Its length and mucosal surface serve its basic function, which is the production of substances for digestion of food and the absorption of nutrients resulting from digestion. It consists of the duodenum, jejunum and ileum.
Small intestine and cancer
It is claimed that the small intestine is protected from the development of cancer due to:
• The fluidity of its contents, which is less irritating to the mucosa
• The speed of passage of the contents, which reduces the time of contact of the mucosa with possible carcinogenic components of this contents
• Its low content of bacteria
• The large amount of lymphatic tissue in the small intestine, the alkaline pH that characterizes its lumen, the presence of enzymes, such as benzopyrene hydroxylase, etc.
“Although, for all the above reasons, small bowel tumors are extremely rare, when they occur they are in a very high percentage (95%) malignant.”
The most common of these are:
Adenocarcinomas, most often in the duodenum
• Crustaceans and lymphomas, most commonly in the jejunum and ileum
Sarcomas with an equal presence throughout the small intestine
• Metastatic neoplasms of the small intestine.
The fact that adenocarcinomas occur in the duodenum is probably due to the presence, there, of Vater’s tuberculosis, in the area of ​​which the development of tumors is not uncommon (collateral neoplasms). Primary small bowel tumors are extremely uncommon and are rarely diagnosed at an early stage. The disease usually becomes clinically evident in advanced stages, at which point any treatment gives poor results.
Symptoms
The main symptoms are:
• Diffuse abdominal pain
• Palpable mass (symptom observed in 25% of patients)
Bleeding from the rectum (found in 3-76% of cases), appearing either in the form of black discharge, or as massive bleeding, or finally, as a tiny blood loss in the stool, leading to anemia
• Appearance of a clinical picture of an acute abdomen, leading to the discovery of the tumor before metastasis
Occurrence of jaundice (common in duodenal carcinomas).
Diagnosis
Enteroclysis (administration of a contrast agent to the stomach and taking x-rays) allows uniform imaging of the entire small intestine. It is the most appropriate radiological method for the diagnosis of diseases of the small intestine. Endoscopy can be helpful, especially for small bowel tumors located in the distal parts of the duodenum, gastroscopy via jejunum, and final ileum through colonoscopy. The use of an endoscopic capsule may seem helpful, while computed tomography provides information about the topography of the disease and its spread to nearby organs or lymph nodes.
Newer imaging methods are the following:
• Magnetic enteroclysis
• PET-CT: For the detection and characterization (benign or not) of tumor-shaped processes
• Diagnostic laparoscopy: For staging of cancers of the digestive system with possible involvement of the small intestine (possibility of taking biopsies).
What causes small bowel cancer
The association of small bowel cancer with Crohn’s disease, celiac disease (gluten intolerance) and familial polyposis syndrome is known, while predisposing factors are considered to be alcohol, salts and smoked, consumption of white sugar and A, in patients with A immunosuppression.
Treatment
Surgical resection is the only way to treat small bowel cancer. The part of the intestine that carries the tumor and adjacent structures are removed, in case they are infiltrated. Particular reference should be made to duodenal neoplasms, for the treatment of which resection of the anatomically related neighboring structures, namely the head of the pancreas and the bile duct (Whipple pancreodoductectomy) should be performed. Complementary therapy (chemotherapy or radiotherapy) may be provided depending on the histological result. Survival, reported in all small bowel cancers, is relatively good (5 years for over 50% of patients), with a better prognosis for crustaceans and a worse prognosis for adenocarcinoma.
In recent years, rapid technological progress has made it possible to perform almost any type of surgery on the small intestine with the da Vinci robotic system. The advantages are obvious: minimal postoperative pain, faster recovery, fewer complications.
Writes:
Dr. Ioannis K. Kozadinos, Director of the 1st Robotic Surgery Clinic Metropolitan Hospital
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