Sarcomas of the small intestine: causes, symptoms, diagnosis, treatment

Small intestinal sarcomas are very rare. According to statistics, small intestinal sarcoma occurs in 0.003% of cases.

Small intestinal sarcomas are more common in men, and at a relatively young age. The overwhelming majority of sarcomas are round cell and spindle cell lymphosarcomas.

Symptoms, course, complications. The clinical picture of small intestinal sarcomas is varied. A common symptom is pain. However, vague complaints prevail in the first period, so that until the moment when a mobile tumor begins to be palpated, it is hardly possible to suspect a small intestinal sarcoma.

Since small intestinal sarcomas are very rare, the clinical picture of this disease has been poorly studied and there are some contradictions in the description of the frequency of certain symptoms. Bleeding is a common symptom. The more frequent occurrence of intestinal bleeding in sarcomas than in small intestinal cancers is explained by the significantly larger size of the tumors, rich blood supply and increased tendency to decay and ulceration.

Intestinal patency is not impaired for a long time in sarcomas; in 80% of cases it is not impaired at all. Obstruction may be caused not by stenosis of the intestinal lumen, but by intussusception. Perforations in small intestinal sarcomas are extremely rare.

Many authors note the rapid growth of sarcomas. There is a report in the literature of a case where a small intestinal sarcoma increased 10-fold in size in 2 weeks. Some authors point to their slow growth with a sudden acceleration after some time as a distinctive feature of sarcomas. The growth rate is usually explained by the maturity of the tumor: immature round cell tumors grow quickly, more mature ones - spindle cell and fibrosarcomas - grow much more slowly.

The tumor metastasizes to the lymph nodes in 75% of cases. However, the literature notes the ability of sarcomas, unlike cancer, to cause hematogenous metastases; according to some reports, this is more often observed in more mature sarcomas. Of the distant metastases, metastases to the liver are more common (approximately 1/3 of cases).

The prognosis is unfavorable. However, more encouraging data have appeared recently. Thus, according to a number of authors, almost half of the patients operated on for leiomyosarcoma of the small intestine survived for more than 5 years.

All authors, without exception, note the great difficulties in diagnosing this disease. X-ray examination must be carried out, but there is no pathognomonic X-ray picture for small intestine sarcoma. Even laparotomy in some cases does not bring the necessary clarity.

The diagnosis of sarcoma (and other tumors) of the small intestine is established based on X-ray and ultrasound examinations, computed tomography, and laparoscopy. However, since the tumor exists asymptomatically for some period of time, these studies are usually resorted to when complications have developed: profuse intestinal bleeding, obstructive small intestinal obstruction, etc., or in cases of “causeless” severe weight loss of the patient, accelerated ESR (examination in the “order of oncological search”).

The prognosis is poor: without treatment, all patients die.

Treatment of small intestine sarcoma is surgical.

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