What are Small Intestine Tumors or Cancer?

Small intestine, or small bowel, tumors or cancer are a rare form of cancer that occurs in the small intestine. The small intestine is part of your digestive tract which connects the stomach to the large intestine. Even though the small intestine is the largest segment of the gastrointestinal tract (21 feet), it has a low incidence of malignancy. According to the American Cancer Society, 6,110 new cases of small intestine cancer will be diagnosed and there will be 1,110 deaths in 2008.

There are five types of small intestine tumors and cancer:

• Adenocarcinoma is the most common type of small intestine cancer.  It starts in the glandular cells in the inner lining of the intestinal lumen and most occur in the part nearest to the stomach.  They may grow and block the intestine.
• Sarcoma is a type of small intestine cancer, with leiomyosarcoma being a predominant type.  It starts in the smooth muscle cells of the small intestine, usually near to the large intestine.  When these tumors are small and not malignant, they are called leiomyoma.
• Lymphoma
• Carcinoid tumors
• Gastrointestinal stromal tumor

What are the symptoms of small intestine tumors or cancer?

Signs and symptoms of small intestine cancer may include:

• Abdominal pain and cramps in the middle of the abdomen and/or vomiting
• Unexplained weight loss
• Lump in the abdomen
• Blood in the stool

What are the risk factors for small intestine tumors or cancer?

Risk factors may include:

• Diet - Eating a diet high in fat increases your risk of small intestine tumors and cancer
• Crohn's disease
• Celiac disease
• Familial Adenomatous Polyposis (FAP)
• Peutz Yeager Syndrome

Screening & Diagnosis for Small Intestine Tumors or Cancer

Screening and diagnostic methods for small intestine cancer include the following:

• physical exam and history
• blood tests
• 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.
• abdominal x-ray
• barium enema - a procedure that examines the rectum, the large intestine, and the lower part of the small intestine. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is given into the rectum as an enema. An x-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.
• Fecal occult blood test - checks for hidden (occult) blood in the stool. It involves placing a very small amount of stool on a special card, which is then tested in the physician’s office or sent to a laboratory. This test is not needed if the patient is having either colonoscopy or a barium enema.
• Upper endoscopy - An upper endoscopy, or EGD, allows your physician to examine the upper part of your gastrointestinal tract, which includes the esophagus, stomach and duodenum (first part of the small intestine).
• Upper GI series - An upper GI series is a diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.
• Lower GI series - a procedure that examines the rectum, the large intestine, and the lower part of the small intestine. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is given into the rectum as an enema. An x-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.
• Biopsy - a procedure performed to remove tissue or cells for examination under a microscope.
• CT (CAT) Scan - A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles.  A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
• Enteroscopy – A procedure used that allows physicians to visualize approximately 30 – 40% of the small intestine.
• Capsule endoscopy - A capsule endoscopy is a procedure designed to help your physician see inside your gastrointestinal tract. During the procedure, a patient swallows a vitamin-sized pill with a camera inside that takes images. The pill then moves through your digestive tract and images are taken of different parts of your body, such as the esophagus and small intestine.

Staging & Prognosis

The staging for small intestine cancer is 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.

The prognosis (chance of recovery) depends 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.

Treatment

Treatment options for small bowel cancer may include one or more of the following:

• Endoscopy - Small and early tumors of the duodenum and proximal jejunum (areas of the small intestine) may be removed with endoscopy.
• Surgery - the most common treatment of small intestine cancer.  There are two types of surgery which may be option:
  • Resection - Surgery to remove part or the entire organ that contains cancer.  May include the small intestine and nearby organs (if the cancer has spread).  The surgeon may perform an anastomosis, which joins the cut ends the intestine together.
  • Bypass - surgery which allows food in the small intestine to bypass (go around) the tumor that is blocking the intestine but can’t be removed.  
• Radiation therapy - the use of high-energy radiation to kill cancer cells and to shrink tumors. There are two ways to deliver radiation therapy:
  • external radiation (external beam therapy)
    External beam radiation is a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.
  • internal radiation (brachytherapy, implant radiation)
    Internal radiation therapy is given inside the body as close to the cancer as possible. Substances that produce radiation, called radioisotopes, may be swallowed, injected, or implanted directly into the tumor. Some of the radioactive implants are called "seeds" or "capsules." Internal radiation involves giving a higher dose of radiation in a shorter time span than with external radiation. Some internal radiation treatments stay in the body temporarily. Other internal treatments stay in the body permanently, though the radioactive substance loses its radiation within a short period of time. In some cases, both internal and external radiation therapies are used.
• Chemotherapy - the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual.

Last updated 6/08.  Reviewed by S. Mobarhan, MD