Malignant tumors of the small intestine

Epithelial tumors. Cancer of the small intestine is represented by the following histological forms:

1. adenocarcinoma;
2. mucinous adenocarcinoma;
3. ring-fusiform;
4. undifferentiated;
5. unclassifiable cancer.

Adenocarcinomas of the small intestine are rare. Tumors that occur in the area of the large papilla of the duodenum (feces), have a villous surface, usually ulcerated. In other departments, an endophytic growth type is possible, with the tumor stenosing the lumen of the intestine. Ringworm-cell carcinoma is extremely rare.

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

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

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

Malignant tumors of the small intestine may be secondary. Among them, the most frequent are metastases of breast, stomach, lung, uterus, and melanoma.

Malignant and benign tumors of the small intestine are a significant rarity. According to W. Palmer, neoplasms of the duodenum account for only 0.5% of all neoplasms of the digestive system. Thus, in itself "suggests" the conclusion that the mucous membrane of the duodenum, and all the fine, the gut possesses some special protective properties, "immunity" against the development of tumors, especially malignant ones. This feature of the protective mechanisms of the small intestine, the essence of which has not yet been clarified, especially draws attention when comparing the frequency of neoplastic lesions of the duodenum, and also the jejunum and ileum from that of the esophagus, stomach, and large intestine.

Cancer of the duodenum is a very rare malignant tumor, which is revealed, according to different statistics, in 0.04-0.4% of patients who died of cancer. In most cases, the cancerous tumor is located in the descending part of the duodenum (this does not mean cancer of the large papilla of the duodenum, occurring 10-15 times more often). It is believed that for the first time the cancer of the duodenum was described in 1746 by Hamburger.

Sarcoma of the duodenum (leiomyosarcoma, lymphosarcoma, undifferentiated its form) are even less common than cancer. However, if cancer tumors are more often found in old age, then sarcomas - in a younger one.

Pathomorphology. Cancer of the duodenum externally has the appearance of a polyp, sometimes resembling an outgrowth in appearance like a cauliflower or, even more rarely, a crater-like ulcer (as occurs with rapid necrosis and the disintegration of the central part of the tumor). At a histological research - these are cylinder-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 themselves with any symptoms, or the clinical picture is extremely scarce and vague. Only when the tumor reaches a sufficiently large size does the symptoms of high intestinal obstruction appear (first the feeling of bursting in the upper half of the abdomen during meals, the "stomach overflow", then nausea and vomiting at each meal, up to the inability to eat not only thick but also liquid food ), emaciation, up to cachexia, intestinal (or resembling gastrointestinal) bleeding during the disintegration of the tumor and the arrosion of a fairly large blood vessel. At the same time, anorexia develops with a particular aversion to meat, anemia (iron-deficiency anemia), an unmotivated rise in body temperature, a general weakness; when the tumor is located near the large papilla of the duodenum and at its sufficiently large value, the tumor end or intraspecific part of the common bile duct is compressed or germinated with the development of "mechanical" ("suprahepatic") jaundice with all its symptoms.

Diagnosis of malignant tumors of the small intestine

General clinical methods of examination of the patient, including abdominal palpation, in the early stages of the development of the disease, usually do not help the timely diagnosis. Only contrast radiographic examination of the stomach and duodenum, as well as gastroduodenoscopy, conducted in the order of clinical examination or general examination of the patient due to his complaints of malaise and general weakness, allow to identify malignant duodenal tumor before its vivid clinical manifestation (due to complications and metastasis). Biopsy and histological examination of biopsies help to accurately establish the nature of the tumor. Unexplained acceleration of ESR, as well as the emergence and progression of iron deficiency anemia with the constant detection of signs of latent, especially the appearance of symptoms of apparent intestinal bleeding, are alarming to the doctor in terms of the need for "cancer search" and special studies of the gastrointestinal tract.

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

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