Small Intestine Cancer

General Information

About

Small bowel cancer is a rare disease in which malignant (cancer) cells form in the tissues of the small intestine.

The small intestine is part of the body’s digestive system, which also includes the esophagus, stomach, and large intestine. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The small intestine is a long tube that connects the stomach to the large intestine. It folds many times to fit inside the abdomen.

There are five types of small intestine cancer:

  • Adenocarcinoma
  • Sarcoma
  • Carcinoid tumors
  • Gastrointestinal stromal tumor
  • Lymphoma, including adenocarcinoma and leiomyosarcoma.
    • Adenocarcinoma starts in glandular cells in the lining of the small intestine and is the most common type of small intestine cancer. Most of these tumors occur in the part of the small intestine near the stomach. They may grow and block the intestine.
    • Leiomyosarcoma starts in the smooth muscle cells of the small intestine. Most of these tumors occur in the part of the small intestine near the large intestine.

Risk Factors

Risk factors for small bowel cancer include the following:

  • Eating a high-fat diet.
  • Having Crohn disease.
  • Having Celiac disease.
  • Having familial adenomatous polyposis (FAP).

Signs & Symptoms

Possible signs of small bowel cancer include abdominal pain and unexplained weight loss. These and other symptoms may be caused by small intestine cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

  • Pain or cramps in the middle of the abdomen.
  • Weight loss with no known reason.
  • A lump in the abdomen.
  • Blood in the stool.

Diet and health history can affect the risk of developing small intestine cancer.

Detection 

To determine if you are suffering from a GIST tumor, as well as whether it is surgically removable, your surgical oncologist will perform a number of diagnostic tests, including:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.
  • Barium enema: A series of x-rays of the lower gastrointestinal (GI) tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.
  • Fecal occult blood test: A test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.
  • Upper endoscopy: A procedure to look at the inside of the esophagus, stomach, and duodenum (first part of the small intestine, near the stomach). An endoscope (a thin, lighted tube) is inserted through the mouth and into the esophagus, stomach, and duodenum. Tissue samples may be taken for biopsy.
  • Upper GI series with small bowel follow-through: A series of x-rays of the esophagus, stomach, and small bowel. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus, stomach, and small bowel. X-rays are taken at different times as the barium travels through the upper GI tract and small bowel.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, abdomen, and pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Abdominal X-ray: An x-ray of the organs in the abdomen. An x-ray is a type of energy beam that can go through the body onto film, making a picture of areas inside the body.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The biopsy may be done after surgery to remove the tumor. If the tumor clearly cannot be removed by surgery, the biopsy may be done using a fine needle to remove cells from the tumor.
  • MRI: MRI scans use radio waves and strong magnets instead of X-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases.  These scans can help oncologists find the extent of the cancer in the abdomen
  • Liver function test: Evaluates how well your liver is working, as pancreatic cancer may affect your liver function.
  • Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.
  • Laparotomy: A surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken for biopsy.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The type of small intestine cancer.
  • Whether the cancer has spread to other places in the body.
  • Whether the cancer can be completely removed by surgery.
  • Whether the cancer is newly diagnosed or has recurred.

Learn more about small bowel cancer treatment. 

 

Stages

Doctors use a staging system to describe the extent of spread of most types of cancer, including gastrointestinal stromal tumors (GISTs). The most common system used is the TNM system of the American Joint Committee on Cancer (AJCC). This system is based on 4 key pieces of information:

  • T describes the size of the primary tumor, measured in centimeters (cm).
  • N describes whether the cancer has spread to nearby (regional) lymph nodes (this is very rare for GISTs).
  • M indicates whether the cancer has metastasized (spread) to other organs of the body. If a GIST does spread, most often it is within the abdomen, such as to the liver. Less often, it may spread to the lungs and bones.
  • The mitotic rate is a measure of how fast the cancer cells are growing and dividing. It is described as either low or high. A low mitotic rate predicts a better outcome.

Numbers or letters appear after T, N, and M to provide more details about each of these factors:

  • The numbers 0 through 4 indicate increasing severity.
  • The letter X means “cannot be assessed” because the information is not available.

Stage 0: Tis, N0, M0

The cancer is in the earliest stage. It has not grown beyond the top layer of cells of the mucosa of the small intestine. This stage is also known as carcinoma in situ.

Stage I: T1 or T2, N0, M0

The cancer has grown from the top layer of cells of the mucosa and into deeper layers such as the lamina propria (T1a), the submucosa (T1b), or the muscularis propria (T2). It has not spread into nearby lymph nodes (N0) or distant sites (M0).

Stage IIA: T3 or T4, N0, M0

The cancer has grown through most of the wall of the small intestine and into the subserosa (T3 or T4). It has not yet spread to nearby lymph nodes (N0) or to distant sites (M0).

Stage IIB: T4, N0, M0

The cancer has grown through the wall of the intestine and into the serosa or into nearby tissues or organs (T4). It has not yet spread to nearby lymph nodes (N0) or to distant sites (M0).

Stage IIIA: Any T, N1, M0

The cancer has spread to 1 to 3 nearby lymph nodes (N1) but not to distant sites (M0).

Stage IIIB: Any T, N2, M0

The cancer has spread to 4 or more nearby lymph nodes (N2) but not to distant sites (M0).

Stage IV: Any T, Any N, M1

The cancer has spread to distant sites such as the liver, lung, peritoneum (the membrane lining the abdominal cavity), or ovary.

 

Treatments

Different types of treatments are available for patients with small intestine cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial as some clinical trials are open only to patients who have not started treatment.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Types of Treatments

Three types of standard treatment are used:

  • Surgery: Surgery is the most common treatment of small intestine cancer. One of the following types of surgery may be done:
    • Resection: Surgery to remove part or all of an organ that contains cancer. The resection may include the small intestine and nearby organs (if the cancer has spread). The doctor may remove the section of the small intestine that contains cancer and perform an anastomosis (joining the cut ends of the intestine together). The doctor will usually remove lymph nodes near the small intestine and examine them under a microscope to see whether they contain cancer.
    • Bypass: Surgery to allow food in the small intestine to go around (bypass) a tumor that is blocking the intestine but cannot be removed. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.
  • Radiation therapy: Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
  • Chemotherapy: Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Treatments by Stage

Small Intestine Adenocarcinoma

When possible, treatment of small intestine adenocarcinoma will be surgery to remove the tumor and some of the normal tissue around it.

Treatment of small intestine adenocarcinoma that cannot be removed by surgery may include the following:

  • Surgery to bypass the tumor.
  • Radiation therapy as palliative therapy to relieve symptoms and improve the patient's quality of life.
  • A clinical trial of radiation therapy with radiosensitizers, with or without chemotherapy.
  • A clinical trial of new anticancer drugs.
  • A clinical trial of biologic therapy.

Small Intestine Leiomyosarcoma

When possible, treatment of small intestine leiomyosarcoma will be surgery to remove the tumor and some of the normal tissue around it.

Treatment of small intestine leiomyosarcoma that cannot be removed by surgery may include the following:

  • Surgery (to bypass the tumor) and radiation therapy.
  • Surgery, radiation therapy, or chemotherapy as palliative therapy to relieve symptoms and improve the patient's quality of life.
  • A clinical trial of new anticancer drugs.
  • A clinical trial of biologic therapy.

Recurrent Small Intestine Cancer

Treatment of recurrent small intestine cancer that has spread to other parts of the body is usually a clinical trial of new anticancer drugs or biologic therapy.

Treatment of locally recurrent small intestine cancer may include the following:

  • Surgery.
  • Radiation therapy or chemotherapy as palliative therapy to relieve symptoms and improve the patient's quality of life.
  • A clinical trial of radiation therapy with radiosensitizers, with or without chemotherapy.

 

Services at Lombardi

Cancer information from the NCI PDQ service