Overview

Small bowel cancer is a rare form of cancer that affects the small intestine. The small intestine, also known as the bowel, is a long tube that transports digested food from your stomach to your large intestine (colon).

The small intestine is in charge of digesting and assimilation of nutrients from food. It secretes hormones that aid digestion. Because it contains cells that fight bacteria and viruses that enter your body through your mouth, the small intestine plays a role in your body's germ-fighting immune system.

 

Types of small Intestine carcinoma include:

1.  Adenocarcinoma .

2. Carcinoid tumours and paraganglioma(examples of neuroendocrine tumours)

3. Lymphoma .

4. Sarcoma, which includes gastrointestinal stromal tumours (GIST).

 

The type of small bowel cancer you have and its stage will determine which treatment options are best for you.

 

Symptoms of Urethral Cancer

You may not have any symptoms at first. Over time, you might notice it’s hard for you to pee. Maybe you have a weak urine flow or can’t hold it when you do have to go. Or perhaps you go to the bathroom more often, especially at night. You might see blood in the toilet or notice a discharge from your urethra. A swollen spot or a painless lump may appear in your groin or penis. These aren’t always signs of cancer, but can be signs of something else. See your doctor to know for sure.

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Signs and Symptoms

The following are signs and symptoms of small bowel cancer:

• Abdominal pain

• Jaundice (yellowing of the skin )

• Feeling unusually tired or weak

• Nausea Vomiting

• significant weight loss.

• Watery diarrhoea

• Skin flushing .

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Causes :

Most small bowel cancers are caused by unknown factors.

 

Small bowel cancer develops when healthy cells in the small intestine develop mutations in their DNA. The DNA of a cell contains instructions that tell it what to do. Healthy cells divide and grow in a regular pattern to keep your body running smoothly. When a cell's DNA is damaged and it becomes cancerous, however, the cell continues to divide despite the fact that new cells aren't required. These cells clump together to form a tumour. Cancer cells can grow large enough to invade and destroy normal tissue nearby over time.

Some inherited gene mutations can increase your risk of developing small bowel cancer and other cancers. Lynch syndrome, familial adenomatous polyposis (FAP), and Peutz-Jeghers syndrome are examples.

Other bowel illnesses. Crohn's disease, inflammatory bowel disease, and celiac disease are all diseases that affect the intestines and may increase the risk of small bowel cancer.

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Complications

Complications from small bowel cancer include an increased risk of other cancers - People who have small bowel cancer are more likely to develop other cancers, such as those that affect the colon, rectum, ovaries, and uterine lining (endometrium).

Cancer that has spread throughout the body -Small bowel cancer that has progressed to an advanced stage can spread (metastasize) to other parts of the body, most commonly the liver.

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Preventive Measures :

Because small bowel cancer is so rare, it's unclear what might help to lower the risk. If you want to lower your cancer risk in general, try eating a wide variety of fruits, vegetables, and whole grains. Vitamins, minerals, fibre, and antioxidants found in fruits, vegetables, and whole grains may help lower your risk of cancer and other diseases. To get a wide range of vitamins and nutrients, eat a variety of fruits and vegetables.

To get a wide range of vitamins and nutrients, eat a variety of fruits and vegetables.

If you must drink alcohol, do so in moderation. If you choose to drink alcohol, keep your intake to no more than one drink per day for women of all ages and men over the age of 65, and up to two drinks per day for men 65 and younger.

Maintain a healthy body mass index (BMI). If you're at a healthy weight, keep it off by combining a nutritious diet with daily exercise. If you need to lose weight, talk to your doctor about how to do so in a healthy way. Aim to lose weight gradually by increasing your physical activity and lowering your calorie intake.

 

The Prognosis.

Small bowel cancers are notoriously difficult to detect. As a result, people who are suspected of having small bowel cancer are often subjected to a battery of tests and procedures in order to find the cancer or rule it out.

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Tests

To look for signs of small bowel cancer, imaging tests use machines to create images of the body. The following imaging tests are used to diagnose small bowel cancer:

• CT

• MRI

• Positron emission tomography (PET)

• X-rays of the upper digestive system and small bowel after consuming a barium solution (upper gastrointestinal series with small bowel follow-through)

• Nuclear medicine scans, in which a small amount of radioactive tracer is used to improve imaging tests.

 

Exams to see what's going on inside your small intestine :

1. Endoscopic tests involve your doctor inserting a camera into your small intestine to examine the inside walls.:

2. Upper endoscopy .

3. Capsule endoscopy, also known as a pill camera.

4. Except for capsule endoscopy, endoscopic tests allow doctors to insert special tools into the small intestine and remove tissue samples for testing.

 

Surgery

Small bowel cancers can sometimes be found in places that are difficult to detect with other tests. In these cases, your doctor may recommend surgery to check for signs of cancer in your small intestine and surrounding area.

A single large incision in your abdomen (laparotomy) or several small incisions can be used during surgery (laparoscopy).

During laparoscopy, your surgeon inserts special surgical tools, as well as a video camera, through the incisions. The camera allows the surgeon to see inside your abdomen and guide the tools.

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Treatment for small bowel cancer is determined by the type and stage of the disease:

1. Surgery - When possible, surgeons try to remove all of the small bowel cancer. If a small portion of the small intestine is affected by cancer, surgeons may remove only that portion and rejoin the intestine's cut ends. The entire small intestine may need to be removed in some cases. Surgeons may perform a bypass to relieve a blockage in the small intestine if a small bowel cancer cannot be removed

2. Chemotherapy - It is a treatment that uses strong drugs to kill cancer cells. Chemotherapy is a treatment that uses a combination of drugs to kill fast-growing cells, such as cancer cells. It's usually injected into a vein in your arm, but it can also be taken as a pill.If there's a chance the cancer will come back after surgery for small bowel cancer, chemotherapy may be recommended. Chemotherapy may help relieve the signs and symptoms of advanced cancer.

3. Targeted drug treatments concentrate on specific flaws found in cancer cells. Targeted drug treatments can kill cancer cells by preventing them from exploiting these flaws.

4. Immunotherapy - It works by interfering with the immune system's natural processes. If tests show that the cancer cells respond to immunotherapy, it may be an option for advanced small bowel cancer patients.

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Overview of Carcinoid Tumours

Carcinoid tumours are a slow-growing cancer that can develop in a variety of locations throughout the body. Carcinoid tumours, a type of neuroendocrine tumour, usually start in the digestive tract (stomach, appendix, small intestine, colon, or rectum) or in the lungs.

Carcinoid tumours frequently do not manifest symptoms until late in the course of the disease. Carcinoid tumours can produce and release hormones that cause signs and symptoms like diarrhoea and skin flushing.

Surgery is usually used to treat carcinoid tumours, but medications may also be used.

Carcinoid tumours can produce no signs or symptoms in some cases. When they do appear, the signs and symptoms are usually vague and vary depending on the tumor's location.

 

Carcinoid lung tumours have the following signs and symptoms:

-Chest pain

-Wheezing

- Shortness of breath

- Diarrhea

-Redness or a feeling of warmth in your face and neck (skin flushing).

- Weight gain, especially around the midsection and upper back

 

Carcinoid Tumors of the digestive tract cause -

-Abdominal pain

- Diarrhea

- Nausea, vomiting, and inability to pass stool due to intestinal blockage (bowel obstruction)

-Rectal bleeding

- Rectal pain

-Redness or a feeling of warmth in your face and neck (skin flushing).

 

When should you see a doctor? Make an appointment with your doctor if you have any signs or symptoms that bother you and are persistent.

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Causes :

The cause of carcinoid tumours is unknown. In general, cancer develops when a cell's DNA becomes mutated. When healthy cells die, the mutations allow the cell to continue growing and dividing.

A tumour develops from the accumulating cells. Cancer cells can spread to other parts of the body by invading nearby healthy tissue.

The mutations that can lead to carcinoid tumours are unknown to doctors. However, they are aware that carcinoid tumours arise from neuroendocrine cells.

Neuroendocrine cells can be found in all of the body's organs. Some nerve cell functions and some hormone-producing endocrine cell functions are performed by them. Cortisol, histamine, insulin, and serotonin are some of the hormones produced by neuroendocrine cells.

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Carcinoid tumours are caused by a number of factors, including:

Age is a factor. Carcinoid tumours are more common in older adults than they are in younger people or children.

 sex-Carcinoid tumours are more common in women than in men.

Family history -Carcinoid tumours are more likely if you have a family history of multiple endocrine neoplasia type I (MEN I). Multiple tumours in the endocrine system occur in people with MEN I.

 

Difficulties :

Carcinoid tumour cells can secrete hormones and other chemicals, resulting in a variety of complications such as carcinoid syndrome. Among other signs and symptoms, carcinoid syndrome causes redness or a feeling of warmth in your face and neck (skin flushing), chronic diarrhoea, and difficulty breathing.

Carcinoid heart disease is a type of cancer that affects the heart. Carcinoid tumours can release hormones that cause the lining of heart chambers, valves, and blood vessels to thicken. Leaky heart valves and heart failure may result, necessitating valve replacement surgery. Medication is usually effective in controlling carcinoid heart disease.

Cushing syndrome is a condition in which the body produces too much cortisol. A lung carcinoid tumour can cause your body to produce too much cortisol by producing an excess of a hormone.

 

The Prognosis:

The following tests and procedures are used to diagnose carcinoid tumours:

 

Blood tests - Your blood may contain high levels of hormones secreted by a carcinoid tumour or byproducts created when those hormones are broken down by the body if you have a carcinoid tumour.

 

Urine tests - Are a type of test that is used to determine whether or not a Carcinoid tumour patients have high levels of a chemical in their urine, which is produced when the body breaks down hormones secreted by the tumour.

 

A scope or camera that allows you to look inside your body. To examine areas inside your body, your doctor may use a long, thin tube with a lens or camera. Your doctor may be able to see inside your gastrointestinal tract with an endoscopy, which involves passing a scope down your throat. A bronchoscopy, which involves passing a scope down your throat and into your lungs, can aid in the detection of lung carcinoid tumours. Colonoscopy is a procedure that involves passing a scope through your rectum to diagnose rectal carcinoid tumours.

Your doctor may recommend a test that involves swallowing a pill-sized camera to see inside your small intestine (capsule endoscopy).

Tissue removal for laboratory testing. To confirm your diagnosis, a sample of tumour tissue (biopsy) may be taken. The type of biopsy you'll have is determined by the location of your tumour.

 

A surgeon may use a needle to extract cells from a tumour in some cases. A biopsy may also be taken during surgery in some cases. The tissue is sent to a lab for analysis to determine the types of cells in the tumour and how aggressive they appear under a microscope.

Gastrointestinal stromal tumour (GIST):

GISTs (gastrointestinal stromal tumours) are soft tissue sarcomas that can occur anywhere in the digestive system. The stomach and small intestine are the most common targets.

GISTs begin in the walls of your digestive system, in specialised nerve cells. The autonomic nervous system includes these cells. A GIST is caused by a specific change in the DNA of one of these cells, which control digestive processes like food movement through the intestines.

Small GISTs may not cause symptoms and grow at such a slow rate that they have no serious consequences. People with larger GISTs usually seek medical help when they vomit blood or pass blood in their stool as a result of the tumor's rapid bleeding.

Other possible symptoms -

Anaemia, caused by a slow-bleeding tumour; Abdominal pain;

 A growth you can feel in your abdomen;

Nausea; Vomiting;

 Loss of appetite;

Weight loss;

GISTs can develop at any age, but they are most common between the ages of 50 and 70, and almost never before the age of 40. GISTs are caused by an inherited genetic change (mutation) in a small percentage of cases.

 

The Prognosis

Your doctor will examine you thoroughly after asking questions about your symptoms and medical history, looking for a growth in your abdomen. If you have signs and symptoms that suggest you may have a GIST, tests will be performed to locate it and determine the likelihood of it spreading (metastasizing) to other organs. These tests may include the following:

 

1. Computerized tomography (CT) scan with contrast enhancement -You'll drink a liquid that makes your stomach and small intestine more visible on X-rays for this test. A similar substance may also be injected into your veins. The scanner then moves over your abdomen, taking a series of X-rays. The X-rays are combined by a computer into detailed cross-sectional images of your abdominal organs, revealing the tumor's size and location.

2. Upper endoscopy- is a procedure that examines the inside of the mouth. With a flexible, lighted tube (endoscope) passed down through your mouth, the doctor examines the inner lining of the oesophagus, stomach, and first part of the small intestine. During an upper endoscopy, it may be possible to take small samples of abnormal tissue. An intravenous line will be used to administer a mild relaxing medication (sedative) during this test.

3. Ultrasound through an endoscope (EUS). -This test also employs an endoscope, but this time with an ultrasound probe attached to the scope's tip. A computer translates the echoes into an image of the structures in the abdomen, showing the precise location of the tumour, as sound waves from the probe create echoes that bounce back to the probe. These areas may also be visible if the tumour has spread to your liver or the lining of your abdomen. An EUS can also be used to determine the depth of a tumour within the stomach wall or elsewhere in the gastrointestinal tract.

4. Fine-needle aspiration biopsy - is a type of biopsy that uses fine needles to extract tissue. A small sample of tumour tissue is required for a definitive GIST diagnosis. Endoscopic ultrasound with fine-needle aspiration is the preferred method for obtaining a biopsy sample. This procedure is similar to an EUS, but it uses a thin, hollow needle on the endoscope's tip. The needle is used to extract small amounts of tissue for analysis in the lab.

Because these tests aren't always possible or yield inconclusive results, a suspected GIST can't always be found without surgery. Following the removal of the tumour, tissue analysis is performed.

 

Laboratory tests on biopsies- These tests reveal the proteins produced by tumour cells. Immunohistochemistry is one of these tests that detects specific proteins controlled by genes in GIST cells. The identification of these proteins aids in the treatment decision-making process. To find GIST genes in tumour DNA, actual genetic testing of biopsy samples is sometimes required. GIST cells are also examined under a microscope to see how many cells are actively dividing out of 50 different microscopic fields. The mitotic rate is the name given to this figure. The higher a tumor's mitotic rate, the more aggressive it is and the more likely it is to spread to other organs.

 

Medications

In carefully selected cases, small, asymptomatic GISTs discovered during tests for another condition may be approached with watchful waiting.

 

• Surgical procedures

Unless the GIST is too large or involves too many organs and tissues, large or symptomatic GISTs are usually surgically removed. Resection is also postponed or avoided in people whose general health makes surgery too risky, as well as those who are at risk of developing metastatic GISTs. Minimally invasive surgery, which involves inserting a viewing tube (laparoscope) and surgical instruments through small incisions in the abdomen, is frequently used to resect GISTs.

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• Drug therapy with a specific goal

Targeted drug treatments are designed to target specific abnormalities found in cancer cells. Targeted drug treatments can kill cancer cells by blocking these abnormalities. The enzyme tyrosine kinase, which aids cancer cell growth, is the target of these drugs for GISTs.

The first-line targeted therapy, imatinib (Gleevec), is used to prevent GIST recurrence after surgery. The drug is also used to shrink tumours before surgery, in cases where surgery isn't an option, and to manage recurrent GIST. Treatment usually lasts as long as the medication is effective. If your GIST does not respond to imatinib or becomes resistant to it over time, other tyrosine kinase inhibitors may be recommended. Targeted drug therapy is a hot topic in cancer research, and new treatments are likely to emerge in the near future.

 

Soft tissue sarcoma-

Because there are so many different types of soft tissue sarcoma, it's critical to figure out the exact nature of each tumour before deciding on the best treatment.

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Diagnosis :

Your doctor may use the following methods to assess the area of concern:

1. CT

2. MRI

3. PET

4. Barium follow through.

Biopsy is a procedure that is used to examine a soft tissue when sarcoma is suspected, it's best to go to a medical centre that treats a lot of people with this type of cancer. To ensure proper surgical treatment and planning, experienced doctors will choose the best biopsy technique. Among the possibilities are:

• A core needle biopsy is a type of biopsy that involves the use of a needle to This method can be used to obtain tiny tubes of tumour material. Doctors usually try to get samples from different parts of the tumour.

• Surgical biopsy is a procedure that involves the removal of a part of the body. Your doctor may recommend surgery to obtain a larger sample of tissue or to completely remove a small tumour in some cases.

• A pathologist (a doctor who specialises in analysing body tissues) examines the tissue sample in the lab for signs of cancer. The pathologist will also examine the sample to determine the type of cancer and whether it is aggressive.

 

The size, type, and location of your soft tissue sarcoma will determine your treatment options.

 

1. Surgical procedure: Soft tissue sarcoma is commonly treated with surgery. The cancer and some healthy tissue surrounding it are usually removed during surgery.

2. Radiation and chemotherapy may be used to shrink the tumour and avoid amputation when soft tissue sarcoma affects the arms and legs. Radiation therapy is a type of treatment that uses high-powered beams of energy to treat cancer. Among the possibilities are:Prior to surgery. Before surgery, radiation can help shrink the tumour, making it easier to remove.During the operation. Intraoperative radiation delivers a higher dose of radiation to the target area while sparing the surrounding tissues.Following surgery. Any cancer cells that remain after surgery can be killed with postoperative radiation.

3. Chemotherapy is a drug treatment that kills cancer cells by using chemicals. Chemotherapy can be taken as a pill or injected into a vein (intravenously). Chemotherapy works better for some types of soft tissue sarcoma than for others. Chemotherapy, for example, is frequently used to treat rhabdomyosarcoma.

 

The Paraganglioma

Paraganglioma is a type of cancer that affects the nervous system. A paraganglioma is a tumour that develops from a specific type of nerve cell that can be found all over the body. These specific nerve cells (chromaffin cells) regulate blood pressure and perform other important functions in the body. Growths can form when chromaffin cells become abnormal (tumors). Pheochromocytomas refer to tumours that develop in the adrenal glands. Paragangliomas are tumours that occur in other parts of the body.

The majority of paragangliomas are noncancerous (benign). However, some paragangliomas can turn cancerous (malignant) and spread to other parts of the body (metastasize).

 

Paragangliomas are extremely uncommon tumours. They can strike at any age, but they're most common in people between the ages of 30 and 50. The cause of most paragangliomas is unknown, but some are caused by gene mutations passed down from parents to children.

Catecholamines or adrenaline, which is the fight-or-flight hormone, are commonly secreted by paraganglioma cells. High blood pressure, a rapid heartbeat, sweating, headaches, and tremors are all symptoms of this condition.

The most common treatment for paraganglioma is surgery to remove the tumour. Additional treatments may be considered if the paraganglioma is cancerous or spreads to other parts of the body.

 

The Prognosis:

Blood and urine tests are among the tests used to diagnose paraganglioma. To determine the levels of hormones in your body, your doctor may recommend blood tests and urine tests. These tests may detect extra hormones produced by paraganglioma cells, as well as chromogranin A, a tumour marker.

Imaging examinations. Imaging tests produce images of the paraganglioma to assist your doctor in determining the tumor's extent and the best treatment options. MRI, CT, and specialised nuclear medicine imaging, such as a metaiodobenzylguanidine (MIBG) scan and a positron emission tomography (PET) scan, are some of the tests that may be performed.

Testing for genetic mutations. Gene mutations that can be passed down from parents to children can cause paragangliomas. As part of your treatment, genetic testing may be recommended.

Paragangliomas are uncommon, and many doctors have rarely, if ever, seen a patient with this condition. Inquire about your doctor's experience treating paraganglioma. If your doctor's experience with paragangliomas and other neuroendocrine tumours makes you uncomfortable, get a second opinion from a doctor who specialises in paragangliomas and other neuroendocrine tumours.

 

Medication:

Your treatment options will be determined by the location of your paraganglioma, whether it has spread to other parts of the body, and whether it is producing excess hormones that cause symptoms.

Surgery is usually used to treat paraganglioma. If the paraganglioma cells produce hormones, the hormones must be blocked before treatment can begin. This is usually accomplished through the use of medications. Additional treatments may be considered if the paraganglioma cannot be completely removed during surgery or if it spreads to other parts of the body.

There are several treatment options available, including:

Treatments to keep the tumor's hormones in check. If your paraganglioma produces too many hormones, you may need treatment to control your signs and symptoms and lower your hormone levels. Before you start paraganglioma treatment, you must first lower and control your hormone levels.

Alpha blockers, beta blockers, and calcium channel blockers are some of the medications used to control hormone levels. Other measures could include consuming a high-sodium diet and drinking plenty of water.

1. Surgical procedures. The paraganglioma is removed through surgery. Your doctor may recommend an operation to remove as much of the paraganglioma as possible, even if it can't be completely removed. If your paraganglioma produces too many hormones, you may need to take hormone-controlling medications before surgery. When hormone-producing paragangliomas are disrupted, such as during surgery, excess hormones are released, causing serious problems.

2. Radiation therapy is a type of treatment that uses gamma rays to control tumour growth, radiation therapy employs high-energy beams such as X-rays and protons. If the paraganglioma cannot be completely removed with surgery, radiation therapy may be recommended. It can also be used to treat paraganglioma pain that has spread to other parts of the body.Stereotactic body radiotherapy is a type of specialised radiation therapy that involves aiming multiple beams of radiation at the tumour. The beams are precisely aimed on the paraganglioma cells, ensuring that no healthy tissue is damaged in the process.

3. Thermoablation therapy - Thermal ablation is a treatment that uses heat or cold to kill tumour cells and control paraganglioma growth. In some cases, such as when a paraganglioma spreads to other parts of the body, such as the bones or the liver, this may be an option. Radiofrequency ablation is a type of thermal ablation treatment that uses electrical energy to heat tumour cells. Cryoablation, a type of treatment that uses cold gas to freeze tumour cells, is another option.

4. Chemotherapy -Chemotherapy is a type of treatment that uses drugs to kill fast-growing cells, such as cancer cells. Your doctor may recommend chemotherapy to help shrink the tumours if your paraganglioma has spread. If your paraganglioma produces too many hormones, you'll be given hormone-controlling medications before starting chemotherapy.

5. Targeted drug therapy- these treatments are designed to target specific abnormalities found in cancer cells. Targeted drug treatments can slow the growth of cancer cells or cause them to die by blocking these abnormalities. Drugs that deliver radiation to tumour cells more directly. Radiation can be delivered directly to tumour cells using drugs that combine a chemical that seeks out paraganglioma cells with a radioactive substance. If a paraganglioma spreads to other parts of the body, these treatments may be an option.

 

Waiting with bated breath. In some cases, such as if the paraganglioma is slow-growing and not causing symptoms, your doctor may advise against treatment right away. Instead, during regular follow-up appointments, your doctor may monitor your condition.

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