SMALL BOWEL CANCER

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Understand facts on Small Bowel Cancer

About Small bowel CancerSmall bowel cancer is cancer affecting the small Crohn’s disease, which lies between the stomach and the colon, or large bowel. The three main parts of your small intestine include the

  • Duodenum
  • Jejunum and
  • Ileum.

The small bowel is around 6 meters (over 19 feet) long. Small intestine is mainly involved in the digestion and absorption of nutrients, glucose, vitamins and minerals that is derived from the food you consume. The main types of small bowel cancer are named after the cells where they develop: adenocarcinoma, sarcoma, neuroendocrine tumours (including carcinoid tumours) and lymphoma.

Types of Small bowel cancerAdenocarcinoma: 

Adenocarcinoma is the most common type of small bowel cancer which begins in the epithelial cells lining the bowel, usually developing in the duodenum.

Neuroendocrine tumours: 

Neuroendocrine tumours, including carcinoid tumours, develop from hormone producing cells, usually in the appendix or the ileum.

Lymphoma:

 Lymphomas are usually found in the jejunum.

Sarcomas: 

Sarcomas develop in soft tissues usually in the ileum but can affect any part of the small bowel.The small bowel may also be affected by cancers that began elsewhere in the body, called secondary cancer

Causes and risk factors for small bowel cancer

There are many causes of small bowel cancer which include

  • Familial adenomatous polyposis - in which an inherited faulty gene causes polyps to develop in the lining of the bowel. Gardner syndrome is a subtype of FAP.
  • Hereditary non-polyposis colorectal cancer (HNPCC or Lynch syndrome) - in which there’s a rare genetic fault.
  • Peutz Jeghers syndrome - where benign polyps form in the bowel.
  • Crohn’s disease related cancers tend to be adenocarcinomas in the ileum
  • Coeliac disease may cause a slightly increased risk of developing lymphoma or adenocarcinoma of the small bowel.
  • Lifestyle factors may affect small bowel cancer risk, including eating a diet rich in red meat, smoked foods or high in fat.
  • Smoking and drinking alcohol may also affect a person's small bowel cancer risk.

Symptoms associated with a Small Bowel Cancer

The symptoms associated with the cancer of the small intestines include:

  • Bloody or tarry stools
  • Anemia- due to loss of blood
  • Abdominal cramping
  • Loss of appetite and loss of weight
  • Bloated up sensation
  • Vomiting
  • Diarrhea

Diagnosis of a Small Bowel Cancer

These are the following diagnostic evaluations, your doctor might advise as part of evaluation to diagnose small intestinal cancer.

Blood tests

To detect anemia, and signs of nutritional depletion.

Endoscopy and Colonoscopy

Your doctor passes a lighted, thin and a flexible tube, down your throat, to reach your duodenum and the upper tract of your jejunum. Using colonoscopy, the part of your ileum is accessed by passing a long lighted tube through your anal canal. A biopsy may be necessary from suspicious areas.

CT Scan

Tumours within the small bowel, their exact location and relation to the surrounding structures can be made out with CT scan.

Capsule endoscopy

You are asked to swallow a capsule, as big as a large pill. This capsule is fitted with a light, camera and a video recorder. The camera takes 2 -6 pictures per second. And the capsule completely views the entire small intestine, for a period of 8 hours. The pictures are then viewed using a special software.

Treatment of small bowel cancer

Treatment for small bowel cancer will depend on the type of tumour, the location of the tumour, the stage it has reached and whether it has spread elsewhereAn operation may be recommended to remove the tumour and adjacent lymph nodes and the healthy segments of small intestine are joined back.Other cancer treatments include chemotherapy, radiotherapy and biological therapies.

Outlook after small bowel cancer treatment

A person's survival chances are better if the cancer is detected early enough for treatment to be more effective.Survival is usually better if the cancer is limited to the inner walls of the small intestine and the lymph nodes are not involved.

Prevention of small bowel cancer

The association of small bowel cancer with underlying conditions makes it possible to identify groups at risk and to develop screening programmes.

  • People with a family history of polyp syndromes, such as Peutz-Jeghers and Gardner syndrome, may benefit from regular screening using upper GI tract studies.
  • People with coeliac disease are at higher risk of developing both adenocarcinoma and lymphoma of the small bowel. They need to maintain a gluten-free diet.
  • People with coeliac disease who also have new onset weight loss, diarrhea, or abdominal pain need immediate medical advice, including possible CT scan of the abdomen and barium study of the small bowel to rule out cancer.
  • People with Crohn’s disease and small bowel bypass procedures also require immediate medical attention. Crohn’s disease-related adenocarcinoma frequently develops in the lower end of the small bowel, making colonoscopy a potentially useful screening tool.

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