The small intestine is the part of the digestive tract that connects the stomach to the large intestine. Its interior is covered by several cells that are responsible for the secretion of both substances necessary for the digestion and absorption of nutrients.When some of these cells become malignant, lose control mechanisms that allow to reproduce and die normally, there is a neoplasia or cancer of the small intestine.
It must be said, however, that the majority of tumors which occur in the small intestine, between 75% and 90% are benign. Most of the time these tumors do not cause symptoms and whether they are usually intestinal obstruction or chronic bleeding. Generally not treated unless they produce significant bleeding that can lead to a state of anemia, in which case it will be surgically removed.
Small intestine cancer can be of different types depending on the cell type from which they occur.
Adenocarcinomas derived from intestinal cells capable of secreting substances are malignant tumors more frequent bowel. Occurred mainly at the end of the duodenum and jejunum the initial and most often in people with intestinal polyps.
Intestinal lymphomas are usually non-Hodgkin’s type. They are usually localized, single location, but sometimes appear as diffuse tumors along the small intestine, especially the ileum. Usually aggressive tumors that invade easily into the intestine adjacent structures. The incidence is higher in people suffering from celiac disease.
Sarcomas are rare tumors of the small intestine and appear mainly in the jejunum and ileum.
Notably a type of intestinal tumors are carcinoid tumors. These tumors arise from cells with hormone secretion capacity existing in the intestinal wall, so that not only digestive symptoms but also produce other derivatives of thyroid hormones, particularly of serotonin. It can be seen in appendix and rectum, but which occur in the small intestine, most often in the jejunum or ileum duodenum, are more aggressive and tend to liver metastases.
Most small bowel tumors give symptoms by blocking the digestive tract that cause, so that can cause chronic intestinal pain difficult to control, alterations in intestinal transit and sometimes intestinal obstruction. May ulcerate and bleed, which can be chronic anemia due to bleeding. Sometimes nausea and vomiting can occur.
Diffuse intestinal lymphomas can give fevers, impaired intestinal absorption, weight loss and severe fatigue.
Carcinoid tumors, as well as possible that can cause intestinal obstruction in terms of their size, are characterized by marked asthenia and symptoms resulting from hormonal secretion. Serotonin causes these tumors producing increased secretion of intestinal peristalsis increased, decreased uptake and increased fibrosis. This fibrosis usually affects the intestines and especially the right heart valves (pulmonary and tricuspid), which can lead to heart failure, sudden episodes of hypotension (often triggered by stress, alcohol or certain foods), telangiectasias and wheezing. Carcinoid syndrome is characterized by intense facial flushing, diarrhea and cardiac involvement, although it should be said that there are carcinoid tumors that do not cause these symptoms to have a low hormone production.
An intestinal tumor should be suspected in a patient with long-standing symptoms of intestinal obstruction, intestinal pain, fatigue, or dark stools. In addition to a physical examination, blood test in assessing whether there is anemia. You can also perform a test for fecal occult blood.
The difficulty in diagnosing these tumors is that its location is not easily accessible. Imaging tests such as barium contrast radiography or computed tomography (CT) can not always give good results. Endoscopy will see tumors as long as they are in an accessible area of the small intestine. Today, thanks to capsule endoscopy, it is easier to image areas with poor access.
Be suspected of a carcinoid tumor when the patient has symptoms of digestive symptoms compatible with a small bowel tumor and there facial flushing or symptoms resulting from heart valve disease as described above. Urine can be determined in a derivative of serotonin in the event of a carcinoid tumor is very high.Similarly, plasma serotonin levels can also be elevated.
The 80% of carcinoid tumors have cells in their receivers to a substance, somatostatin. If a scan is performed which is used in an analog radiolabeled somatostatin, can be observed as these tumors capture the substance.
It is sometimes said that there is only digestive symptoms, which until it intervenes and analyzed the tumor can not discern what type of cancer of the small intestine is about.
The main option for Small intestine cancer treatment is surgery. In general, try to perform a wide resection and removed in the same operation the lymph nodes in the affected area.
If the tumor can not be removed or has spread, you can opt for palliative surgeries such as intestinal diversions and isolates the affected bowel segment to prevent recurrent episodes of intestinal occlusion.
In the case of lymphoma is usually associated chemotherapy or radiotherapy to surgical resection.
Carcinoid tumors presenting symptoms resulting from hormonal secretion and metastases usually have given, mainly liver, thus not recommended surgical resection of these unless they are unique or highly localized.Chemotherapy is usually associated to treatment, although not very sensitive to it.
In case you can not be operated, will control the symptoms produced by carcinoid tumors with octreotide, loperamide, antihistamines, bronchodilators or corticosteroids.
There are no specific preventive measures for small bowel tumors. At best, if you have chronic digestive symptoms, you should go as soon as possible the gastroenterologist.
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