HIV Foundation Health The unknown colon cancer: How to prevent tumors in the small intestine

The unknown colon cancer: How to prevent tumors in the small intestine

When it comes to colon cancer, most people think of colon cancer. What is less well known is that the small intestine can also develop malignant tumors. What you should know about it, about symptoms, treatment and the combination of colon and small bowel cancer.

Small bowel cancer accounts for up to five percent of all bowel cancers; around 2,600 men and women were diagnosed with small bowel cancer in 2016, compared with around 60,000 colon cancer. “It is important to classify a carcinoma on the one hand by localization, i.e. in the case of bowel cancer, small or colon cancer, but also differentiate it on the basis of its biological characteristics,” reports Ulrich Graeven, chief physician at the Clinic for Hematology, Oncology and Gastroenterology at Maria Hilf Mönchengladbach Hospital.

Cancer of the small intestine is usually biologically very different from cancer of the colon

While colon cancer is usually adeno tumors, i.e. growths of the mucous membrane, this affects only a small fraction of small bowel cancer. The most common forms of small bowel cancer, depending on the cells that cause the disease, are:

  • Neuroendocrine tumors (NET) with around 50 percent, they arise from hormone-producing cells
  • Gastrointestinal stromal tumors (GIST) make up about ten percent, these tumors originate from the connective tissue in the gastrointestinal tract.

The differing biological characteristics of the two types of colon cancer, colon and small bowel cancer, “make these two diseases so fundamentally different, even though both affect the bowel,” explains the oncologist.

Causes of small bowel cancer and why it is less common than colon cancer

What triggers the fact that the cells in the small intestine no longer act normally, but degenerate and multiply in an uncontrolled manner, is still largely unknown. It is assumed that there is a connection with pollutants in food that come into contact with the small intestine during passage and can thus influence its cells.

It is well known that the small intestine connects directly to the stomach. This first section of the three-part small intestine is called the duodenum, followed by the jejunum and ileum. In addition to transporting the chyme to the large intestine, the task of the five-meter-long small intestine is to break down certain food components and release them into the blood. The most important ones are carbohydrates, which are processed into various sugars, fat, but also vitamins and trace elements.

The chyme is still thin in this section of the intestine and is therefore transported on quickly. The contact time with the intestinal wall is much shorter than later in the large intestine, “which could explain why colon cancer is much more common than small intestine cancer,” the gastroenterologist explains the possible background. In addition, the mucous membrane in the small intestine is less susceptible to certain factors such as pollutants than that in the large intestine.

Risk factor hereditary diseases

However, there is also a familial willingness to develop small bowel cancer: Hereditary polyposis syndromes such as familial adenomatous polyposis (FAP) and Lynch syndrome. Genetically, a large number of polyps develop in the large intestine, sometimes also in the small intestine. These are adenocarcinomas, but are very rare in the small intestine compared to NET and GIST.

Small intestinal tumors associated with FAP are usually only discovered when polyps have been detected in the large intestine. In the course of further diagnosis of the familial predisposition, these rare small bowel carcinomas are also identified.

Small bowel cancer symptoms

Small bowel cancer usually grows slowly. Frequently, signs only appear when the disease has progressed and the tumor is taking up space. Depending on you can

  • Bleeding,
  • Stomach pain,
  • nausea
  • Constipation or diarrhea

occur. If the tumor is large, it can even block the intestines (ileus). The intestinal obstruction manifests itself through massive pain, it is always a medical emergency that is life-threatening and must be treated immediately.

Small bowel cancer prognosis varies

Small bowel cancer is usually only discovered at an advanced stage. In more than 70 percent, the carcinoma is only diagnosed in stage three or four, i.e. later than this applies to this common colon cancer – again the comparison with colon cancer.

The survival rates for small bowel cancer are therefore somewhat lower. “The decisive factor, however, is always the type of cancer of the small intestine,” explains the expert. If a GIST or NET is detected early, the chances of survival are very good. If, on the other hand, it is adenocarcinoma, which is also usually discovered later, the prognosis is not quite as favorable.

Diagnosis of small bowel cancer

The classic examination methods of gastroscopy and colonoscopy only cover the upper or lower part of the small intestine, “the almost five meters in between are not reached with these examination techniques,” explains the expert.

Imaging methods such as magnetic resonance tomography (MRT) or computed tomography (CT) are only used if there are symptoms and suspicion of this intestinal tumor. Capsule endoscopy, which shows images from the small intestine, also provides information.

Only when these examinations reveal an abnormality is it possible to specifically mirror the small intestine. “However, this is very time-consuming and cannot be used as a preventive examination – also because these intestinal tumors are very rare,” emphasizes Ulrich Graeven.

Small intestinal cancer therapies – surgery and its consequences

Overall, the following applies to the various small intestinal tumors: If possible, an operation should be performed. “If the tumor is limited, parts of the small intestine can usually be removed without any problems,” explains the oncologist in more detail.

A stoma, i.e. an artificial anus, is therefore usually not necessary. However, it is crucial which part of the small intestine is missing and which functions it had, which trace elements and vitamins it passed on to the body. This deficiency must then be compensated for through appropriate nutrition or medication.

Treatment for small bowel cancer varies depending on the type of tumor

Parts of the removed tumor are examined histologically. For the therapy plan, it is crucial whether it is NET, GIST or the rare familial adenocarcinoma in the small intestine. “A generally applicable therapy scheme for small bowel cancer is not possible because there is not just one small bowel cancer, but different ones, it always depends on its type,” emphasizes the oncologist.

Accordingly, there are many different therapy options. If a gastrointestinal stromal tumor (GIST) has metastasized, for example, there are very good drugs for further treatment. “This is not the classic chemotherapy, but we use so-called tyrosine kinase inhibitors, with very good results,” reports the expert. These are inhibitors, such as imitanib, that can block certain signaling pathways within the cells. They are sometimes also used before an operation to reduce the size of a tumor that is too large and therefore inoperable, or after an operation to avoid a relapse.

If the cancer of the small intestine is a neuroendocrine tumor (NET), on the other hand, surgery is often the only treatment required. The NET is further subdivided with regard to the need for drug therapy, taking into account its growth rate. This subdivision of the NET is also of crucial importance for planning therapy for metastatic NET.

Ademocarcinoma of the small intestine is treated on the basis of the results from the treatment of colon tumors.

Small bowel cancer prevention

Targeted prevention against these rare tumors is hardly possible – apart from the well-known rules for a healthy life, i.e. without smoking, with a sensible diet, extensive alcohol restriction and sufficient exercise. Because little is known about the possible causes of small bowel cancer, they cannot be influenced.

However, there is an important tip from the expert for everyone in whose families there are genetically determined polyps in the large intestine: Remember to not only limit the preventive measures to the large intestine, but also to extend it to the small intestine. Although this is provided for in the relevant colorectal cancer screening and follow-up programs, it must not be overlooked.

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Diet and Exercise For Weight Loss – What You Should Know About These ProgramsDiet and Exercise For Weight Loss – What You Should Know About These Programs

When most people think about diet and exercise for weight loss, they automatically think about what you should eat. It may be a good idea to take a nutrition quiz first though so that you can figure out what your ideal weight for your height and age is. Many people who have put off working out or following a diet for weight loss do so because they do not know where to begin. There is no right place to start. Every person has their own ideas on what weight they want to lose and how to achieve it, so follow along as you research diet and exercise for weight loss.

Start with what you already enjoy doing. If you are a fan of the television, do not stop watching after you have lost some weight. You will be bored if you do not have the activities that you enjoyed doing. Take up a new sport to keep yourself motivated. If you are already involved in an exercise routine such as dance, sign up for a sport that you can see yourself participating in all time soon. Starting a new sport will give you something to look forward to each day.Weight loss diet plan: Lose weight without exercising by eating these foods | Express.co.uk

Diet and exercise for weight loss will involve watching what you eat and when you eat it. Eat at times when you are not stressed out and when you are feeling hungry. Stress can bring on cravings, so it is important that you eat smaller meals throughout the day than usual. Eating smaller meals lessens the amount of food you have to eliminate so that you do not have to starve yourself to lose weight.

Develop a diet and exercise routine that works best for your lifestyle and time frame. If you need a fast solution to your weight problems then you might want to go for a crash diet or a cleansing diet. These are quick solutions that are not long term. Choose one that will allow you to see results quickly.

You should also think about the types of foods that you eat. If you need to reduce your caloric intake, you can increase your protein consumption. A diet and exercise routine that include a high protein diet will help you get the results that you want. If you want to add muscle mass, you can increase the amount of lean meats, fruits, vegetables, and dairy products in your diet. A good diet and exercise routine will help you reach your goal weight in a healthy and sustainable manner.

You can consult a dietitian to help you design a diet and exercise plan. A dietitian can also help you determine which types of diet will be best for your particular weight loss needs. Remember, different people have different metabolisms. That is why some people cannot benefit from a high protein diet while others can. Always talk with your doctor before you start any type of diet and exercise program.

At 20, 40, 60 and 70 years: how to eat healthily at any ageAt 20, 40, 60 and 70 years: how to eat healthily at any age

Sometimes the body needs more protein, sometimes more carbohydrates and after a certain age it should be less overall. If you want to eat healthily for a lifetime, you should always keep an eye on your age when shopping and cooking.

According to today’s recommendations, a healthy diet consists of plenty of fresh vegetables and fruit, good oils, as little industrially processed food as possible, economical consumption of animal products, white flour and sugar – from children to old people.

So there is only healthy and unhealthy diet, but no age-related diet. But: Over the years and depending on the situation in life, the need and utilization of nutrients change. And here age definitely plays a role. For example, the nutritionists at the University of California in San Diego have put together an overview of what to look out for .

This is what matters from 20 to 40:

The basal metabolic rate is highest in young adults, which means that the body consumes the most calories even without physical activity. At this age, many people can “eat what they want” without getting fat. At least at this age, the body forgives a few fast-food orgies and other antics.

In general, it is important to build up muscles, bones and connective tissue between the ages of 20 and 30 , also with the help of a sensible diet. Everyone can benefit from this basis in later years, when it is no longer so easy to maintain fitness.

In these years, special attention to nutrition requires more of a life circumstance for women: pregnancy.

Special dietary instructions for young pregnant women only

In addition to a diet full of high-quality nutrients and the natural avoidance of tobacco and alcohol , it is important to ensure an optimal supply of vitamins, minerals and trace elements so that the child develops well. Eating for two, on the other hand, is completely unnecessary and wrong.

Therefore, all expectant mothers should take folic acid in the first 3 months of pregnancy . Iodine tablets can also be useful. And vegans also have to pay attention to a number of micronutrients that they lack by avoiding animal foods: iron, zinc , calcium, vitamins B12, B2 and D as well as an appropriate intake of omega-3 fatty acids.

This is important from 40:

From the age of 40, the metabolism begins to slow down. While the body can usually break down too much sugar and carbohydrates by the age of 30, it loses this ability by the age of 40 at the latest. Suddenly, an unchanged diet is reflected in the stomach and hips.

Anyone who is only now finding an adequate diet can still set the course for a healthy future.

Anyone who has already eaten reasonably healthy should now pay more attention to the following elements:

  • Fruits and vegetables in bright colors – the antioxidants they contain act as cell protection with an antiaging effect in the body.
  • more whole grains on the menu
  • a (small) portion of red meat twice a week – good for building muscle , also important for women because of the prevention of iron deficiency
  • Vegetarians should pay particular attention to green leafy vegetables such as spinach, kale or Swiss chard.

Here are some things to watch out for in your 50s and 60s:

Now begins a dangerous age for cardiovascular problems such as high cholesterol and high blood pressure. Anyone who has neglected their diet and has not taken much exercise must expect type 2 diabetes .

It is now important to have a diet that keeps the blood sugar level stable and prevents deposits in the blood vessels. It should be low in cholesterol, high in fiber and slowly digestible carbohydrates, so:

  • lots of vegetables
  • little animal fat
  • no sugared soft drinks
  • little white flour products

In addition:

  • nuts
  • Good oils (olive, flaxseed)
  • Fish (omega-3 fatty acids and vitamin D)
  • Low-fat dairy products (calcium)

Changes in hormones accelerate the loss of calcium from the bones. The substitution of calcium plus vitamin D can now counteract the threat of osteoporosis . Because of the breakdown of estrogen during menopause , it occurs earlier and more frequently in women. But bone loss threatens men too.

An omega-3 supplement can benefit heart health if someone doesn’t eat sea fish. Omega-3 fatty acids stabilize the blood vessels.

Proper nutrition with 70 plus:

With age, various physiological and psychological changes occur that directly affect nutritional needs. The taste buds and appetite decrease, as does the desire to cook freshly and by yourself.

The body is less able to absorb and use many vitamins and minerals. With age, the digestive juices in the stomach change, reducing the absorption of iron, calcium, and vitamins B6, B12, and folic acid.

Long-term use of prescription drugs can decrease the absorption of certain nutrients.

Less calories, but not less nutrients

Seniors need fewer calories than younger people, but no fewer nutrients. Protein becomes important again in old age: it can delay muscle loss in old age, especially when combined with strength training.

As a rule of thumb, one gram of protein per kilogram of body weight per day . However, it should not be exclusively protein from meat, as it promotes inflammation, especially in the joints.

Because digestion becomes sluggish with age, fiber is important for the 70+ generation. A teaspoon of psyllium husks are a recommended alternative to the vegetables or whole grains that would be necessary for an optimal supply. To do this, seniors have to drink plenty, even if that is difficult for many.

“Cancer cells are fed” – underestimated health risks lurk in meat and sausage“Cancer cells are fed” – underestimated health risks lurk in meat and sausage

Iron deficiency is often discussed. There is hardly any talk about the opposite, the frequent overloading with heme iron, the iron form made from red meat and sausage. It promotes the common diseases of diabetes, cancer and arteriosclerosis. FOCUS Online shows how you can meet your iron needs in a healthy way.

The trace element iron is indispensable for a number of vital metabolic functions in the body. As a component of hemoglobin in the red blood cells, it supplies every body cell with oxygen. Iron deficiency, which manifests itself in anemia, exhaustion, susceptibility to infection, affects around 20 percent of women and ten percent of men in Germany. The higher risk for women is explained by menstruation and decreases accordingly when the childbearing phase of life is over.

Many people have an excess of iron – and know nothing about it

Iron deficiency is known and many nutrition-conscious people pay attention to adequate iron intake. However, significantly more people could have anything but an iron deficiency, namely too much of this trace element. Probably very few people know about it, although it carries a high risk of disease.

Heme iron and non-heme iron: these are the differences

First and foremost, it is important for these relationships – there are the two known, different forms of iron, only one of which can be hazardous to health:

1. Heme iron , i.e. bivalent iron (Fe), mainly found in red meat and sausage. Heme iron has a high bioavailability, the body can use at least 20 percent from food.

2. Non-heme iron , trivalent iron (Fe3), from plant-based nutrient suppliers such as legumes, whole grains, nuts, oil seeds and various types of vegetables. Non-heme iron must first be oxidized to some form of Fe in the small intestine in order for the body to use it. In this way, only around five percent of the iron from food comes into play.

The iron requirement per day is 15 milligrams for women and 10 milligrams for men.

Underestimated health risk heme iron

What is certain is that most people in industrialized nations have at least a sufficient supply of the trace element. Due to our meat and sausage-heavy diet, a large part is even oversupplied with heme iron, and thus risks diseases. Various studies indicate these relationships .

“We assume that too much heme iron can have negative health consequences through eating meat,” explains Matthias Riedl, board member of the Association of German Nutritionists (BDEM) and diabetologist, nutritionist, internist, managing director and medical director at Medicum Hamburg.

The human organism is not prepared for high meat consumption

Normally, a complex mechanism of substances in the liver and intestines controls the iron level. If too much iron storage protein ferritin is measured, the body slows down absorption. “This does not work adequately with large amounts of heme iron, the body continues to absorb it, simply because this form of iron is extremely easy to use,” says the expert.

The nutritionist explains that the cause lies in our evolutionary history. Up until two million years ago, humans were purely plant-eaters, only then did they add animal consumption. That was sometimes more, mostly less meat – definitely a lot less than is regularly eaten today. The human organism is not prepared for this.

High consumption of heme iron feeds cancer cells

The excess iron is then deposited in the pancreas, liver and spleen, which can put stress on the organs. But that’s not all. “Heme iron can promote mutations via certain chemical compounds – for example in intestinal cells, but also in other cells,” warns the internist.

In addition, these compounds have a cytotoxic effect, so they can not only change cells, but also damage them. “And cancer cells, on the other hand, are properly fed by heme iron, so to speak,” says the expert. Malignant cells have a high demand for this trace element. A high consumption of heme iron means that existing cancer cells grow better and are stronger against the immune system.

Meat lovers are more likely to develop diabetes and arteriosclerosis

In addition to the connection between heme iron and cancer, many nutritional studies have shown two other negative effects of the “meat iron”:

1. Numerous studies show that people who consume a lot of sausage and meat are particularly likely to have type 2 diabetes .

2. In addition, this dietary preference often leads to arteriosclerosis , with the well-known secondary diseases of high blood pressure, heart attack and stroke.

“If people don’t eat ‘appropriately’, they get sick”

The higher the meat consumption, the higher the risks for cancer, diabetes and arteriosclerosis. What actually stands behind it: “If people do not eat ‘species-appropriate’, i.e. eat too much red meat and sausage and thus too much heme iron, they will get sick,” warns Matthias Riedl. It is well known that primitive peoples who still eat originally – eat very little meat and no sausage – do not have arteriosclerosis at all, for example.

Trivalent iron from plants is converted into bivalent iron

So heme iron has a rather negative effect on the body. Non-heme iron, on the other hand, does not pose these health risks – but is converted into bivalent iron in the body in order to make it available. Doesn’t it then become as unfavorable as bivalent heme iron? “No, because the trivalent iron from plants is converted into a bivalent iron, but not into heme iron,” explains the expert.

Providing the body with healthy iron – vegetables and fruits with non-heme iron

In order to provide the body with sufficient iron without meat, there are a number of plant-based foods that have a high content of non-heme iron, such as:

  • Lentils around 2.7mg / 100gr
  • Chickpeas around 2.7mg / 100gr
  • Peas 1,5mg / 100gr
  • Spinach 3,6mg / 100gr
  • Chanterelles 6.5mg / 100gr
  • Elderberry 1.6mg / 100gr
  • Pine nuts 9.2mg / 100gr
  • Millet 6.9mg / 100gr
  • Flaxseed, ground 8,4mg / 100gr
  • Amaranth 8.9mg / 100gr

Spinach contains a comparatively high amount of iron for a plant-based food, but at the same time the substances it contains can prevent it from being absorbed by the body. Beans or lentils are therefore better suited as a vegetarian source of iron.

Intelligently upgrade the bioavailability of iron from vegetables and fruits

Sure, none of these foods provide as much iron as meat. “The availability of iron from plant-based foods can be increased by cleverly combining the ingredients in a meal,” says Matthias Riedl. Vitamin C, for example, improves absorption. Suggestion for a corresponding daily plan:

  • In the morning: oatmeal / muesli with fruit, a glass of orange or lemon juice for breakfast,
  • Lunch: millet salad with paprika (the pods are extremely rich in vitamin C),
  • In the evening: whole wheat pasta with broccoli or parsley pesto

Coffee and tea inhibit iron availability

However, there are also plant substances that have an inhibiting effect on iron absorption. These are phytates and polyphenols, for example, these plant substances are contained in coffee and tea. So avoid these drinks during, immediately before and after a meal containing iron. In wholemeal products, on the other hand, the phytate content plays a lesser role, as they convince with their high iron content.

Cover your iron requirement healthily, certain meats are also allowed

“Those who follow a purely vegetarian / vegan diet can still get too little iron, especially women are at risk here,” says the expert.

Pregnant and breastfeeding women in particular should take preparations if they have a proven iron deficiency. Otherwise there is a ‘species-appropriate’ solution for everyone: That means a small, moderate meat meal per week, preferably poultry meat, because white meat is not statistically associated with the disease risks mentioned.