
When should you go to the doctor?
Small bowel cancer usually only causes symptoms – if at all – at an advanced stage. It is therefore advisable to start colon cancer screening at the age of 50 or before. People who are closely related to have cases of intestinal polyps or other types of cancer should go to regular early detection when they are younger. The same applies to other risk groups such as patients who have overcome colon cancer or people with a weakened immune system or existing cardiovascular diseases.
A medical examination is recommended at the latest when the first symptoms of a serious bowel disease appear. These can be unusually severe stomach problems such as vomiting, nausea or pain, and blood deposits in the stool. If serious symptoms such as an intestinal obstruction or colicky abdominal pain occur, an emergency doctor must be called immediately.
In addition, you should see a doctor with severe flatulence, absent bowel movements and weight loss. In general, medical advice is required as soon as symptoms arise that cannot be traced back to any specific cause and do not go away after a few days.
Treatment & Therapy
The choice of treatment is determined by the type of small bowel tumor. A benign small bowel tumor or small bowel polyp can be surgically removed. The operation is based either on an endoscopic procedure or a so-called open operation with a normal abdominal incision.
The endoscopic variant is sometimes also used to take tissue samples if small bowel cancer is suspected.
If the diagnosis reveals that the small intestinal tumor is malignant and appears as small intestinal cancer, surgical removal is used in combination with subsequent radiation and chemotherapy. Some types of tumor can only be healed with radiation treatment without surgical removal.
Outlook & forecast
Since small bowel cancer is a tumor disease, the further course depends very much on the time of diagnosis and the spread of the tumor. If metastasis has already occurred, the life expectancy of the person affected is usually significantly reduced and the cancer of the small intestine cannot be completely cured.
With an early diagnosis, however, the chances of a positive course of the disease increase. If the cancer of the small intestine is not treated, the affected person will suffer from constipation, diarrhea and severe abdominal pain. It can also lead to permanent nausea or bloody stools. The quality of life of those affected is considerably restricted and reduced by the disease.
The sooner the cancer of the small bowel is removed, the more likely it is that the cancer has not yet spread further in the body. Surgical interventions and chemotherapy can help alleviate the symptoms. Chemotherapy, however, is associated with severe side effects. Furthermore, a healthy lifestyle can have a very positive effect on the course of the disease and prevent the development of small bowel cancer.
Up to now, no essential procedures are known for the prevention of small intestinal tumors. Only a possible early detection can increase the chance of a cure in the case of a small intestinal tumor as cancer. In addition, prophylaxis against small bowel cancer includes the containment of key risk factors and a healthy lifestyle.
In connection with small intestinal tumor prevention, this is based on avoiding unfavorable lifestyle habits, which result in particular from the ingestion of alcohol, nicotine and carcinogenic ingredients in food. A diet rich in fiber and vitamins, sufficient exercise to strengthen the body’s immune defenses and a healthy body weight can prevent small intestinal tumors.
Follow-up care depends on the type of previous therapy. If a resection of the small intestine was unavoidable, specialist teams are also provided. Often there is a short bowel syndrome, which makes it difficult to absorb nutrients. A special, monitored diet is essential here. This can also result in further operations.
If it is necessary to create an artificial anus (anus praeter, stoma), a trained team (stoma therapist) will supervise and supervise the follow-up care alongside a specialist. The hospital can be left after five to seven post-op days with regular food intake and elimination. Further aftercare takes place at home; possibly in cooperation with a nursing service.
Sutures are usually removed ten to twelve days postoperatively by the attending physician or family doctor. He must also monitor the progress and initiate appropriate measures in the event of resorption disorders that indicate short bowel syndrome. One of the conceivable options would be parenteral nutrition via a port implant into a central vein.
If a relief stoma was applied, it can be moved back later. If surgical measures are not indicated, regular follow-up checks are carried out on the affected area (including lymph nodes and metastases in neighboring areas) after chemotherapy or radiation. In the case of recurring carcinoma, treatment measures (no cure; only contain the carcinoma as far as possible) must be explained and implemented. This is done via chemotherapy, radiation and / or medication.
You can do that yourself
Small bowel cancer must be treated by a doctor. Self-help measures should only be carried out in addition to the medically prescribed therapy.
An important contribution that the patient can make themselves is the reduction of risk factors associated with certain lifestyle and eating habits. Certain factors have been shown to be linked to an increased risk of colon cancer. These include a low-fiber, high-fat diet and regular consumption of meat and sausage products.
It is assumed that the long time these foods stay in the intestine means that carcinogenic substances remain in contact with the intestinal mucosa for longer and impair the intestinal cells. Also included are counterproductive obesity, lack of exercise and excessive consumption of alcohol and nicotine. In contrast, the substance chlorophyll, which is contained in green salads and green vegetables, is said to have a positive effect. In naturopathy, chlorophyll is also used as an isolated active ingredient against colon cancer.
Patients who need an ostomy (artificial bowel anus) often suffer mainly from an emotional point of view. In addition to psychotherapy, contact with other affected persons can also help to come to terms with the new living conditions. There are various self-help groups that are also present online. Many of these associations also present products that make life easier with an ostomy.