Small Intestine Cancer

21.03.2024

SMALL INTESTINE CANCER DIAGNOSIS AND TREATMENT

Small bowel cancer is a relatively rare type of cancer that can affect any part of the small intestines. Although the small intestine is the longest part of the digestive system, it accounts for only a small percentage of digestive cancers. Small bowel cancer can be of various types, such as adenocarcinoma, lymphoma, carcinoid tumor and sarcoma. The importance of this type of cancer lies in the fact that it is often diagnosed late, as it may not show obvious symptoms in the early stages. Because symptoms are often nonspecific (e.g., abdominal pain, weight loss, anemia), making an accurate diagnosis can be difficult. Early diagnosis can significantly increase treatment success, so regular screenings and prompt medical intervention are important in individuals with risk factors (e.g., genetic syndromes, previous gastrointestinal diseases). Although small bowel cancer is rare, it represents an important area of ​​understanding and management of digestive tract cancers. This type of cancer is also an important focus for research in gastroenterology and oncology.

Image 1: Complaints such as nausea, vomiting, weight loss and abdominal pain may occur due to small intestine cancer.

WHAT ARE THE RISK FACTORS?

Although small bowel cancer is relatively rare, some risk factors may increase the likelihood of developing this type of cancer.

Genetic Factors and Family History: Some genetic syndromes, especially conditions such as Lynch syndrome (HNPCC) and familial adenomatous polyposis (FAP), may increase the risk of small bowel cancer. There may be an increased risk in individuals with a family history of small intestine cancer.

Other Intestinal Diseases: Chronic inflammatory bowel diseases, especially Crohn's disease and ulcerative colitis, may increase the risk of small bowel cancer.

Age and Gender: Small bowel cancer is generally more common in people aged 60 and over. Men are slightly more prone to this type of cancer than women.

Nutrition and Lifestyle: High-fat and low-fiber diets may increase the risk of small bowel cancer. Lack of physical activity and obesity are also risk factors. Alcohol consumption and smoking may increase the risk, according to some studies.

Previous Cancer Treatment: People who have previously undergone radiation therapy may have an increased risk of small bowel cancer, especially after radiation to the pelvic area.

Digestive System Surgeries: Individuals who have had stomach surgery may have a slightly higher risk of developing small intestine cancer after the operation.

The presence of these risk factors does not mean that you will develop small bowel cancer, but it may increase the risk. Regular medical check-ups of individuals at risk and early screening tests when necessary are important for the early diagnosis of cancer.

HOW IT OCCURS?

The mechanisms of development of small bowel cancer are associated with the interaction of a number of genetic and environmental factors. Normally, intestinal cells grow and divide in a balanced manner. However, mutations occurring in DNA can disrupt this balanced process. These mutations can trigger tumor formation by causing cells to grow and divide uncontrollably and extend their lifespan. Genetic syndromes, such as Lynch syndrome or familial adenomatous polyposis, may increase the risk of developing these mutations. Some environmental factors may also play a role in the development of small intestine cancer. Nutritional habits, lifestyle factors (smoking and alcohol use), inflammatory bowel diseases and some previous bowel surgeries may increase the risk of developing cancer. Tumor development in the small intestine may also be associated with a weakened ability of the immune system to normally recognize and destroy abnormal cells. These complex interactions contribute to the development and progression of small bowel cancer.

Image 2: In small intestine cancer, emergencies such as ileus (obstruction in the intestines) may occur.

WHAT ARE THE SYMPTOMS?

Small bowel cancer is a type of cancer that usually does not show obvious symptoms and is therefore difficult to diagnose. However, some findings may indicate the presence of the disease.

Common findings of small intestine cancer:

Abdominal Pain or Discomfort: It is one of the most common symptoms and usually occurs as constant or intermittent pain in the abdominal area.

Weight Loss: Unexplained and unintentional weight loss is a possible symptom of small bowel cancer.

Diarrhea or Constipation: Changes in bowel habits, especially long-term ones, may be a sign of small bowel cancer.

Nausea and Vomiting: In some cases, the tumor can cause an intestinal obstruction, resulting in nausea and vomiting.

Digestive Problems: Gas, bloating, or other digestive discomfort may occur.

Anemia: Anemia can be caused by blood loss or iron deficiency and can cause symptoms such as fatigue and pallor in patients.

Gaitada Kan: Blood in the stool or black stools may be a sign of bleeding in the intestine.

Jaundice: If the tumor blocks the bile ducts, yellowing of the skin and whites of the eyes may occur.

Although these symptoms are not specific to small bowel cancer, if there are prolonged or unexplained symptoms, it is important to see a doctor for medical evaluation. These symptoms can also be a sign of other digestive diseases, so a thorough medical examination is necessary for a correct diagnosis.

HOW IS IT DIAGNOSED?

Diagnosis of small bowel cancer is usually made through a combination of evaluation of symptoms and various medical tests. First, the patient's medical history and physical examination are performed. Taking symptoms and risk factors into consideration, more specific diagnostic tests are directed. These tests include blood tests (such as complete blood count, liver function tests), stool tests (occult blood test), and imaging tests (ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), which are especially important for small intestine cancer). capsule endoscopy and double balloon enteroscopy. If necessary, a biopsy is performed to evaluate the presence and spread of the tumor. Biopsy allows tumor tissue to be examined under a microscope and is critical to making a definitive diagnosis. Diagnosis of small bowel cancer can often be difficult because the symptoms are often vague and other more common It can be confused with intestinal diseases, so a comprehensive medical evaluation and appropriate diagnostic tests are of great importance.

WHAT ARE THE PATHOLOGICAL TYPES?

Small bowel cancer can occur in various pathological types, and the clinical behavior and response to treatment of each type may differ. Here are the main pathological types of small bowel cancer:

Adenocarcinoma: It is the most common type of small intestine cancer and usually occurs in the duodenum (the first part of the small intestine). Adenocarcinomas arise from the mucosal layer of the intestine.

Carcinoid Tumors: These types arise from neuroendocrine cells, usually located in the middle part of the small intestine. Carcinoid tumors can produce hormones, which can lead to carcinoid syndrome.

Gastrointestinal Stromal Tumors (GIST): These tumors develop from the muscle cells of the intestinal wall or from the precursors of these cells. GISTs can be found in the small intestine, but can also occur in other gastrointestinal areas such as the stomach and colon.

Lymphoma: Small bowel lymphomas usually arise from lymphoid tissue, which is part of the immune system. Small bowel lymphomas can be divided into Hodgkin lymphoma and Non-Hodgkin lymphoma.

Each pathological type involves specific genetic alterations and clinical features, and these factors are taken into account in choosing treatment. Therefore, pathological diagnosis is important for a definitive diagnosis and appropriate treatment plan. Determining the pathological type helps understand tumor behavior, prognosis, and potential treatment options. In the diagnosis of small bowel cancer, it is important to examine some receptors and genetic markers to understand the molecular profile of the tumor. In particular, for gastrointestinal stromal tumors (GIST), the presence of KIT (CD117) and PDGFRa (Platelet-Derived Growth Factor Receptor alpha) proteins is checked, as these receptors play a critical role in the diagnosis and treatment of GISTs. The HER2/neu receptor may also be important in some small bowel adenocarcinomas and may respond to HER2-targeted therapies. PD-L1 (Programmed Death-Ligand 1) expression can be used to evaluate response to immunotherapy. Additionally, the status of Microsatellite Instability (MSI) and Mismatch Repair (MMR) proteins can be examined, especially in terms of response to immunotherapy. The presence of gene mutations such as KRAS, NRAS and BRAF may also be important, especially in determining treatment options and predicting the course of the disease. Analysis of these molecular and genetic factors allows accurate identification of the disease and the creation of more effective, personalized treatment plans. Therefore, when small bowel cancer is diagnosed, investigating these receptors and molecular markers is a widely adopted approach in oncology practice.

HOW IS TUMOR STAGING DONE?

Tumor staging in small bowel cancer is a process used to determine the extent of spread of the cancer. This process is usually done with the TNM classification system. TNM refers to the size and local spread of the Tumor (T), spread to nearby Lymph Nodes (N), and Metastasis (M).

TNM staging system for small bowel cancer:

T (Tumor):

T1: The tumor is confined to the mucosa (inner membrane) or submucosa (lower layer).

T2: The tumor has spread to the muscle layer.

T3: The tumor has reached the serosa (outer membrane).

T4: The tumor has spread to neighboring organs or structures.

N (Lymph Node):

N0: The cancer has not spread to the lymph nodes.

N1: There is cancer spread to nearby lymph nodes.

N2: There is spread to more and/or more distant lymph nodes.

M (Metastasis:

M0: No distant metastasis.

M1: There is distant metastasis.

This staging system plays an important role in determining how far the cancer has progressed and treatment options. For a more detailed staging and appropriate treatment plan, doctors often use a variety of diagnostic tests (for example, computed tomography, magnetic resonance imaging, endoscopy) and procedures such as biopsy. Staging results have a great impact on the patient's treatment options and prognosis.

Image 3: In small intestine cancer, temporary or permanent removal of the intestine (ileostomy) may be necessary.

HOW IS TREATMENT DONE ACCORDING TO STAGES?

Treatment methods for small intestine cancer vary depending on the stage of the disease. At each stage, the most appropriate treatment options are determined by taking into account the spread of the cancer and the patient's general health condition.

Treatment approaches according to stages:

Early Stage (Stage I and II):

Surgery: The main treatment for early stage small bowel cancer is surgery. Removing the tumor and some of the surrounding healthy tissue is usually sufficient.

LocalAdvanced Stage (Stage III and sometimes II):

Neoadjuvant Treatment: Before surgery, chemotherapy or radiotherapy may be applied to shrink the tumor or increase the success of surgery.

Surgery: It is the process of removing the tumor, surrounding tissues and affected lymph nodes.

Adjuvant Treatment: After surgery, chemotherapy and/or radiotherapy may be applied to reduce the risk of cancer spread.

Metastatic Cancer (Stage IV):

Palliative Surgery: Performed to relieve symptoms (for example, relieve obstruction).

Systemic Treatment: Chemotherapy is used to control metastasis and relieve symptoms.

Targeted Therapy and Immunotherapy: In some cases, drugs or immunotherapy that target the molecular profile of the tumor may be administered.

Radiotherapy: Can be used for pain control and relief of symptoms.

Supportive Care: Pain management, nutritional support and other supportive treatments are applied to improve the patient's quality of life.

Since each patient's situation is different, the treatment plan should be specific to the individual. Doctors determine the most appropriate treatment approach by taking into account the patient's general health condition, the characteristics of the cancer, and the patient's preferences. During the treatment process, it is important to follow up regularly and make adjustments to the treatment plan when necessary.

WHAT ARE THE DRUGS USED IN TREATMENT?

Treatment methods used in small intestine cancer vary depending on the type and stage of the cancer. Chemotherapies, targeted therapies (smart drugs) and immunotherapies are among the treatment options. Some treatment methods used in small intestine cancer:

Chemotherapy Drugs:

Fluorouracil (5-FU): Often used in combination with other medications.

Capecitabine: It is an oral chemotherapy drug.

Oxaliplatin: Can be used together with other chemotherapy drugs.

Irinotecan: It is a preferred chemotherapy drug in some cases.

Targeted (Smart) Drug Therapies:

Imatinib: It is used in the presence of KIT mutation in gastrointestinal stromal tumors (GIST).

Sunitinib: It is used in the treatment of GIST in cases resistant to imatinib.

Regorafenib: Can be used in the treatment of GIST as 3. series.

Immunotherapy:

Pembrolizumab: PD-1 inhibitor may be particularly effective in small bowel cancers that show high MSI-H or MMR protein deficiency.

Nivolumab: PD-1 inhibitor, used in some advanced cancers.

The use of these medications may vary depending on the characteristics of the patient's cancer, general health status, and previous treatments received. In addition, the use of these drugs may be associated with various side effects, so they should be used under the supervision and recommendation of a doctor. Treatment options are constantly evolving with innovations in cancer research.

HOW SHOULD FOLLOW-UP BE DONE AFTER RECOVERY?

Follow-up after small bowel cancer treatment is vital to monitor the patient's recovery progress and detect possible recurrences early. Generally, more frequent doctor visits are recommended in the first few years after treatment. During these visits, physical examinations, blood tests (such as complete blood counts and liver function tests), and periodic imaging tests (such as CT, MRI, or ultrasound) are performed. If necessary, more specific procedures such as endoscopy may also be performed. Patients should notify their doctor immediately if they notice any new symptoms or health problems. Additionally, maintaining a healthy lifestyle, eating a balanced diet, and exercising regularly can help improve overall health and reduce the risk of potential recurrence. The follow-up plan after small bowel cancer treatment should be customized based on the patient's individual risk factors, the unique characteristics of the cancer, and the type of treatment. In this process, regular communication and cooperation between the doctor and the patient is critical for the long-term health of the patient.