Small Intestine Cancer

Small intestinal cancer is a very uncommon and rare disease. A condition when the cells continue to divide without any restriction and control in the small intestine is referred to as small intestine cancer. These extra cells lead to the formation of a large mass called a tumor.

The other name for the small intestine Is also called small bowel. It helps to attach the stomach with the large bowel or intestine. The main and vital function of the small intestine is to break and absorb fats, vitamins, and many other nutrients that are useful for the body. In the case of the small intestine, the tumor causes the obstruction or blockage of the small intestine.

There are a total of five different types of intestinal cancer:

  • Adenocarcinomas: Almost thirty to forty percent of patients are reported for this cancer. This type of cancer begins in the wall or lining of the small bowel. Initially, it appears as a harmless, non-malignant mass knows as a polyp, but with time, it becomes cancerous.
  • Carcinoid tumors: This is a type of cancer that has a very slow progression. It is mostly diagnosed in the lowest portion of the small bowel. It can also reach your rectum or appendix. A wide quantity of hormones such as serotonin is released from these tumors.
  • Sarcoma: These cancerous cells reside and grow in the soft tissues of the small bowel.
  • Gastrointestinal stromal tumors: This is a very rare type of small intestine cancer. It only starts in the abdomen. Not all these tumors are malignant.
  • Intestinal lymphomas: Cancer that begins in the lymph nodes is known as lymphoma. People with different immunodeficiency disorders have higher chances to develop this type. This indicates that the defense system of your body is very weak and can’t protect your body from germs and infections.

What are the causes which and individuals are at risk?

There is not an exact reason till now that how it starts and what is the root cause. But many factors may increase the risk of this disease. These are:

  • Age: People with the age of sixty can develop this cancer very easily.
  • Gender: Men are at higher risk to develop small intestine cancer.
  • Heredity: Some birth diseases may lead to this cancer.
  • Smoking: Smoking is injurious to health and smokers are at higher risk to develop any type of cancer.
  • Diet: Diet with high fats and carbs can be the reason for small intestine cancer.
  • Working with or living nearby to harmful chemicals such as peroxyacetic acid can be a root cause of cancer.
  • Diseases: Cohn’s disease, colitis, or celiac diseases are the reasons for small intestine cancer.
  • Lymphedema: Any damage to vessels connected with lymph nodes can be the reason for intestinal cancer.

What are the main signs and common symptoms?

If you notice the following signs and symptoms you must visit your doctor without wasting any time. These symptoms can be a reason for small intestine cancer or any other serious disease. These are:

  • Ache or contractions in the mid of your abdomen
  • Rapid weight loss without any known cause
  • A bulge in the abdomen
  • Bleeding with feces

Which tests can help you in determining small intestinal cancer?

You will check and examined thoroughly by your PCP. He or she will ask some questions related to your health. You can discuss with them your problems.

Most of the time doctor advises MRI tests. These tests provide a clear image of your small intestine so they can locate any possible tumor in your small intestine

X-rays are also used for the diagnosis of any residing tumor.

CT scan is also considered an option for this.

Your doctor may recommend endoscopy. It is a procedure in which the doctor looks inside the portions of the stomach, small intestine, or esophagus. For this purpose, a small tube along with a tiny camera is used. Your doctor will ask you to take some medicines before this procedure.

Other minor preliminary tests can be:

  • Blood tests: These tests help in the detection of different substances in the blood and body.
  • Liver tests for diagnosing functioning of the liver
  • Fecal occult blood test for detection of any pathology or blood in the feces
  • Lymph node biopsy: The doctor takes out a small piece of the lymph node to diagnose cancer cells.
  • Laparotomy: It is an operation and doctors make a cut in the abdomen to look inside and determine any pathology.

What are the common treatments?

The type of treatment differs for every patient. It depends on the type of intestinal cancer to which extent it has been spread.

Mostly, surgery is adopted as the treatment. In this surgery, the part of the intestine with the cancer is removed. Sometimes bypass method such as ostomy is used in which the food can flow around a polyp or the tumor which can’t be eradicated due to any reason.

Radiation therapy is also done after the surgery to kill any chance of cancer coming back.

Chemotherapy is also one of the options.

There are also many therapies nowadays. 

You should discuss it with your doctor which will be the best option for you.

The Basics of an Ostomy

A lot of people have confused about different types of ostomies and aftercare. This article is written to help them understand ostomy in the best possible way.

Different terms are associated with the Ostomy such as stoma, colostomy, urostomy, ileal conduit, and ileostomy. So mean of you don’t know the difference between these terms and you want to know what happens if you undergo this condition.  Here are some examples with a complete explanation of all these processes.

How to take care of a colostomy patient?

Ms. Lora is a 69-year-old woman. She is a black –American and a retired educational officer. Her family members i.e. father and elder brother died because of breast and bowel cancer. All of them used to eat pork and foods high in fats. They also used to smoke a lot.

Even though Ms. Lora never had any difficulty or discomfort in her bowel movements, but she noticed less stool output with constipation and diarrhea for the last seven months.

The diseases that can reason for colostomy are:

  • Crohn’s disease
  • Constipation
  • Fistula in between rectum and vagina
  • Hirschprung disease
  • Birth defects
  • Imperforate anus
  • Perofrated diverticula
  • Rectal injury
  • Necrotizing enterocolitis

Ms. Lora needs to undergo a colostomy. A piece of the colon will be used to make a stoma and divert the passage of the bowel contents toward it.

She had a sigmoid colostomy that’s why it is made on the left side of the abdomen.

On the 3rd to 5th day, gas functioning will start.  At the start, the feces will be dark red or brown along with the mucus. Gradually it will come to normal color and consistency.

Ms. Lora’s healthcare expert may recommend she adapt an irrigation method that will help her regulating her smooth bowel and movements. It also helps in predicting bowel movements. So a patient does not need to wear a pouching system.

It is introduced in the body through a colostomy irrigation kit.

Ms. Lora’s nurse helped her to choose the best pouching system for her. Also, she helped her to learn about how to take care of her stoma. She can use these appliances or accessories for the first few weeks or days after the surgery. A skin barrier or wafer might be needed.

Her nurse will also educate her about how to clean the stoma and change the pouch. Simple water is the best of cleaning the stoma. Avoid any kind of soap or oil. Dry the skin completely and then attach the new pouching system.

Ms. Lora’s nurse will encourage her to look at her stoma. She needs to know the difference between a diseased or healthy stoma. The stoma should look as red as her mouth’s tissues. There is no nerve ending present in the stoma, it must be always wet or soggy. There can be stomal bleeding sometimes; there is nothing to be worried about. It can be risky if the bleeding does not stop for hours.

Ms. Lora wants to know how to empty the pouch. The nurse informs her that she needs to empty her pouch once it is one-third filled. She can use a tail closure and directly empty it into the toilet.

In case of some complications such as intestinal blockage, rectal injury, or parastomal hernias a second surgery is needed.

How to take care of an ileostomy?

Mr. Ben is a 29 years old white-American with a background of ulcerative colitis when he was eighteen years old. Her two sisters died because of toxic megacolon at twenty-five. When he was 7 years old his father died of gastrointestinal hemorrhage and his mother died two years after due to diabetes. He has many friends who can take care of him. He has been admitted for surgery for the restorative proctectomy also referred to as, ileal pouch-anal anastomosis.

Before her surgery and while he was admitted, the nurse inquired about the early bowel prep and antibiotic uptake. Mr. Ben tells him that he drank polyethylene glycol to cleanse his bowel completely. And he also consumed antibiotics.

Then his surgeon told him that his colon and rectum needed to be removed while his anus and sphincter will remain intact. The surgeon told him that he will use a part of his ileum to make a reservoir (internal). This will be a temporary ileostomy till the pouch heals completely. This ileostomy is required for almost eight to twelve weeks.

Mr. Ben has discovered different types of pouching systems on the internet. His nurse introduced him to a two-piece pouching system.  The pouching system should be sterile until it Is opened.

After the stoma surgery, he was under observation in the ICU for forty-eight hours. The nurse checked his abdomen if it was soft or tender. This ileostomy was made on the lower right side.

Mr. Ben used a nasogastric tube and a urine bag. He had a little pain compared with the pain at the time of ulcerative colitis.

The day when his bowel movements can be heard, the nasogastric tube and catheter were removed. His recovery was on the way and he started to empty the Ostomy pouch with the help of a nurse on his side. The nurse told him to prevent leakage and change his pouch after every four to six hours.

His doctor asked him to drink plenty of water and drinks to prevent dehydration.  And chew his food properly. He should take foods that can thicken his stool.

On the 8th day following the surgery, he will be discharged from the hospital with an Ostomy nurse.

How to take care of a patient with a urostomy?

Mr. J is a fifty-six years old Hispanic lady. He has three adults.  Four years ago he undergo an ileal conduit for the treatment of bladder cancer. It is the most used procedure for patients with invasive bladder cancer.

During the first few days, the nurse noticed yellowish urine with mucus m in the urostomy pouch, placed at the right side of the umbilicus. She also ensures the presence of the stents near the stoma.

Mr. S abdomen is soft and he has active bowel movements. His nurse told him how to change or drain the pouch. He used a stoma cap for preventing leakage. He sits on the toilet seat and drains the pouch between his legs into the seat.

His doctor told him that he must drink 8 Oz water daily. He should avoid garlic, asparagus, and onion because it may lead to an offensive odor in his pouch.

He knew the limitations of his physical activities. He can participate in sports but should avoid games that require a lot of pressure on the abdomen.

What is the role of a nurse?

All the test and procedure before Ostomy makes a patient very nervous. He is already worried about his Ostomy and is almost blank that how he or she would handle this situation. An Ostomy nurse helps the patient to learn their basic care routine. He or she encourages them towards improvement. If you get an expert and kind Ostomy nurse you can recover in time.

How To Avoid A Leaky Ostomy Pouch

For those of us who have to live the rest of our lives with the addition of a stoma, there is truly nothing worse than having to deal with a leaky ostomy pouch. If you are not familiar with what an ostomy is, then count your blessings; I have way more knowledge about the world of ostomy than I ever wish to have, but here I am writing another pointless article about ostomies and stomas that literally no one will ever read.

Regardless, I find it necessary to come on here today and talk about the topic of ostomy once again. That is why I am going to spend some time talking about what ostomy pouch leaks are, how to avoid them, and some basic tips and tricks that you can hopefully use to avoid having a leaky ostomy pouch in your future.

After all, nobody wants to be around someone who is constantly smelling like hell’s bowls – ostomy pouches are probably some of the most disgusting and repulsive smelling things in the existence of the human race and the earth itself. With all of that out of the way, let’s talk about how to avoid having a leaky ostomy pouch. 

All people with ostomies have to deal with leaks at some point in their lives. It is unfortunately just a sad fact about living life with a stoma; however, there are multiple factors that can lead to a leaky ostomy pouch system, so it is important to determine the cause of the leak in order to properly address and fix the issue and prevent leaks in the future. Once you have found the main source of the problem, then you can begin to look for ways in which to fix it.

You can even hop on the internet and see if other ostomates have had similar issues in their own ostomy pouch systems and can offer some insight or advice. The first thing that you will want to make sure of is that you are using the correct wafer for your ostomy pouch system. There are different types of wafers made for different purposes, and since everyone has a different body and different experience, there may be a need to change the wafer you are using. For example, if you find a flat wafer to be leaking content, then it might be better for you to switch to a convex wafer. This is just one example of a simple solution that can totally explain and solve your ostomy pouch leakage problem.

Another way that you might prevent leaks in your ostomy pouch system is to empty the contents of your ostomy pouch before it gets too full. Sometimes when the pressure build up is too great inside the ostomy pouch, it can create problems for the skin barrier around your stoma and can cause leakage of gas or of output. So if you have not already invested in some type of ostomy pouch that allows for the release of gas, that might be a good investment for you. If you are experiencing a lot of gas in your ostomy pouch, simply release some of it into the outside air or in the bathroom, and you may find there to be less leakage once some of the pressure has been eliminated. 

Guide for an Ostomy Nurse

Many nurses are not sure about how to take care of an Ostomy patient. This article will help you to get answers to all your questions.

In the USA almost 100,000 individuals undergo Ostomy surgery every year. Fecal or urinary diversion surgeries are performed which allows the body to pass out urine and feces. Ostomies can be permanent or temporary. It can be continent or incontinent. In case of incontinent surgeries, you need to keep an external pouching system with you. In this article, we will mainly discuss incontinence and types of pouching systems.

During this procedure, a hole is created in the abdomen and a small or large intestine is pulled up to the abdominal wall and sewed there, resulting in a stoma. A stoma is an opening that allows the feces and urine to leave the body. The surgeon decides which portion of the intestine will be involved in the surgery depending upon the condition of the patient.

Some situations which demand Ostomy are:

  • Colon cancer or rectal cancer
  • Any trauma or injury in the bowel or rectum such as a bullet shot.
  • Leakage in the bowel
  • Cancer in the bladder

The most basic and common types of Ostomy are:

  • Ileostomy
  • Colostomy
  • Urostomy

In the case of Ostomy, a patient can’t control urination or fecal discharge because there is no sensation or nerves around the stoma. Also, there is no sphincter present. This is the reason a patient can’t control the flow of the gas, urine, or feces out of the body.

Ileostomy

This type of Ostomy ileum also called the small intestine is involved in the formation of the stoma. It allows the feces to leave the body. Ileostomy patients always require a pouching system to collect the feces, very acidic. If these feces come in contact with the stoma it may destroy stromal tissues.

Colostomy

Different parts of a colon are used for the creation of a stoma. Colostomy patients can use the irrigation method. It helps them to predict their next bowel movement and they can live without wearing a pouch. They usually use a cap or a stopper over the stoma instead of the pouching system. This cap can be helpful to absorb any possible mucus and protects stoma, and your clothes.

Urostomy

A urostomy is also known as the ileal conduit. During this surgery, the surgeon attaches the ureters with the one end of the ileum and brings the second end to the abdominal surface to form an opening, stoma. A conduit is formed through the section of the ileum, that’s why a pouching system is a required must.

Stoma

A normal and healthy stoma appears dark pink and red. It looks damp, bright, and non-ulcerated. You feel no pain over the stoma. With time, it shrinks in size. Mostly, it takes six weeks for a stoma to heal. If you notice something extraordinary you must consult it with a doctor.

Typically, a stoma is submerged indicating that it comes a little out of the skin. This helps in attaching the pouching system. In the case of ileostomy and urostomy stoma maybe two centimeters over the skin while one centimeter in case of colostomy. The height may differ depending on the obesity, shortening of intestines, and tumors.

Stomas that are flat with the skin or more embedded give hard time to the patients for attaching pouching system. In this type of stoma, there are chances of more leakage of feces and urine below or beneath the pouch. If a patient with budded stoma notices any retraction he or she should contact the doctor.

Sometimes a stoma gets prolapsed and a part of the intestine can protrude out. It is an alarming situation. There can be many reasons for a prolapsed stoma, such as:

  • Pregnancy
  • Strained abdominal muscles
  • Obesity
  • Increased pressure between the abdomen
  • Parastomal hernia ( a serious condition)
  • Surgical errors

The prolapsed stoma can be treated with sugar or a cold compress. Both of the methods lessen the swelling.

Site for the stoma

The stoma can be created in any portion of the abdomen ( all four quadrants). It depends on the type of Ostomy. The location of a stoma is very important as it can prevent many complications and stool output also depends on the location of the stoma.

Different outputs

During the first few days after the surgery, a patient is not allowed to take anything by mouth (N.PO). There is very low stool output and it is very dark hot red. Gradually food and liquids are allowed and the output starts to change. It becomes dark green and then becomes brown and there is also an increase in the output.

As soon as a person starts to eat through the mouth there can be an odor in the stool. It can make you awkward in public places. For this issue, a filter or deodorant is placed inside the pouch.

The output depends on the type of Ostomy and part of the intestine that is involved. For example, Ileostomies outputs are liquid, semisolid feces are formed as a result of ascending or transverse colostomy. And output results of descending and sigmoid colostomy are completely formed solid.

The output of the urostomy differs from other ostomies that produce feces. Urine production should start instantly. There might be blood in the urine for some time after the urostomy. The patient may also notice mucus, it is normal and it will decrease after some time of the surgery.

To prevent the blocking of the ureters stents are placed and brought outside the stoma. These are very flexible, lenient. After some days of the surgery, they are removed by the doctor. Sometimes you may notice urine dripping out of these stents. In this condition, advice from a healthcare provider is needed.

Stoma skin problems

ICD or irritant contact dermatitis is the most common skin issue following the Ostomy. It takes place due to the interaction of bowel contents with the skin. It might be due to pouch leakage or sealing issues.

It almost affects 55% of the patients after the Ostomy. The symptoms of ICD are:

  • Loss of epidermal tissues
  • Cramps
  • Damp area

If it is left untreated it can cause more soreness or discomfort. The skin around the stoma should look normal just like the other skin on the abdomen.

Mucocutaneous separation is another complication. It occurs if the clamps or sutures that hold the stoma to the abdomen get too rigid and if the blood supply to the stoma is disturbed due to any reason. In this condition, the clamps are lost and there is a hollow by the side of the stoma. This space or pocket is filled with alginate and is bandage by using hydrocolloid, then the pouching system is placed.

Some other skin issues are:

  • Contraction of the stomal opening is called stoma stenosis
  • Stoma becomes very dark or black called stoma necrosis
  • Redness and moist skin around the stoma called allergic contact dermatitis
  • Enlargement of blood vessels known as peristomal varices
  • Inflated hair follicles called folliculitis
  • Ulcers nearby the stoma, ulcerative colitis, Crohn’s disease, and arthritis

Things you must know about the pouching system

Ostomy pouching systems are used for the collection of urine or stool. They differ in size and structure. There are some noticeable differences.

Types of the Pouching system

The pouching system used for colostomy or ileostomy can have an open or closed-end. A patient who uses an open-end pouch can drain or empty the pouch without removal of the pouch. And it can be closed after emptying it. While a pouch with closed ends needs to be removed each time you want to empty it. These pouches are odor-resistant. If there is no leakage or there are no fees attached outside the pouch, the odor must not be there.

The main difference between the urostomy pouches is that it has a spout at the end of the pouch. This end is used for draining the urine out. You must keep the spout in the open position when you want to drain the pouch. There is also an antireflux baffle that prevents the backflow of the pouch. You can use a connector along with a spout to increase the storage capacity of the pouch during the night. It will help you to have proper sleep without any disturbance.

Pouching systems are classified as a one-piece barrier or two-piece barrier. The only difference between a one-piece pouching system and a two-piece pouching system is that there is no separation between the skin barrier and the pouch in the case of a one-piece pouching system.

How to empty and change the pouch?

The pouch should be emptied when it is almost one-third filled. If the pouch gets heavy it pulls the pouch downward and there might be a leakage of the bowel contents.

If you notice any leakage you must change your pouch immediately. Otherwise, it can cause peristomal skin issues.

You can wear a pouching system for two to three days if there is no leakage. Don’t confuse yourself between changing the pouch and emptying the pouch.

How to prevent popping of the pouch

Sometimes there may be  a lot of gas in the pouch. If the gas is not ventilated at a time the pouch becomes like a balloon. The patient can use a filter within the pouch which helps in preventing gas accumulation and is odor resistant.

Must know

Before leaving a hospital a patient must know how to change or empty the pouch, how to observe the stoma, and cut the skin barrier according to the size of their stoma. You should encourage your patients to look at their stoma. You must help them to believe that there is nothing shameful or embarrassing about it.

How To Avoid Getting Gas In Your Ostomy Pouch

We are all too familiar with that awful sensation of a ballooned up ostomy pouch. Not only does it put unnecessary and uncomfortable pressure on your stoma and your abdomen, but it is also harder to hide your ostomy pouch when it is ballooned up to the size of the hindenburg and can be seen from miles away even underneath your clothes.

Well, if you have been recently struggling with controlling the gas that is filling up your ostomy pouch, then we have something in common. I have actually been dealing with this problem for months on end, and it has ruined a lot of social situations and various nights out because I feel insecure about the gas that has filled up my ostomy pouch so fast.

It is even more annoying when you constantly have to change your ostomy bag because it keeps filling up so quickly. Also, we all have experienced having the seal on our skin barrier become burdened or irritated due to the pressure of the over-inflated ostomy pouch. I was so tired of this problem that I ended up doing a lot of my own research about gas in ostomy pouches to see if there are certain things that I can do to battle the gas or even prevent it. Fortunately my hard work paid off and I was able to find a bunch of different articles written about ostomy pouches and how to solve the problem of the pouch being over-inflated with gas. 

First off, it is important to note some of the primary reasons for getting gas in our bodies. Normal people (people who don’t have a stoma or have to live with an ostomy pouch) actually fare a lot better when it comes to getting gas because they have a way to stop the gas from coming out of their body at unwanted times.

Those of us with a stoma, however, are forced to just let the gas build up inside of our ostomy pouches until things are about ready to burst. That is why it is actually really important to figure out what types of things can create gas in our systems and try to avoid doing those things as best as we can.

The first thing I would like to talk about is how eating different types of food can cause gas. Believe it or not, the old myth about beans is actually true; beans can cause a lot of gas in our bodies. So the next time you go to take a great big bite of Johnsonville baked beans, think about the effects that the gas will have on your ostomy pouch in the long run. Other food like cabbage and sweet potatoes can also cause a lot of gas, so those would be good things to avoid eating if you are out on the town for the night.

Surprisingly, the way that we eat also has a huge impact on the amount of gas that we may experience. Chewing food with your mouth open or attempting to talk while eating can cause us to swallow a lot of air, which will in turn create more gas that needs to go somewhere else.

I hope this article helped you overcome your gassy ostomy pouch problem – good luck!