The small intestine, or small bowel, lies between the stomach and the colon. Its primary function is to digest and absorb nutrients.
Types of small intestine cancers
These major types make up about 60% to 70% of small intestine cancers:
Adenocarcinoma
Lymphoma
Sarcoma
Carcinoids
Occasionally, small bowel cancer may actually be metastatic cancer, meaning that it has spread to the small bowel from a primary cancer located elsewhere in the body. There are also several benign tumors that can arise from the small bowel including: adenomas, leiomyomas, fibromas, and lipomas.
The symptoms of small bowel cancer include:
cramping pain in the tummy
weight loss
nausea and vomiting
anaemia (a low number of red blood cells), due to blood loss
dark or black stools (bowel motions), due to bleeding in the small bowel
diarrhoea
jaundice
fatigue
You will need tests to diagnose small bowel cancer. Tests may include endoscopies, x-rays, CT or MRI scans. Doctors may also need to collect tissue samples (biopsy) from the affected area.
Surgery is the main treatment for cancer of the small bowel. It may be used to remove the affected section of the bowel and join the bowel back together. Radiotherapy or chemotherapy may be used after surgery or used in combination (chemoradiation).
Diagnosis
A physician will first record your complete medical history and perform a physical examination. Also, the doctor will likely order some basic blood tests, especially if there is a history of blood loss in the stool, diarrhea, etc.
Additional tests to diagnose small bowel cancer can include:
Stool sample to test for blood
Endoscopy or colonoscopy: looks inside the duodenum and the upper part of the jejunum (from above, through the throat and past the stomach) or the lower part of the ileum (from below).
Enteroscopy can investigate more of the small bowel but is more invasive and requires special equipment and training. There is also a pill with a small camera, which can be used to assess the bowel (capsule endoscopy). The pill is swallowed and then takes pictures periodically, which are sent wirelessly to a computer where they can be viewed.
Barium x-rays: also known as small bowel follow-through, in which the patient first drinks barium liquid (which looks white on x-ray) and then gets abdomen x-rays to follow the passage of the barium through the entire small bowel. Enteroclysis, a special kind of barium study, which uses double contrast (both barium and methylcellulose) to get a better picture of the intestine can also be used. This technique can also be used with CT (CAT) scans.
Radiology test: CT scans, ultrasound scans and other kinds of x-rays, which sometimes pick up a small bowel tumor, but more importantly look at other parts of the body to see if the cancer may have spread
MRI may be ordered if liver involvement is suspected, which can occur with carcinoid tumors.
Treatment
Treatment options for small intestine cancer vary, depending on the type of tumor, the stage of the cancer and your overall health. Your medical oncologist works with you to create a care plan designed around your treatment preferences.
Surgery. When surgery is possible, it delivers the most positive outcomes for small intestine cancer. We use minimally invasive procedures to remove the tumor and any affected surrounding tissues. Depending on the size and location of a tumor, surgery may rejoin the small intestine or bypass a section of the bowel. Both procedures can help restore function.
Chemotherapy. Chemotherapy targets cancer cells in tumors and cancer cells that spread to other parts of the body. We use chemotherapy after surgery to destroy any remaining cancer cells and stop them from spreading.
Clinical trials. Small intestine cancer is rare, and because of that, there are few approved and effective treatments. We often assist patients who are interested in experimental clinical trials.
Precision genomics. A team of multidisciplinary physicians work together to evaluate the genetic variations of cancer cells. Results are compared to all available cancer treatments—for any type of cancer—to see if a treatment exists that targets the genetic traits of your cancer cells.
Radiation. On rare occasions, we may use radiation to target and destroy cancer cells or ease your symptoms. Radiation can be administered externally using high-energy X-rays. It can also be delivered inside the body with a needle or wire that carries a radioactive substance into or near the cancer.
