Cancer of a small intestine

Description:

Cancer of a small intestine rather rare oncological disease of a digestive tract which makes only 2% among other malignant tumors of a GIT. Generally these new growths are presented by an adenocarcinoma, sarcoma, carcinoid and lymphoma of intestines.

Cancer of a small bowel makes from 0,5 to 16,9% of all cancer tumors of intestines according to different authors. On summary statistics meets in 2,5 - 3,5% of cases in relation to other localizations of cancer in intestines.

Men are ill and 2 times more often than women. Elderly people get sick preferential.

Each of them has the certain gistofiziologichesky features, various behavior pattern and, respectively, specific clinical manifestations. The most frequent on occurrence are adenocarcinomas – the malignant tumors growing from ferruterous tissue of a mucous membrane of a small intestine. About a half of them is noticed in a duodenum, about 30% are diagnosed in lean and 20% - in ileal.

High frequency of cancer of small intestine is noted in the developing Asian countries, and the lowest – in advanced industrial countries of Western Europe and in the USA. Higher predisposition to development of this disease in the black population in comparison with the population with light skin is noted. Men have higher tendency to development of cancer, than the woman in the ratio of the frequency of occurrence 1.4:1. The prevailing number of cases is noted aged 60 years are more senior, and the frequency of its development increases with age.

Reasons of cancer of small intestine:

Among the reasons promoting development of cancer of small intestine it should be noted existence of adenomatous polyps in a mucous membrane of a small intestine which meet as sporadic, that is it is accidental, and in the presence of family adenomatous a polypose – a hereditary disease of the genetic nature.

Other reasons as consider, chemical carcinogens which are a part of food can serve and together with it come to intestines; smoking; alcohol abuse; chronic inflammatory and enzymatic diseases of bodies of a digestive tract (disease Krone, nonspecific ulcer colitis, Gee's disease); peptic ulcer; impact of radiation exposure, some genetic anomalies (for example, Peyttsa-Yegers's syndrome), and also oncological diseases of other bodies which give metastasises in tissue of a small intestine.

Pathogeny:

Cancer of a small bowel meets more often in initial department lean and final loops ileal guts, more often happens single and is exclusively rare - multiple.

In most cases the cancer tumor of a small bowel proceeds from a cylindrical epithelium of intestinal glands and on a histologic structure is an adenocarcinoma. Sometimes mucous cancer is found.

(Precancer) intestinal ulcers, adenomas, chronic inflammations, diverticulites contribute to development of cancer.

The cancer tumor grows in a gut gleam, more rare vnutristenochno and only sometimes ekzofitno more often. Cancer growing in a gleam narrows a gut, and generally concentrically (koltsevidno) and much more rare eccentric.

The gut loop located above narrowing can extend, and its muscular layer hypertrophies. At the expressed and long stenozirovaniye of an intestinal gleam the bringing intestinal loop can pererastyagivatsya, become thinner and even to perforate in a free abdominal cavity with development of peritonitis. Passability of a gut in connection with invagination can sometimes be broken.

Cancer of a small bowel ulcerates infrequently. Gives metastasises in mesenteric and retroperitoneal lymph nodes, a liver, a peritoneum, an epiploon, lungs, adrenal glands, bones, kidneys, a firm meninx etc., and innidiation generally happens in the lymphogenous way. The tumor can grow together with the next intestinal loop, a large intestine, a bladder, female internal generative organs, an epiploon and together with the increased regional lymph nodes to represent a big and slow-moving conglomerate. The ulceration and disintegration of a tumor can lead to formation of fistulas with the next bodies.

Symptoms of cancer of small intestine:

Clinical manifestations at cancer of a small intestine develop gradually and, unfortunately, most often patients see a doctor at later stages when the tumor burgeons deeply in tissue of intestines and metastasizes in the next bodies.

The most frequent initial symptoms are dispepsichesky frustration: nausea, vomiting, abdominal distention, spastic pains in intestines. Further decrease in body weight which can be connected both with reduced food, and with bystry progressing of tumoral process is observed.

In certain cases, especially in the presence of sarcoma, intestinal bleedings can be observed. In case of development of massive tumors quite often there is an obstructive intestinal impassability which is shown by abdominal distention, vomiting, dehydration and without the corresponding treatment can lead to death. New growths can also squeeze the next fabrics and bodies that can serve as the reason of development of jaundice, pancreatitis, ascites and ischemia of intestines. Sometimes tumoral defeat serves as the reason of a rupture of an enteric wall that leads to other alarm condition of a patient – peritonitis.

Malignant tumors of a small intestine are subdivided on:
- The adenocarcinoma meets seldom, happens at the disease Krone affecting a small bowel develops in a proximal part of a jejunum more often.
- Primary malignant lymphoma which proceeds from an ileal gut and often develops at a Gee's disease.
- Carcinoid tumors most often develop in an appendix, from them in 50% multiple tumors meet, and of more than 2 cm metastasize in nearby bodies and fabrics, is more often in a liver. Are clinically characterized by intestinal impassability, pains, bleedings.
- Kaposha's sarcoma in 20% of cases can be combined with other primary malignant damages of intestines, such as lymphocytic leukosis, lymphosarcoma, Hodzhkin's disease, adenocarcinoma. Any site of digestive tract, both a stomach, and a small bowel, and a distal part of a large intestine can be affected. The clinic is corresponding: sometimes asymptomatic, but bleedings, a diarrhea, invagination are possible.

Diagnosis:

For diagnosis of oncological diseases of a small bowel the fibrogastroscopy, X-ray inspection, an angiography of vessels of an abdominal cavity, a kolonoskopiya, a laparoscopy, a computer tomography, a nuclear magnetic resonance, and also a biopsy for establishment like cells and degree of their zlokachestvennost are most often used.

The differential diagnosis has to be carried out with tuberculosis of a small bowel, a disease Krone, arteriomesenteric impassability, benign tumors of the small bowel, a colon cancer, tumors of ovaries wandering a kidney, an inborn stenosis of a gut.

Cancer therapy of a small intestine:

Cancer therapy of a small bowel depends on a stage of a disease and a type of a tumor. In 2/3 cases resort to surgical removal of an oncological new growth that quite often leads as to decrease in symptomatology, and promotes increase in life expectancy.

In certain cases operation has palliative character, that is is carried out only for the purpose of relief of sufferings of the patient.

In cases of not operability or in the presence of the tumor sensitive to chemotherapeutic means, apply therapy with use of the drugs suppressing growth and interfering development of tumor cells.