Duodenum &

Small Intestine Cancer

Duodenum & Small Intestine Cancer Surgery

Adenocarcinomas are one of the most common of small intestinal malignancies, followed by carcinoid tumours, lymphomas, and leiomyosarcomas. Small bowel cancer is rare, accounting for 1% of gastro-intestinal malignancies. According to an experienced intestine cancer surgeon in Kolkata, approximately half of all small bowel adenocarcinomas are located in the duodenum, making this the most favoured site.

    Risk Factors for Small Intestine Cancer (Adenocarcinoma)

    • Race/ethnicity
    • Age: It tends to occur in the older people who are in their 60s and 70s
    • Sex: Occurs slightly more often in men than in women.
    • Smoking and alcohol intake
    • Celiac disease
    • Diet: Studies suggested that diets high in red meat and salted or smoked foods might raise the risk of small intestine cancer.
    • Crohn’s disease
    • Colon cancer
    • Inherited syndromes: Patients with some inherited conditions are at higher risks

    Intestine cancer (mainly adenocarcinoma)

    • Familial adenomatous polyposis (FAP)
    • Peutz-Jeghers syndrome (PJS)
    • Lynch syndrome
    • Cystic fibrosis (CF)

    Clinical presentation

    Clinical presentation and diagnosis is generally delayed, says the small intestine cancer surgeon at our clinic in Kolkata.
    • Blood in the stool (faeces)
    • Diarrhoea
    • Dark/black stools
    • A lump in the abdomen
    • Abdominal pain or cramps
    • Unexplained weight-loss
    • Abdominal pain accompanied by severe vomiting or nausea.
    • CT scans have an overall accuracy rate of 47%.
    • A small bowel investigation followed by upper and lower endoscopy. New investigation tools, including CT enteroclysis, capsule endoscopy, and MR enteroclysis now allow for an extensive exploration of the small bowel

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    Localised Intestine cancer surgery
    Complete removal (R0) of the primary tumour with loco-regional lymph node resection is recommended. In the context of posterior invasion, pre-operative treatment should be considered, and resection reconsidered after 2–3 months of chemotherapy. In the context of unresectable metastases, primary tumour resection is not recommended except in an emergency such as bowel obstruction, perforation or uncontrolled bleeding. For duodenal tumours, a Whipple resection should be performed for a tumour in the second segment of the duodenum or for an infiltrating tumour in the proximal or distal duodenum. A duodenal resection alone could be performed for a proximal duodenal tumour or a distal duodenal tumour with no infiltration of adjacent organs. For jejunal and ileal tumours, an R0 resection with lymph node resection and jejuno-jejunal or ileo-ileal anastomosis should be performed. If the last ileal loop or Bauhin’s valve are involved, an ileocoecal or right hemicolectomy should be performed with ligation of the ileocolic artery so as to allow for lymph node resection.

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