Small Intestine Cancer

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Overview

Small intestine cancer, or simply, intestinal cancer, happens when the cells present in the lining of the small intestine start dividing abnormally.

The small intestine is divided into three parts, which are duodenum (the portion that connects the stomach with the small intestine), jejunum (middle portion of the small intestine) and ileum (the portion that connects the small intestine to the colon). This cancer type commonly arises from the duodenum.

It is one of the rare cancers in India. Major risk factors for this condition include poor diet habits, presence of polyps, history of bowel disorders, etc.

Types

Based on the type of the cells that they originate from, small intestine cancers are categorised into the following types:

1. Adenocarcinoma: This is the common type of small intestine cancer, and it begins in the secretory cells that are responsible for releasing digestive juices and mucus. Initially, they appear as non-cancerous polyps, which may later transform into a tumour.
2. Sarcoma: This cancer type forms in the soft tissues that are present in the small intestine.
3. Carcinoid Tumours: This is a slow-growing cancer type that forms in the small intestine’s lower section. It may not have any symptoms in the early stages, and it can be seen spreading to organs like the liver, appendix, rectum, etc.
4. Gastrointestinal Stromal Tumours: This cancer type begins in the lining of the GI tract. Gastrointestinal stromal tumours could be either benign or malignant.
5. Lymphoma: Also called intestinal lymphoma, this cancer type forms in the lymph nodes. This cancer type is more common among those with a weaker immune system.

Symptoms

The symptoms of small intestine cancer are often confused with that of less severe health conditions. This leads to delayed diagnosis, wherein the condition is diagnosed months after it develops and starts showing symptoms.

Pain and discomfort are the primary symptoms associated with small intestine cancer. Other key symptoms associated with small intestine cancer include:

Abdominal bloating
Nausea and vomiting
Loss of appetite
Abdominal cramps
Presence of a lump in the abdomen region
Extreme tiredness and weakness
Unintentional weight loss
Vitamin deficiency
Dark stools
Anaemia
Diarrhoea
Jaundice

Courses

The exact cause of small intestine cancer is not known. However, a few factors that can increase the risk of small intestine cancer are identified, and they are listed below:

Presence of Polyps: Polyps are the protruding masses present in the small intestine, large intestine and rectum. These polyps are usually benign and harmless. However, in a few cases, they develop into a tumour. Therefore, those with polyps should take extra care and get them addressed as early as possible.
Bowel Inflammation: The risk of small intestine cancer is high among those with chronic bowel disorders. Conditions, such as Crohn’s disease and celiac disease can lead to an increased risk of small intestine cancer.
Smoking and Drinking: Tobacco and alcohol consumption is also a big risk factor for small intestine cancer and various other cancers.
Obesity: Those who are obese have a higher small intestine cancer risk.
Personal History of Colorectal Cancers: Those with a history of colorectal cancers are at an increased risk of getting small intestine cancer.
Family History of Colorectal Cancers: Those having a family history of colorectal cancers have a higher risk of small intestine cancer.
Inherited Genetic Disorders: Incidence of certain inherited genetic disorders, namely familial adenomatous polyposis (FAP), Peutz-Jeghers syndrome, Lynch syndrome, cystic fibrosis and MUTYH-associated polyposis is linked with increased small intestine cancer risk.
Unhealthy Diet and Lifestyle: Increased consumption of smoked and charred food and foods rich in animal fat also contribute to an increased risk of small intestine cancer. An inactive lifestyle also increases one’s risk of getting diagnosed with this disease.
Age: Increasing age is another risk factor for this disease.
Gender: Small intestine cancer is found to be more common among men than women.

Diagnosis

In many cases, the diagnosis of small intestine cancer is delayed due to vague and non-specific symptoms. This leads to various complications and calls for the need for a comprehensive treatment plan. Delayed diagnosis also has a negative impact on clinical outcomes and survival rates. Therefore, one must avoid ignoring symptoms and consult a doctor for an accurate diagnosis. Following are the key procedures employed in the detection and diagnosis of small intestine cancer:

a. Physical Exam and Medical History Assessment: In the beginning, the doctor physically examines the patient for the signs of small intestine cancer, such as the presence of lumps or any other anomalies. The doctor may also take notes of the symptoms experienced by the patient, underlying medical conditions, previously-received treatments, allergies, etc.

b. Blood Tests: In small intestine cancer patients, the tumour starts bleeding over time, and this leads to anaemia. A simple blood test may be recommended to check if all different types of blood cells are present in optimum quantities. Blood tests may also be recommended to assess liver and kidney functions. This test is also helpful in checking if cancer has spread to other organs in the body.

c. Faecal Occult Blood Test: This test helps in detecting small amounts of blood that cannot be seen through naked eyes. The presence of blood in stools is an indication of polyps, bowel inflammation, small intestine cancer or colorectal cancer. In the case of a positive faecal occult blood test, additional tests may be recommended in order to arrive at a definitive diagnosis.

d. Endoscopy: Endoscopy is a diagnostic procedure that is recommended for the diagnosis of most gastrointestinal cancers. A slender tube that is fitted with a light source and video camera is inserted into the GI tract, and this allows the technicians to thoroughly check the regions of the bowel for the presence of polyps and other abnormalities. There are different types of endoscopy available for the diagnosis of small intestine cancer:

Upper Endoscopy: An upper endoscopy is a medical procedure, wherein a tiny camera fixed to a long, flexible tube is used to visually examine the upper digestive tract, which comprises the esophagus, stomach and duodenum (upper portion of the small intestine). If the doctor finds anything abnormal, a little amount of tissue from the suspected area is collected using a specialised tool. This tissue sample is later examined under a microscope for the presence of cancer cells.
Capsule Endoscopy: Capsule endoscopy does not involve a long tube like the traditional endoscopy. Instead, it uses a tiny, wireless camera to capture the images of the patient’s digestive tract. The camera is sent to the small intestine in the form of a capsule. As it passes through the small bowel, it captures several images, which is transmitted to a recorder that is put on the patient’s belt around the waist. Capsule endoscopy lasts for over 8 hours, and the camera capsule passes out naturally through a bowel movement. This camera is later collected and the images obtained are transferred onto a computer to create a video, which is later thoroughly assessed by the doctor. Capsule endoscopy can detect a multitude of small intestine anomalies, namely various inflammatory bowel disorders, presence of polyps, cancer formation, etc. It is a safe and reliable procedure for the diagnosis of small intestine cancer.This medical procedure is particularly helpful in examining the small intestine as this organ is extremely long and has a complex and curvy structure. It is important to note that collecting tissue samples is not possible during capsule endoscopy.
Double-balloon Enteroscopy (Endoscopy): This is a unique endoscopy procedure recommended for small intestine cancer. Unlike routine endoscopy that uses one long tube, this method uses two tubes that are placed one inside the other. Of the two tubes, the one on the inside is the endoscope that is fitted with a light source and video camera in order to capture the images of the insides of the small intestine. These tubes are also fitted with a balloon at the end, which helps in keeping the endoscope in place throughout the scan through inflation and deflation. This endoscope setup could be sent to the small intestine either through the mouth or rectum. If the doctor finds something abnormal during the scan, he/she collects a small amount of tissue from the suspected area for further analysis.

e. Barium X-ray: At times, the doctor may recommend Barium X-ray for a small intestine cancer diagnosis. During this procedure, the patient is made to drink a small quantity of liquid barium, which, upon swallowing, coats the lining of the esophagus, stomach and small intestine. Later, an X-ray scan is performed.

The X-rays are absorbed by barium, and the barium-coated regions appear white on the X-ray film. This helps the doctor in thoroughly studying the lining of the small intestine and find if there are any abnormalities, such as inflammation, polyps or tumour.

f. Imaging Tests: Various imaging tests, namely MRI scan, PET CT scan, etc., may be recommended to obtain detailed information on the size, shape and exact location of the tumour. Additionally, the results from these imaging tests help doctors in disease staging, treatment planning, therapy monitoring and restaging.

g. Biopsy: Biopsy is recommended for the definitive diagnosis of small intestine cancer. During this procedure, a small amount of tissue is collected from the suspected area, and it is later examined under a microscope for the presence of abnormal cells. The biopsy sample may be either collected during the endoscopy or surgery.

Treatment

There are multiple treatment approaches available for small intestine cancer. While devising the treatment plan, the doctor considers multiple parameters, such as the stage of the disease, exact location of the tumour, its size, age of the patient, his/her overall health condition and preferences.

Primarily recommended treatment options for small intestine cancer include surgery, radiation therapy and chemotherapy. Those small intestine cancers that do not respond to the conventional treatments may be treated with immunotherapy and targeted therapy.

a. Surgery: Surgery is the main line of treatment for small intestine cancer. Depending on the stage and other factors, the doctor may recommend one of the surgical procedures:

Polypectomy: For early-stage small intestine cancers, which are localised and contained within a polyp, the doctor may recommend the removal of that polyp. Polypectomy is a simple procedure that can be performed during an endoscopy too.
Small Bowel Resection: Small bowel resection is a surgical procedure, wherein the surgeon removes the part of the small intestine that is affected by cancer. A few lymph nodes close to this region may also be removed to check them for the presence of cancer cells. Once the cancer is removed, the healthy portions of the small intestine are reconnected. Small bowel reconstruction is a major surgical procedure, and it is important for patients to strictly follow all the instructions given by the doctor.
Minimally-invasive Surgery: Small intestine cancers are treated with both open and minimally invasive surgeries. Minimally invasive surgical approaches include laparoscopic surgery and robotic surgery. Laparoscopic surgery uses tiny incisions through which the surgical instruments, a light source and a video camera are inserted for the removal of the tumour.

Robot-assisted surgery is another minimally-invasive approach, wherein the arms of the robotic surgery system imitate the hand movements of the surgeon, only with enhanced precision. Robotic surgeries are performed through tiny incisions as well. Minimally invasive surgeries have multiple advantages, such as shorter hospital stays, reduced blood loss and pain, minimal scarring and faster recovery.

For larger tumours or for tumours that are close to the critical organs like the pancreas and liver, open surgeries are largely preferred. For a better understanding of their treatment plan, the patients and their caregivers must talk to their doctors.

b. Chemotherapy: Chemotherapy is often a part of the treatment plans made for small intestine cancer. This treatment approach involves the administration of strong anticancer drugs into the body to destroy the cancer cells, slow their growth and relieve the symptoms caused by the disease.

Chemotherapy may be administered before the surgery in order to shrink the tumour (neoadjuvant chemotherapy); it may also be administered after the surgery to destroy the residual cancer cells and bring down the risk of cancer recurrence (adjuvant chemotherapy).

Chemotherapy is also given as a part of palliative therapy wherein the patient has advanced small intestine cancer, which is difficult to treat, and the patient needs support in managing the symptoms, such as pain and discomfort, caused by the disease.

c. Radiation therapy: Radiation therapy is also recommended for small intestine cancer management. It involves the usage of powerful radiation beams to kill cancer cells. Radiation therapy may also be used to alleviate the symptoms caused by the disease. In a few cases, radiation therapy is combined with chemotherapy in order to enhance the efficacy of the treatment administered.

d. Immunotherapy: For small intestine cancers that do not respond to the conventional treatment approaches, immunotherapy may be recommended. Immunotherapy involves stimulating the patient’s own immune system to launch an attack against cancer cells. Immunotherapy works by strengthening, directing or restoring the body’s natural defences against cancer.

e. Targeted Therapy: Targeted therapy is another unique treatment approach that is recommended for small intestine cancers – only in cases where the patient is showing no response to main treatments. It is also known as precision therapy because it attacks cancer cells only. Targeted therapy works by identifying particular vulnerabilities present on the cancer cells and blocking their growth via multiple complex mechanisms.

Frequently Asked Questions

1. Is small intestine cancer treatable?

Yes, small intestine cancer is treatable. Small intestine cancer management is more feasible lately as we have multiple treatment options available today.

Studies have found that early detection positively impacts the quality of clinical outcomes and survival rates. If small intestine cancer is detected in its early stage, surgery alone is sufficient to treat it successfully in a few cases.

In order to catch small intestine cancers in the early stages, one should be mindful of the symptoms. Any pain, swelling or discomfort associated with the abdominal region should not be ignored and brought to the attention of a doctor immediately.

2. Can small intestine cancer come back?

Yes, in a few cases, small intestine cancers can recur. However, they can still be treated with positive outcomes if they are caught early.

In order to prevent relapses or catch them early, it is important for patients to keep up their follow-up appointments that will be scheduled after the treatment.

3. Can small intestine cancer spread?

Yes, small intestine cancer can spread to other organs if it is not treated on time. In the beginning, it will spread to the nearby lymph nodes, and as the disease progresses, it starts spreading to nearby organs like the liver, lungs, etc.

Early diagnosis and timely treatment play a significant role in reducing the risk of cancer metastasis.

4. Can I prevent small intestine cancer?

There are no known ways to prevent small intestine cancer completely. Nevertheless, there are a few measures that you can follow to reduce your small intestine cancer risk:

Having a balanced diet helps you in reducing your small intestine cancer risk. Increased red meat consumption is a risk factor for small intestine cancer. Therefore, limit your red meat and animal fat consumption and instead ensure that your diet is rich in essential macronutrients and micronutrients along with fibres.
Smoking and alcohol also increase your small intestine cancer risk. Quitting tobacco and reducing your alcohol intake can help you in bringing down your small intestine cancer risk.
Having an active lifestyle also goes a long way. Reduced activity and obesity increase the risk of various cancer types including small intestine cancers. Therefore, you must consider regular exercise that can help you maintain a healthy weight and thereby reduce your small intestine cancer risk