Tumors of the small intestine, such as small bowel cancer, are among the rather rare pathological changes of the intestinal tract and are characterized by a gradual progression of the disease.
What is small bowel cancer?
Small bowel cancer or small bowel tumor can be defined as a tumor that manifests in a specific area of the intestine, that is, in the digestive tract. Small bowel cancer can be recognized as both benign and malignant tumor depending on its typical nature and the types of cells it contains. A benign tumor of the small intestine is called a small intestinal polyp, while a malignant tumor is called a small intestinal cancer. 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 tumor was classified depending on its localization. In addition to the tumor of the small intestine in the duodenum, a cancer of the small intestine can also develop in the jejunum or the ileum. The malignant form in small bowel tumor is typically in the duodenal area.
Causes
In the context of the targeted search for causes, it has not yet been possible to clearly clarify which triggers can be considered for the development of small bowel cancer. Currently, various concomitant or pre-existing diseases such as Crohn’s disease, the so-called polyposis syndromes, and Peutz-Jeghers syndrome are being shortlisted as hereditary causes, as well as reduced immune system defenses for the expression of small bowel tumor. In addition to internal factors as triggers for the growth of small intestinal tumors, external influences such as cancer-causing substances in food, such as preservatives and dyes, as well as various chemical substances, may also be considered as causative factors. In particular, people who suffer from HIV infection and have survived organ transplantation may develop a small intestine tumor.
Symptoms, complaints, and signs
Initially, there are no symptoms associated with small bowel cancer. After some time, nonspecific symptoms are observed, which can also occur in other diseases. Thus, the patient often suffers from abdominal pain, nausea, vomiting, constipation, and diarrhea. As the disease progresses, bleeding and colicky pain are added. In extreme cases, the growth of the tumor can also lead to life-threatening intestinal obstruction. This is also announced by colicky 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 with deeper-lying small bowel cancer. If the tumor is located in higher sections of the small intestine, these symptoms are often absent. Without treatment, more and more sections of the intestine are affected. Initially, the cancer spreads to neighboring loops of the intestine, leading to adhesions. In addition to intestinal obstruction, later stages of the disease can also lead to intestinal perforation and bleeding. These are life-threatening complications that can lead to death even before metastases form. After metastasis through the lymph nodes, daughter tumors may grow in the lungs, bones and other organs. Eventually, the cancer may spread within the peritoneum and cause significant water retention in the abdomen.
Diagnosis and progression
Small bowel cancer is not noticeable until it reaches a certain size. Depending on a certain growth stage, the small bowel tumor causes typical symptoms such as constipation, nausea and vomiting, and pain in the lower abdomen. Digestive activity may also be affected depending on the type of small bowel tumor. Many people complain of bloody stools and bloody secretions from the intestines in advanced stages with small bowel tumor. As the tumor growth progresses, a malignant small bowel tumor can lead to the formation of metastases by the spread of cells that attach to other organs and cause cancer growth there. The diagnosis of small bowel tumor is quite diverse and is done with technical procedures such as X-ray based examination, colonoscopy, diagnostic ultrasound and surgical opening of the abdominal cavity. This is also called exploratory laparotomy.In people with little body weight, a large tumor of the small intestine can be felt by hand. Laboratory diagnostic tests of stool also provide indications that a tumor is present in the intestine. Final clarification of whether the tumor is small bowel cancer comes only with more advanced measures.
Complications
A characteristic feature of small bowel cancer is intestinal obstruction by the tumor. The subsequent breakthrough through the intestinal wall causes peritonitis. Typical accompanying symptoms include abdominal pain, constipation, blood in the urine, diarrhea, nausea, and vomiting. These health disorders are life-threatening and require immediate treatment measures and intensive medical care. Usually, these complications are a sign of advanced colorectal cancer. The type and extent of the health disorders determine the course of the disease and thus also the chances of cure. In the case of benign tumors of the small intestine in the form of intestinal polyps, small tumors without involvement of the lymph nodes and adjacent organs with metastases, there is a favorable prognosis. Typical serious disorders are the spread of tumors and metastases to the neighboring organs such as liver, kidneys and bladder. This disease process can lead to squeezed vital blood vessels as well as infarction and death of the intestine and other affected organs. The liver is most frequently affected by the spread of tumors and metastases. Coagulation disorders, liver failure, impaired consciousness and edema occur. Prolonged cough with expectoration of 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 terminal stage of the disease, the prognosis is always negative, as 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 see a doctor?
Small bowel cancer usually causes symptoms only at an advanced stage, if at all. It is therefore advisable to start colorectal cancer screening from the age of 50 or even before. People who have cases of intestinal polyps or other types of cancer in their immediate family should go for regular screening at a younger age. The same applies to other risk groups such as patients who have overcome colorectal cancer or people with a weakened immune system or existing cardiovascular diseases. Medical clarification is recommended at the latest when the first symptoms of a serious bowel disease appear. These can be unusually severe stomach complaints such as vomiting, nausea or pain, as well as blood deposits in the stool. If serious symptoms such as intestinal obstruction or colicky abdominal pain occur, an emergency physician must be called immediately. In addition, severe bloating, lack of bowel movements and weight loss should be taken to the doctor. In general, as soon as complaints occur that cannot be attributed to any particular cause and do not subside after a few days, medical advice is required.
Treatment and 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 removed surgically. The operation is based either on an endoscopic procedure or a so-called open surgery with a normal abdominal incision. The endoscopic variant is sometimes also used to take tissue samples in cases of suspected small bowel cancer. If the diagnosis reveals that the small bowel tumor is malignant and appears as small bowel cancer, surgical removal in combination with subsequent radiation and chemotherapy is used. Some tumor types can be cured without surgical removal only on the basis of radiation treatment.
Outlook and prognosis
Because small bowel cancer is a tumor disease, its further course depends very much on the time of diagnosis and the spread of the tumor. If metastasis has already occurred, this usually significantly reduces the life expectancy of the affected person, and small bowel cancer cannot be completely cured. However, early diagnosis increases the chances of a positive course of the disease.If small bowel cancer is not treated, those affected suffer from constipation, diarrhea and severe abdominal pain. They may also experience permanent nausea or bloody stools. The quality of life of those affected is considerably restricted and reduced by the disease. The earlier the small bowel cancer is removed, the higher the probability that the cancer has not yet spread further in the body. Surgical procedures and chemotherapy can provide good relief from the symptoms. However, chemotherapy is associated with strong side effects. Furthermore, a healthy lifestyle can also have a very positive effect on the course of the disease and prevent the development of small bowel cancer.
Prevention
For prevention in small bowel tumor, no significant procedures are known so far. Only possible early detection can increase a chance of cure in small bowel tumor as cancer. In addition, prophylaxis against small bowel cancer includes the containment of key risk factors and a healthy lifestyle. In the context of small bowel tumor prevention, this is based on the avoidance of unfavorable lifestyle habits, particularly those associated with the intake of alcohol, nicotine and carcinogenic ingredients in the diet. A diet rich in fiber and vitamins, sufficient exercise to strengthen the body’s immune defenses, and a healthy body weight can prevent a small bowel tumor.
Follow-up
Follow-up care depends on the type of therapy that preceded it. If a small bowel resection was unavoidable, additional specialist teams are provided. Short bowel syndrome often occurs, making nutrient absorption difficult. In this case, a special, monitored diet is essential. This can also result in further operations. If an artificial bowel outlet (anus praeter, stoma) has to be created, a trained team (stoma therapists) will supervise and monitor the aftercare in addition to the specialist. The patient can leave the hospital 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. Suture removal is usually performed ten to twelve days post-operatively by the attending physician or family doctor. He or she must also monitor the course of the procedure and initiate appropriate measures in the event of absorption disorders that indicate a short bowel syndrome. One conceivable option would be parenteral nutrition via a port implant in a central vein. If a relief stoma has been applied, it can be moved back later. If surgical measures were not indicated, regular follow-up of the affected area (including lymph nodes and metastases in neighboring areas) is performed after chemotherapy or radiation. In the case of recurrent carcinoma, measures for treatment (no cure; only containment of the carcinoma as far as possible) are to be explained and carried out. This is done via chemotherapy, radiation, and/or medication.
What you can do yourself
Small bowel cancer absolutely must be treated by a physician. Self-help measures should only be carried out in addition to the medically prescribed therapy. An important contribution that patients can make themselves is to reduce risk factors associated with certain lifestyle and dietary habits. Certain factors have been shown to be associated with an increased risk of colorectal cancer. These include a low-fiber, high-fat diet and regular consumption of meat and sausage products. It is suspected that the high residence time of these foods in the intestine causes carcinogenic substances to remain in contact with the intestinal mucosa for longer and affect the intestinal cells. Other counterproductive factors are 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 have had to have a stoma (artificial bowel outlet) often suffer emotionally. In addition to psychotherapy, contact with other affected persons can help them to come to terms with their new circumstances. There are various self-help groups for this purpose, which are also present online. On the pages of many of these associations, products are also presented that make life with a stoma easier.
