Malignant tumors of the small intestine

Epithelial tumors. Small intestine cancer is represented by the following histological forms:

1. adenocarcinoma;
2. mucinous adenocarcinoma;
3. signet ring cell;
4. undifferentiated;
5. unclassifiable cancer.

Adenocarcinomas of the small intestine are rare. Tumors arising in the area of the major duodenal papilla (Vaters) have a villous surface and are usually ulcerated. In other areas, an endophytic type of growth is possible, with the tumor stenotic of the intestinal lumen. Signet ring cell carcinoma is extremely rare.

Malignant carcinoid. Histologically, it is difficult to distinguish it from benign carcinoid. Mitoses are rare. The criterion for its malignancy is pronounced tumor invasion into the intestinal wall, ulceration of the mucous membrane and metastases in the mesenteric lymph nodes. Sometimes the latter form a conglomerate, much larger in size than the primary tumor.

According to the International Histological Classification, non-epithelial tumors of the small intestine are represented by two groups - leiomyosarcoma and other tumors. Leiomyosarcomais the most common soft tissue tumor in the small intestine. It is often subject to ulceration and also forms cystic cavities.

In the small intestine, various types of malignantlymphomas (lymphosarcoma, reticulosarcoma, lymphogranulomatosis, Burkitt's tumor) and unclassifiable tumors are possible. Tumors can be single or multiple, nodular or diffuse, and are often subject to necrosis and ulceration. In this case, the slit-like nature of ulceration can help in making a diagnosis.

Malignant tumors of the small intestine can be secondary. Among them, the most common are metastases of breast cancer, stomach cancer, lung cancer, uterine cancer, and melanoma.

Malignant and benign tumors of the small intestine are quite rare. According to W. Palmer, neoplasms of the duodenum make up only 0.5% of all neoplasms of the digestive organs. Thus, the conclusion that the mucous membrane of the duodenum, and the entire small intestine, has some special protective properties, "immunity" against the development of tumors, especially malignant ones, "suggests itself". This feature of the protective mechanisms of the small intestine, the essence of which has not yet been clarified, is especially noteworthy when comparing the frequency of neoplastic lesions of the duodenum, as well as the jejunum and ileum with that of the esophagus, stomach, and colon.

Duodenal cancer is a very rare malignant tumor, which is detected, according to various statistics, in 0.04-0.4% of patients who died from cancer. In most cases, the cancer is localized in the descending part of the duodenum (this does not mean cancer of the major papilla of the duodenum, which occurs 10-15 times more often). It is believed that duodenal cancer was first described in 1746 by Hamburger.

Sarcomas of the duodenum (leiomyosarcoma, lymphosarcoma, its undifferentiated form) are even rarer than cancer. However, if cancerous tumors are more often detected in old age, then sarcomas are more common in younger people.

Pathomorphology. A cancerous tumor of the duodenum looks like a polyp, sometimes resembles a growth in appearance like a cauliflower or, which is observed even more rarely, a crater-shaped ulcer (which occurs with rapid necrosis and decay of the central part of the tumor). In histological examination, these are cylindrical cell tumors, much less often - tumors originating from the epithelium of the duodenal glands.

Symptoms of malignant tumors of the small intestine

In the early stages of development, malignant tumors do not manifest any symptoms or the clinical picture is extremely scanty and vague. Only when the tumor reaches a sufficiently large size do symptoms of high intestinal obstruction appear (at first, a feeling of distension in the upper abdomen during meals, "overflowing stomach", then nausea and vomiting at every meal, up to the inability to eat not only thick but also liquid food), emaciation, up to cachexia, intestinal (or resembling gastrointestinal) bleeding during tumor disintegration and erosion of a sufficiently large blood vessel. At the same time, anorexia with a particular aversion to meat, anemia (iron deficiency anemia), unmotivated increase in body temperature, general weakness develop; when the tumor is located near the large papilla of the duodenum and is large enough, compression or tumor tissue growth occurs on the terminal, intrapancreatic part of the common bile duct, with the development of “mechanical” (“suprahepatic”) jaundice with all its symptoms.

Diagnosis of malignant tumors of the small intestine

General clinical examination methods of the patient, including abdominal palpation, at early stages of the disease, as a rule, do not help to make a timely diagnosis. Only contrast radiographic examination of the stomach and duodenum, as well as gastroduodenoscopy, carried out in the order of a medical examination or general examination of the patient due to his complaints of malaise and general weakness, allow to detect a malignant tumor of the duodenum before its bright clinical manifestation (due to the occurrence of complications and metastasis). Biopsy and histological examination of biopsy specimens help to accurately determine the nature of the tumor. Unexplained acceleration of ESR, as well as the occurrence and progression of iron deficiency anemia with constant detection of signs of latent, especially the appearance of symptoms of obvious intestinal bleeding during coprological examination, alert the doctor in terms of the need for an "oncological search" and special studies of the gastrointestinal tract.

Treatment of malignant tumors of the small intestine is only surgical, in advanced cases - symptomatic.

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