Adenocarcinoma of the Small Bowel - Risk Factors, Symptoms, Diagnosis, and Management

Introduction:

The small intestine is a part of the digestive system. It breaks down foods and nutrients to be absorbed into the body. The small intestine refers to a long tube that connects the stomach to the large intestine. The small bowel is differentiated into three parts: the duodenum, the jejunum, and the ileum. Small bowel cancer develops when healthy cells in the lining of the small intestine change and grow out of control, forming a mass of cancer cells.

What Is Adenocarcinoma of the Small Bowel?

There are five types of cancers of the small bowel: adenocarcinoma, sarcoma, lymphoma, carcinoid tumors, and gastrointestinal stromal tumors. Adenocarcinoma is one of the most common types of small bowel tumors, and it begins in the glandular cells present in the lining of the small intestine. It usually occurs in the duodenum or jejunum.

What Are the Major Risk Factors for Adenocarcinoma of the Small Bowel?

The following factors increase the risk of small bowel cancer:

• Eating a high-fat diet.

• Having Crohn's disease.

• Having celiac disease.

• Having familial adenomatous polyposis.

What Are the Signs and Symptoms of Adenocarcinoma of the Small Bowel?

• Unexplained weight loss.

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• Abdominal pain.

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• Blood in the stool.

• Dark or black stools.

• Diarrhea.

• A lump in the abdomen.

What Is the Diagnosis for Adenocarcinoma of the Small Bowel?

The following tests are done for the diagnosis of adenocarcinoma of the small bowel:

• A physical examination of the patient is done, and history is asked about the symptoms.

• Blood Tests: Blood tests are done to see the red blood cell count to check whether the cancer is causing any bleeding.

• Liver Function Test: Blood samples are taken and tested for substances that are released from the liver. Small bowel cancer can cause liver disease, which increases the amount of substances released from the liver.

• Computed Tomography (CT) Scan: This procedure takes a series of pictures of the inside of the body, and the pictures are seen on a computer.

• Magnetic Resonance Imaging (MRI): This procedure uses a magnetic field to show the inside of the body.

• Biopsy: Biopsy refers to the removal of a small amount of tissue for examination in the laboratory. A biopsy can give a definitive diagnosis of cancer.

• Barium Swallow: The patient drinks a liquid solution called barium which coats the lining of the small intestine, and a series of x-rays are performed.

• Endoscopy: An endoscope refers to a thin and flexible tube attached with a camera inserted through the mouth into the esophagus, stomach, and duodenum. A tissue sample (biopsy) can also be removed during endoscopy for analysis.

• Capsule Endoscopy: It is a newer technique in which a capsule (pill) attached with a camera is swallowed by the patient, which travels through the digestive tract and shows the inside of the small intestine. The capsule comes out of the body during a bowel movement.

• Colonoscopy: A long, thin tube is inserted into the rectum and anus to view the entire colon and the last part of the small intestine.

• Laparotomy: In this procedure, a small cut is made in the wall of the abdomen to check for the disease. Sometimes, organs, lymph nodes, or tissues are removed during the procedure.

• Positron Emission Tomography (PET) Scan: A small amount of radioactive substance is injected into the body, and many images are taken to view the inside of the body.

How Is the Staging of Adenocarcinoma of the Small Bowel Done?

Staging is used to find how far cancer has spread. There are three ways through which cancer spreads in the body: tissue, blood, and lymph. When cancer spreads to other parts of the body, it is called metastasis. The metastatic tumor is similar to the primary tumor. Small intestine cancer is also grouped according to whether or not the tumor can be completely removed by the surgery. Small bowel cancer can recur even after it is treated. Cancer can recur in the small intestine or any other part of the body.

What Is the Treatment of Adenocarcinoma of the Small Bowel?

The common treatment methods are:

• Surgery: Surgery is the most commonly preferred treatment of adenocarcinoma of the small bowel. Two types of surgery include:

• Resection: Surgery to remove part or all of the small intestine. Part of the small intestine is removed, and the cut ends are joined (anastomosis). The doctor also removed the lymph nodes near the small intestine and checked them for cancer.

• Bypass: If a tumor is blocking the intestine. Surgery is done to bypass and allow the food to pass through the small intestine,

• Radiation Therapy: Radiation therapy uses high-energy x-rays to kill cancer cells. There are two types of radiation therapy:

• External Radiation Therapy: Radiation is sent to the area of cancer from a machine outside.

• Internal Radiation Therapy: Radioactive substance is placed directly into cancer which kills cancer cells.

• Chemotherapy: In chemotherapy, drugs are used to kill cancer cells or stop them from growing.

• Immunotherapy: In this type of treatment, the patient's immune system is used to kill the cancer cells.

• Radiation Therapy With Radiosensitizers: Radiosensitizers refer to the drugs that make tumor cells more sensitive to radiation therapy. A combination of radiotherapy and radiosensitizers can kill more cancer cells.

What Is the Treatment Of Metastatic Small Bowel Cancer?

If cancer spreads to other parts of the body from the original place, it is called metastatic cancer. Diagnosis of metastatic cancer can be difficult sometimes. Often, chemotherapy is the first line of treatment recommended for metastatic cancer.

Conclusion:

Adenocarcinoma of the small bowel is an infrequent disease. Early-stage cancers can be treated by surgery, chemotherapy, or radiation therapy. Late-stage or advanced cancers are difficult to control and cure, and the patient should be given treatment to relieve pain and emotional support.

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