Small Intestine Cancer
General Information(Symptoms and Treatment)
Stages of Small Intestine Cancer
Treatment Options
The small intestine (also called small bowel) is part of the
body's digestive system. It is a long, coiled tube that connects the
stomach to the large intestine. The small intestine receives food from
the stomach, helps break it down, and absorbs nutrients that are used
by the body. The three parts of the small intestine are the duodenum,
jejunum, and ileum. The duodenum connects to the stomach, and the ileum
connects to the colon.
Small intestine cancer often starts in the duodenum. The most
common type of small intestine cancer is adenocarcinoma (cancer that
begins in cells that make and release mucus and other fluids). Other
types of small intestine cancer are sarcomas, carcinoid tumors,
gastrointestinal stromal tumors, and lymphomas.
General Information About Small Intestine Cancer
Key Points
- Small intestine cancer is a rare disease in which malignant
(cancer) cells form in the tissues of the small intestine.
- There are five types of small intestine cancer.
- Diet and health history can affect the risk of developing
small intestine cancer.
- Signs and symptoms of small intestine cancer include
unexplained weight loss and abdominal pain.
- Tests that examine the small intestine are used to detect
(find), diagnose, and stage small intestine cancer.
- Certain factors affect prognosis (chance of recovery) and
treatment options.
Small
intestine 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.
The small intestine
connects the stomach and the colon. It includes the duodenum, jejunum,
and ileum.
There
are five types of small intestine cancer.
The types of cancer found in the small
intestine are adenocarcinoma,
sarcoma, carcinoid tumors, gastrointestinal stromal tumor,
and lymphoma. This
summary discusses adenocarcinoma and leiomyosarcoma
(a type of sarcoma).
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.
See the following PDQ summaries for more
information on small intestine cancer:
- Adult Soft Tissue Sarcoma Treatment
- Childhood Soft Tissue Sarcoma Treatment
- Adult Non-Hodgkin Lymphoma Treatment
- Childhood Non-Hodgkin Lymphoma Treatment
- Gastrointestinal Carcinoid Tumors Treatment
- Gastrointestinal Stromal Tumors Treatment
Diet
and health history can affect the risk of developing small intestine
cancer.
Anything that increases
your risk of getting a disease is called a risk
factor. Having a risk factor does not mean that you will
get cancer; not having risk factors doesn't mean that you will not get
cancer. Talk with your doctor if you think you may be at risk. Risk
factors for small intestine cancer include the following:
- Eating a high-fat diet.
- Having Crohn disease.
- Having celiac disease.
- Having familial
adenomatous polyposis (FAP).
Signs
and symptoms of small intestine cancer include unexplained weight loss
and abdominal pain.
These and other signs and symptoms may be caused by
small intestine cancer or by other conditions.
Check with your doctor if you have any of the following:
- Pain or cramps in the middle of the abdomen.
- Weight loss with no known reason.
- A lump in the abdomen.
- Blood
in the stool.
Tests
that examine the small intestine are used to detect (find), diagnose,
and stage small intestine cancer.
Procedures that make
pictures of the small intestine and the area around it help diagnose small intestine
cancer and show how far the cancer has spread. The process used to find
out if cancer cells have spread within and around the small intestine
is called staging.
In order to plan
treatment, it is important to know the type of small intestine cancer
and whether the tumor can be removed by surgery.
Tests and procedures to detect, diagnose, and stage small intestine cancer
are usually done at the same time. The following tests and procedures
may be used:
- 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.
- Liver
function tests : A procedure in which a
blood sample is checked to measure the amounts of certain substances
released into the blood by the liver.
A higher than normal amount of a substance can be a sign of liver
disease that may be caused by small intestine cancer.
- Endoscopy
: A procedure to look at organs and tissues inside
the body to check for abnormal
areas. There are different types of endoscopy:
- 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 is inserted
through the mouth and into the esophagus, stomach, and duodenum. An
endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may
also have a tool to remove tissue samples, which are checked under a microscope for signs of
cancer.
- Capsule
endoscopy : A procedure to look at the
inside of the small intestine. A capsule that is about the size of a
large pill and contains a light and a tiny wireless camera is swallowed
by the patient. The capsule travels through the digestive tract, including
the small intestine, and sends many pictures of the inside of the
digestive tract to a recorder that is worn around the waist or over the
shoulder. The pictures are sent from the recorder to a computer and
viewed by the doctor who checks for signs of cancer. The capsule passes
out of the body during a bowel
movement.
- Double
balloon endoscopy : A procedure to look at
the inside of the small intestine. A special instrument made up of two
tubes (one inside the other) is inserted through the mouth or rectum and into the small
intestine. The inside tube (an endoscope with a light and lens for
viewing) is moved through part of the small intestine and a balloon at
the end of it is inflated to keep the endoscope in place. Next, the
outer tube is moved through the small intestine to reach the end of the
endoscope, and a balloon at the end of the outer tube is inflated to
keep it in place. Then, the balloon at the end of the endoscope is
deflated and the endoscope is moved through the next part of the small
intestine. These steps are repeated many times as the tubes move
through the small intestine. The doctor is able to see the inside of
the small intestine through the endoscope and use a tool to remove
samples of abnormal tissue. The tissue samples are checked under a
microscope for signs of cancer. This procedure may be done if the
results of a capsule endoscopy are abnormal. This procedure is also
called double balloon enteroscopy.
- 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 or lymph nodes are removed or
tissue samples are taken and checked under a microscope for signs of
disease.
- Biopsy
: The removal of cells or tissues so they can be
viewed under a microscope to check for signs of cancer. This may be
done during an endoscopy or laparotomy. The sample is checked by a pathologist to see if it
contains cancer cells.
- 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, 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.
- MRI
(magnetic resonance imaging): A procedure that uses a
magnet, radio waves,
and a computer to make a series of detailed pictures of areas inside
the body. This procedure is also called nuclear magnetic resonance
imaging (NMRI).
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 is in the inner lining of the small
intestine only or has spread into or beyond the wall of the small
intestine.
- Whether the cancer has spread to other places in the body,
such as the lymph nodes, liver, or peritoneum
(tissue that lines the wall of the abdomen and covers most of the
organs in the abdomen).
- Whether the cancer can be completely removed by surgery.
- Whether the cancer is newly diagnosed or has recurred.
Stages of Small Intestine Cancer
Key Points
- Tests and procedures to stage small intestine cancer are
usually done at the same time as diagnosis.
- There are three ways that cancer spreads in the body.
- Cancer may spread from where it began to other parts of the
body.
- Small intestine cancer is grouped according to whether or
not the tumor can be completely removed by surgery.
Tests
and procedures to stage small intestine cancer are usually done at the
same time as diagnosis.
Staging is used to find out
how far the cancer
has spread, but treatment decisions are not based on stage. See the General
Information section for a description of tests and procedures used to
detect, diagnose,
and stage small intestine
cancer.
There
are three ways that cancer spreads in the body.
Cancer can spread
through tissue, the
lymph system, and
the blood:
- Tissue. The cancer spreads from where it began by growing
into nearby areas.
- Lymph system. The cancer spreads from where it began by
getting into the lymph system. The cancer travels through the lymph vessels to other parts
of the body.
- Blood. The cancer spreads from where it began by getting
into the blood. The cancer travels through the blood vessels to other parts
of the body.
Cancer
may spread from where it began to other parts of the body.
When cancer spreads
to another part of the body, it is called metastasis.
Cancer cells break
away from where they began (the primary
tumor) and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system,
travels through the lymph vessels, and forms a tumor (metastatic tumor) in another
part of the body.
- Blood. The cancer gets into the blood, travels through the
blood vessels, and forms a tumor (metastatic tumor) in another part of
the body.
The metastatic tumor is
the same type of cancer as the primary tumor. For example, if small
intestine cancer spreads to the liver,
the cancer cells in the liver are actually small intestine cancer
cells. The disease is metastatic small intestine cancer, not liver cancer.
Small
intestine cancer is grouped according to whether or not the tumor can
be completely removed by surgery.
Treatment depends on
whether the tumor
can be removed by surgery
and if the cancer is being treated as a primary
tumor or is metastatic
cancer.
Recurrent Small Intestine Cancer
Recurrent small intestine cancer is cancer that has
recurred (come back) after it has been treated. The cancer may come
back in the small intestine or in other parts of the body.
Treatment Option Overview
Key Points
- There are different types of treatment for patients with
small intestine cancer.
- Three types of standard treatment are used:
- Surgery
- Radiation therapy
- Chemotherapy
- New types of treatment are being tested in clinical trials.
- Biologic therapy
- Radiation therapy with radiosensitizers
- Patients may want to think about taking part in a clinical
trial.
- Patients can enter clinical trials before, during, or after
starting their cancer treatment.
- Follow-up tests may be needed.
There
are different types of treatment for patients with small intestine
cancer.
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. Some clinical trials
are open only to patients who have not started treatment.
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 lower the risk that the cancer
will come back, 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 or keep them from growing. 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 of the cancer being treated.
External radiation therapy is used to treat small intestine cancer.
Chemotherapy
Chemotherapy is a cancer
treatment that uses drugs
to stop the growth of cancer cells, either by killing the cells or by
stopping them 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 cerebrospinal
fluid, 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.
New
types of treatment are being tested in clinical trials.
This summary section
describes treatments that are being studied in clinical trials. It may
not mention every new treatment being studied. Information about
clinical trials is available from the NCI website.
Biologic
therapy
Biologic therapy is a
treatment that uses the patient's immune
system to fight cancer. Substances made by the body or
made in a laboratory are used to boost, direct, or restore the body's
natural defenses against cancer. This type of cancer treatment is also
called biotherapy or immunotherapy.
Radiation
therapy with radiosensitizers
Radiosensitizers are drugs
that make tumor cells more sensitive to radiation therapy. Combining
radiation therapy with radiosensitizers may kill more tumor cells.
Patients
may want to think about taking part in a clinical trial.
For some patients,
taking part in a clinical trial
may be the best treatment choice. Clinical trials are part of the
cancer research process. Clinical trials are done to find out if new
cancer treatments are safe and effective or better than the standard treatment.
Many of today's
standard treatments for cancer are based on earlier clinical trials.
Patients who take part in a clinical trial may receive the standard
treatment or be among the first to receive a new treatment.
Patients who take
part in clinical trials also help improve the way cancer will be
treated in the future. Even when clinical trials do not lead to
effective new treatments, they often answer important questions and
help move research forward.
Patients
can enter clinical trials before, during, or after starting their
cancer treatment.
Some clinical trials
only include patients who have not yet received treatment. Other trials
test treatments for patients whose cancer has not gotten better. There
are also clinical trials that test new ways to stop cancer from recurring (coming back) or
reduce the side effects
of cancer treatment.
Clinical trials are
taking place in many parts of the country. See the Treatment Options
section that follows for links to current treatment clinical trials.
These have been retrieved from NCI's
listing of clinical trials.
Follow-up
tests may be needed.
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.
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.
Treatment Options for Small Intestine Cancer
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.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with small intestine adenocarcinoma. For more specific
results, refine the search by using other search features, such as the
location of the trial, the type of treatment, or the name of the drug.
Talk with your doctor about clinical trials that may be right for you.
General information about clinical trials is available from the NCI
website.
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.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with small intestine leiomyosarcoma. For more specific
results, refine the search by using other search features, such as the
location of the trial, the type of treatment, or the name of the drug.
Talk with your doctor about clinical trials that may be right for you.
General information about clinical trials is available from the NCI
website.
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.
-NIH
