Small Intestine Cancer

Clinical Manifestations

The symptoms and course of malignant tumors in the small intestine vary depending on the type and location of the tumor. It is generally believed that the average duration of adenocarcinoma is 5-6 months, leiomyosarcoma is 8-9 months, and carcinoid is 12-25 months. Symptoms appear earlier in those located in the duodenum; Carcinoid tumors often occur in the ileum, and symptoms are relatively late. The symptoms of malignant tumors of the small intestine include abdominal masses, abdominal pain, intestinal obstruction, fever, anemia, weight loss, etc; Those located in the duodenum may have jaundice, frequent vomiting, etc; Tumor perforation may present with peritonitis.

Figure 2. Regulating salt and water metabolism

Types of colorectal cancer

Small intestinal tumors can be benign or malignant. The main malignant types include:

Adenocarcinoma: Originating from glandular cells on the inner wall of the intestine, usually occurring in the duodenum or jejunum.

Neuroendocrine tumors (NETs)/carcinoids: Endocrine cells originating from the intestinal wall, most commonly found in the ileum. If transferred to the liver, they secrete hormones and cause carcinoid syndrome.

Lymphoma: an immune system cancer that can originate from the small intestine.

Gastrointestinal stromal tumor (GIST): Originating from Cajal stromal cells in the digestive tract wall. Many are related to KIT or PDGFRA gene mutations.

Sarcoma: such as smooth muscle sarcoma (smooth muscle tissue) or extremely rare histiocytoma.

Disease Examination

Disease Examination	Detail
Barium contrast imaging for small intestine cancer	Small intestinal barium contrast can display the location and extent of small intestinal diseases, but the positivity rate is relatively low. The gas barium double contrast method, especially the intubation method of small intestine gas barium double contrast, increases the diagnostic rate of small intestine hemorrhagic lesions by 10% to 25%. Small intestine barium contrast has almost no diagnostic value for vascular lesions.
Radionuclide imaging	Radioisotope imaging is a non-invasive examination mainly used for locating small intestinal bleeding, and its sensitivity is stronger than angiography. The positive rate of diagnosis for small intestinal active bleeding is 40% to 50%, but sometimes false positives may occur.
Angiography examination	Choose vascular imaging examination for small intestinal diseases, especially gastrointestinal bleeding. This method is an effective diagnostic and therapeutic approach, as long as the contrast agent extravasation is observed, a clear diagnosis can be made and embolization treatment can be performed simultaneously. But this examination is affected by the speed of blood loss and the timing of the examination, and the contrast agent must be injected into the blood supply artery of the bleeding site during the bleeding activity period in order to be successful.
Capsule endoscopy	The emergence of capsule endoscopy has brought a revolution to the diagnosis of small intestinal diseases. The capsule endoscope is only the size of a paperclip, and during the examination, patients only need to swallow the capsule endoscope like swallowing a drug capsule, wearing a data recorder vest. After swallowing the capsule, it can be checked by a doctor to confirm that the capsule has entered the small intestine before leaving the hospital.

Treatment Options

The treatment depends on the tumor type, stage, location, and overall health status of the patient:

Surgery: The main and potential treatment method for local tumors. The scope of surgery ranges from local resection to more extensive resection of affected intestinal segments and their associated lymph nodes.

Chemotherapy: Used as an adjuvant to kill remaining cancer cells after surgery, or as the primary treatment for advanced or metastatic diseases. Common drugs include fluorouracil (5-FU), capecitabine, and oxaliplatin.

Targeted therapy: These drugs target specific molecules involved in cancer growth. For example, imatinib is used for GIST with KIT mutations, and bevacizumab (an anti angiogenic drug) can be used for some adenocarcinomas.

Radiation therapy: Due to the small intestine's sensitivity to radiation, it is not commonly used, but may be helpful in specific situations, such as treating local pain caused by metastasis.

Symptom and side effect management: Nutritional support is crucial, and sometimes parenteral nutrition (intravenous injection) is needed. Medications are also used to treat symptoms of carcinoid syndrome.

Conclusions

Small intestine cancer is a complex and rare group of diseases. Its vague symptoms often lead to delayed diagnosis, underscoring the importance of seeking medical evaluation for persistent abdominal issues, especially unexplained weight loss or bleeding. Treatment typically involves surgery and may include chemotherapy, targeted therapy, or radiation. Prognosis depends heavily on early detection and the specific tumor type. Ongoing research into the genetic basis and potential environmental triggers, including the microbiome, offers hope for more effective diagnostics and therapies in the future.

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Clinical Manifestations

Types of colorectal cancer

Disease Examination

Treatment Options

Conclusions

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